Stroke Is Associated with Refractory Hypertension among Resistant and Refractory Patients in a Cross-Sectional Study

Abstract Background Refractory hypertension (RfH) is a severe phenotype of resistant hypertension (RH) linked to higher risk of stroke and other adverse cardiovascular events, but knowledge about it is still lacking. Objectives To evaluate the association between RfH and stroke. Methods We conducted a cross-sectional study in a referral clinic for patients with severe hypertension in the period from 2018 to 2020. RH was defined as uncontrolled blood pressure (BP) despite the use of 3 antihypertensive agents, including a diuretic, or the use of ≥ 4 agents regardless of BP control. RfH was defined as lack of BP control despite use of ≥ 5 antihypertensive agents. Individuals were classified as RfH or RH, and multivariate logistic regression models were constructed to examine the association between RfH and stroke. Results We evaluated a total of 137 patients; 81% were female, and 93,3% were Black or multiracial. The mean age was 64.4 years. Stroke was more prevalent in the RfH group (35.7%), in comparison to the RH group (12.8%) (p value = 0.01). Unadjusted odds ratio (OR) and 95% confidence interval (CI) for factors associated with stroke were RfH (OR 3.77; 95% CI 1.45 to 9.80), systolic BP (OR 1.02; 95% CI 1.002 to 1.04) and diastolic BP (OR 1.03; 95% CI 1.001 to 1.06). Adjusted OR for factors associated with stroke were RfH (OR 3.55; 95% CI 1.02 to 12.42), systolic BP (OR 1.02; 95% CI 0.99 to 1.05) and diastolic BP (OR 1.01; 95% CI 0.96 to 1.06). Conclusion RfH was associated with higher prevalence of stroke. Efforts are required to better understand this association to prevent adverse cardiovascular outcomes in these patients.

Clinical Characteristics and Therapeutic Adherence of Women in a Referral Outpatient Clinic for Severe Hypertension

Abstract Background Cardiovascular disease is the main cause of death worldwide. There is a lack of studies addressing this issue in women and its risk factors, such as hypertension. Objective To evaluate the clinical and therapeutic profile of women with hypertension and to determine which factors are related to treatment adherence and blood pressure control. Methods Cross-sectional study of 181 hypertensive women treated at an outpatient referral clinic. Data were obtained from medical records, face-to-face interviews, and physical examination, using a standardized form. Statistical analysis was performed with prevalence ratio, chi-square and Student's t test. Significance was accepted at p<0.05. Results Most patients were mixed-race or black (91.7%) and the mean age was 66.09 years. Only 44.2% of patients had controlled blood pressure. The prevalence of stroke was 14.9%, whereas the prevalence of coronary artery disease was 19.3%. The mean number of oral antihypertensive drugs prescribed to each individual was 3.41. A history of stroke was more often found in patients with uncontrolled blood pressure (p=0.013) and in those using three or more antihypertensives (p=0.023). Eighty patients (44.2%) had high treatment adherence. Depression was more frequently reported by patients with poorer adherence to treatment (p=0.026). Conclusion Women with hypertension presented a high prevalence of cardiovascular risk factors and cardiovascular events, including a significantly higher prevalence of stroke in those with uncontrolled hypertension. Self-reported depression may help identify patients at risk of nonadherence to treatment.

Drug Profile and Therapeutic Adherence of African-Brazilians with Apparent Resistant Hypertension

Abstract Background Resistant hypertension (RH) is manifested by the presence of blood pressure values resistant to antihypertensive therapy. RH is highly prevalent among black individuals, increasing cardiovascular risk in this population and requiring effective control of this comorbidity. Objectives To investigate the medication profile and therapeutic adherence in black people with apparent RH. Methods This is a cross-sectional study, with a convenience sample of individuals with apparent RH. Data were obtained from medical records. Therapeutic adherence was assessed using the Morisky Therapeutic Adherence Scale of 8 items (MMAS-8) and statistical analysis was performed using the SPSS, version 23. Significance was set at p <0.05. Results Of the 120 individuals, 90 (75%) were women and 72 (60%) were black. Mean SBP was 153.09 (SD 25.59) mm Hg and mean DBP, 90.82 (SD 16.91) mm Hg, with a statistical difference in relation to the target pressure for SBP. Regarding the medication profile, 79.2% of the individuals used the recommended regimen for RH (ACEI / ARB + Diuretic + CCB), with the fourth most used drug being beta-blockers. The average score in MMAS-8 was 6.62 (SD 1.38) points, with 19.2%, 50.0%, and 30.8% showing low, medium, and high adherence, respectively. Conclusions It was evidenced that two-thirds of the individuals did not have high therapeutic adherence and not all used the ideal regimen for the management of RH, nor full doses. Thus, most individuals were probably affected by pseudoresistance, which was initially diagnosed as apparent RH. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

The Impact of COVID-19 on the Cardiovascular System

SUMMARY The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19), has affected many people in Brazil and worldwide. This disease predominantly affects the organs of the respiratory system, but it also damages the brain, liver, kidneys and especially the heart. In the heart, scientific evidence shows that this virus can damage the coronary arteries, generating microvascular dysfunction, favoring acute myocardial infarction. Furthermore, with the increased expression of pro-inflammatory cytokines, it can lead to myocarditis and cardiac fibrosis, inducing changes in the electrical conduction system of the heart, generating cardiac arrhythmias. All these factors mentioned are protagonists in promoting the increase in the mortality outcome. This outcome may be even higher if the individuals are elderly, or if they have other diseases such as type 2 diabetes mellitus or hypertension, because they may already have cardiomyopathy. In this context, this review focused on the impact that COVID-19 can have on the heart and cardiovascular system and the association of this impact with aging, type 2 diabetes mellitus, cardiac arrhythmias and arterial hypertension

Episódios de Alta Frequência Atrial e sua Associação com Eventos Isquêmicos Cerebrais em Pacientes Chagásicos / Atrial High-Rate Episodes and Their Association with Cerebral Ischemic Events in Chagasic Patients

Resumo Fundamento Episódios de alta frequência atrial (EAFAs) estão associados a um risco elevado de eventos isquêmicos cerebrais, porém não existem estudos relacionados com a presença de EAFAs e eventos isquêmicos cerebrais em pacientes chagásicos. Objetivo Investigar a associação entre a presença de EAFAs ≥ 6 minutos e eventos isquêmicos cerebrais em pacientes chagásicos. Métodos Estudo de coorte com pacientes chagásicos, portadores de dispositivos cardíacos eletrônicos implantáveis (DCEIs), acompanhados no ambulatório de arritmias de um hospital universitário, na cidade de Salvador/BA, entre maio de 2016 e junho de 2017. Pacientes com diagnóstico de flutter atrial/fibrilação atrial, com DCEI unicameral e em uso de anticoagulação oral foram excluídos. Foram considerados EAFAs com frequência atrial ≥ 190 batimentos por minuto e duração ≥ 6 minutos (min), e os eventos isquêmicos cerebrais foram identificados por meio de tomografia computadorizada (TC) de crânio. Resultados Os 67 participantes da pesquisa (67,2% do sexo feminino, com idade média de 63,6 ± 9,2 anos) foram acompanhados por 98 ± 28,8 dias e 11,9% dos pacientes apresentaram EAFAs ≥ 6 minutos. A TC de crânio evidenciou eventos isquêmicos cerebrais silenciosos em 16,4% dos pacientes, sendo que, destes, 63,6% haviam apresentado os EAFAs ≥ 6 minutos na análise dos DCEIs. A idade avançada (OR 1,12 [IC 95% 1,03-1,21; p=0,009) e a presença de EAFAs ≥ 6 minutos (OR 96,2 [IC 95% 9,4-987,4; p<0,001]) foram preditores independentes para eventos isquêmicos. Conclusão EAFAs detectados por DCEIs estavam associados à presença de eventos isquêmicos cerebrais silenciosos em pacientes chagásicos. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Abstract Background Atrial high-rate episodes (AHREs) are associated with an increased risk of cerebral ischemic events; however, there are no studies related to the presence of AHREs and cerebral ischemic events in Chagasic patients. Objective To investigate the association between the presence of AHREs ≥ 6 minutes and cerebral ischemic events in Chagasic patients. Methods Cohort study with Chagasic patients with implantable electronic cardiac devices (IECDs), followed at the Arrhythmia Outpatient Clinic of a University Hospital, in the city of Salvador, state of Bahia, Brazil, between May 2016 and June 2017.. Patients diagnosed with atrial flutter / atrial fibrillation, with unicameral IECD and using oral anticoagulation were excluded. AHREs with atrial frequency ≥ 190 beats per minute and duration ≥ 6 minutes (min) were considered, and cerebral ischemic events were identified by computed tomography (CT) of the skull. Results The 67 research participants (67.2% females, mean age 63.6 ± 9.2 years) were followed for 98 ± 28.8 days and 11.9% of the patients had AHREs ≥ 6 min. Skull CT showed silent cerebral ischemic events in 16.4% of the patients, 63.6% of whom had AHREs ≥ 6 min in the analysis of IECDs. Advanced age [OR 1.12 (95% CI 1.03-1.21; p=0.009] and the presence of AHREs ≥ 6 minutes [OR 96.2 (95% CI 9.4-987.4; p <0.001)] were independent predictors for ischemic events. Conclusion AHREs detected by IECDs were associated with the presence of silent cerebral ischemic events in Chagasic patients. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

Características Clínicas da Hipertensão Arterial Resistente vs. Refratária em uma População de Hipertensos Afrodescendentes / Clinical Characteristics of Resistant vs. Refractory Hypertension in a Population of Hypertensive Afrodescendants

Resumo Fundamentos Afrodescendentes têm sido associados a uma maior gravidade da hipertensão arterial e maior incidência de complicações cardiovasculares. Características na apresentação da hipertensão resistente (HR) ou hipertensão refratária (HRf), especificamente nessa etnia, não têm sido devidamente estudadas. Objetivos O estudo compara características clínicas e epidemiológicas e prevalência de eventos cardiovasculares em afrodescendentes com diagnóstico de HR ou de HRf. Métodos: Estudo transversal realizado em ambulatório de referência para pacientes com Hipertensão Grave. O nível de significância foi de 5%. Resultados Avaliados 146 pacientes consecutivos, dos quais 68,7% eram do sexo feminino. A média de idade foi de 61,8 anos, sendo 88,4% afrodescendentes (pardos ou negros). 51% apresentavam HRf. Houve alta prevalência de fatores de risco cardiovascular: 34,2% tinham diabetes, 69,4% dislipidemia, 36,1% obesidade e 38,3% história de tabagismo. Função renal reduzida foi observada em 34,2%. Eventos cardiovasculares prévios ocorreram em 21,8% para infarto do miocárdio e em 19,9% para acidente vascular cerebral. O escore de risco de Framingham foi moderado/alto em 61%. Os pacientes com HRf eram mais jovens (média de idade de 59,38±11,69 anos versus 64,10±12,23 anos, p=0,02), tinham mais dislipidemia (83,8 versus 66,7%, p=0,021) e acidente vascular cerebral (30,4 versus 12,3%, p=0,011) quando comparados aos com HR. O uso de combinação de ACEi/BRA+CCB+Diurético, clortalidona e espironolactona também foi mais frequente em indivíduos com HRf. Conclusão Afrodescendentes com HR apresentaram alto risco cardiovascular, alta prevalência de HRf, maior frequência de dislipidemia e de acidente vascular cerebral, compatível com alta incidência de lesão a órgãos-alvo. (Arq Bras Cardiol. 2020; 115(1):31-39)

Abstract Background Afrodescendants have been associated with a greater severity of arterial hypertension and a higher incidence of cardiovascular complications. Characteristics in the presentation of resistant hypertension (RH) or refractory hypertension (RfH), specifically in this ethnic group, have not been properly studied. Objectives The study compares clinical and epidemiological characteristics and prevalence of cardiovascular events in people of African descent diagnosed with RH or RfH. Methods Cross-sectional study carried out in a referral clinic for patients with severe hypertension. The level of significance was 5%. Results 146 consecutive patients were evaluated, of which 68.7% were female. The average age was 61.8 years, with 88.4% of Afrodescendants (mixed race or black). 51% had RfH. There was a high prevalence of cardiovascular risk factors: 34.2% of subjects had diabetes, 69.4% dyslipidemia, 36.1% obesity, and 38.3% history of smoking. Reduced renal function was seen in 34.2%. Previous cardiovascular events occurred in 21.8% for myocardial infarction and in 19.9% for stroke. The Framingham's risk score was moderate/high at 61%. RfH patients were younger (mean age 59.38±11.69 years versus 64.10±12.23 years, p=0.02), had more dyslipidemia (83.8 versus 66.7%, p=0.021), and stroke (30.4 versus 12.3%, p=0.011) when compared to those with RH. The use of a combination of ACEi/ARB+CCB+Diuretic, chlortalidone and spironolactone was also more frequent in individuals with RfH. Conclusion Africandescendant people with RH had a high cardiovascular risk, a high prevalence of RfH, a higher frequency of dyslipidemia and stroke, compatible with a high incidence of injury to target organs. (Arq Bras Cardiol.2020; 115(1):31-39)

Avaliação da Função do Ventrículo Direito e Fibrose Miocárdica por Ressonância Magnética Cardíaca em Pacientes com Infarto do Miocárdio da Parede Inferior / Assessment of Right Ventricle Function and Myocardial Fibrosis by Cardiovascular Magnetic Resonance in Patients with Inferior Wall Myocardial Infarction

Fundamentos: Disfunção do ventrículo direito (VD) é observada em 30-50% dos pacientes com infarto do miocárdio na parede inferior (IM-I) e é fator preditor de mortalidade precoce. A fibrose miocárdica está associada com disfunção ventricular progressiva e prognóstico grave. Nesses pacientes, a ressonância magnética cardíaca (RMC) é um importante método de estratificação de risco. Objetivos: Avaliar a associação entre disfunção do VD e fibrose miocárdica em pacientes com IM-I por RMC. Métodos: Estudo coorte realizado em um centro de cardiologia de referência. Quarenta indivíduos com IM-I foram incluídos no estudo. RMC foi realizada durante a internação para estimar função do VD e quantificar fibrose miocárdica pela técnica de realce tardio com gadolínio (TRT). Os pacientes foram estratificados quanto à função ventricular, e características clínicas foram comparadas entre os grupos. Resultados: Quarenta pacientes foram incluídos no estudo, 75% eram homens e 43% idosos (idade ≥ 60 anos). Entre os fatores de risco cardiovasculares, hipertensão (45%) e tabagismo (33%) foram os mais prevalentes. A disfunção do VD estava presente em 33% dos pacientes. A massa de fibrose média foi 22 ± 12g nos pacientes com disfunção do VD e 15 ± 8 g nos pacientes com função ventricular preservada (p = 0,051). Conclusões: Os resultados deste estudo indicam uma possível associação entre disfunção do VD e fibrose miocárdica nos pacientes com IM-I. No entanto, outros estudos envolvendo um maior número de pacientes são necessários para confirmar nossos achados

Background: Right ventricular dysfunction (RVD) can be found in 30-50% of patients with inferior wall myocardial infarction (I-MI) and predicts early mortality. Myocardial fibrosis is associated with progressive ventricular dysfunction and severe prognosis. In these patients, cardiovascular magnetic resonance (CMR) is an important risk stratification method. Objectives: This study sought to evaluate the association between RVD and myocardial fibrosis in patients with I-MI, using CMR. Methods: Cohort study conducted in a prominent center of cardiology. Forty individuals with I-MI were included in the study. CMR was performed during hospitalization to estimate parameters of right ventricle function and to quantify myocardial fibrosis through late gadolinium enhancement (LGE) technique. Patients were stratified by ventricular function, and clinical characteristics were compared between study groups. Results: Forty patients were included in the study, 75% were male and 43% elderly (age ≥ 60 years). Hypertension (45%) and smoking (33%) were the most prevalent cardiovascular risk factors. RVD was found in 33% of patients. Mean fibrosis mass was 22 ± 12 g in patients with RVD compared with 15 ± 8 g in patients with preserved ventricular function (p = 0.051). Conclusions: The findings of our study indicate a possible association between RVD and myocardial fibrosis in patients with I-MI. However, further studies with larger series are needed to confirm our findings

In-hospital Mortality in Patients with Rheumatic Heart Disease Undergoing Double Valve Replacement / Mortalidade Intra-Hospitalar em Pacientes com Cardiopatia ReumáticaSubmetidos a Dupla-Troca Valvar

A cardiopatia reumática é um importante problema de saúde pública. Há escassez de dados sobreinfluência de variáveis cirúrgicas na mortalidade de pacientes reumáticos submetidos dupla-troca valvar (DTV).Objetivo: Identificar possíveis variáveis cirúrgicas associadas à mortalidade de pacientes reumáticos submetidos à DTV.Métodos: Estudo retrospectivo de corte transversal, incluindo 104 pacientes >18 anos, com diagnóstico prévio devalvopatia reumática, submetidos à cirurgia de DTV no período de janeiro de 2007 a dezembro de 2011. A coletade dados utilizou os prontuários de pacientes do Hospital Ana Nery, Salvador, BA, Brasil.Resultados: Observou-se diferença estatística significativa entre os grupos do desfecho (óbito intra-hospitalar/alta hospitalar) em relação às variáveis, respectivamente: tempo de anoxia (minutos) de 149,17±40,99 e 123,99±24,12(p=0,001); tempo de CEC 185,53±54,59 e 157,34±34,62 (p=0,006); e o tempo cirúrgico total 350,29±56,69 e 295,23±63,98(p=0,002). Os pacientes que realizaram outro procedimento associado à DTV, no mesmo tempo cirúrgico,apresentaram maior mortalidade (n=10; 31,2%), em relação aos que realizaram apenas a DTV (n=9; 12,8%) (p=0,027).Houve também associação significativa na comparação de pacientes com reabordagem cirúrgica com aqueles querealizaram única abordagem (p<0,001). Não houve diferença estatística quando se comparou desfecho hospitalare os tipos de próteses utilizadas (p=0,219). Conclusões: As variáveis cirúrgicas que tiveram influência na mortalidade foram: tempos de anoxia, de CEC, de cirurgia total, com possíveis pontos de corte, respectivamente, de 150 min, 100 min e 300 min. A necessidade de reabordagemno pós-operatório hospitalar e a realização de outro procedimento no mesmo ato também mostraram significância...

Rheumatic heart disease is a major public health issue. Data on the influence of surgical variables in mortality in rheumatic patients undergoing double valve replacement (DVR) are scarce. Objective: Identify potential surgical variables associated with mortality in rheumatic patients undergoing DVR. Methods: Retrospective cross-sectional study including 104 patients over 18 years, previously diagnosed with rheumatic heart-valve disease, and undergoing DVR surgery from January 2007 to December 2011. Data collection: medical records of patients from HospitalAna Nery, Salvador, Brazil.Results: Outcome groups (in-hospital death vs. hospital discharge) had a significant statistical difference in relation to variables, respectively:anoxia time (in minutes) of 149.17±40.99 and 123.99±24.12 (p=0.001); CPB time 185.53±54.59 and 157.34±34.62 (p=0.006); and totalsurgical time 350.29±56.69 and 295.23±63.98 (p=0,002). Patients who underwent another procedure associated with DVR for the same surgical time showed higher mortality rates (n=10; 31.2%) compared to those who underwent DVR only (n=9, 12.8%) (p=0.027). There was also a significant association when comparing patients with surgical rapprochement with those who underwent one surgery only(p<0.001). There was no statistical difference between hospital outcome and the types of prostheses used (p=0.219). Conclusions: The surgical variables that influenced mortality were: anoxia, CPB and total surgical times, with potential cutoff points of 150, 100 and 300 minutes, respectively. The need for rapprochement during the in-hospital postoperative period, and the performance of another associated procedure in the same surgery were also significant...

Evaluation of variables responsible for hospital mortality in patients with rheumatic heart disease undergoing double valve replacement / Avaliação de variáveis responsáveis pela mortalidade hospitalar em pacientes portadores de doença reumática submetidos à dupla troca valvar

Objective: To describe the hospital mortality and associated clinical and echocardiographic variables in patients with rheumatic disease who underwent double valve replacement surgery. Methods: This is a cross sectional descriptive study of mortality, performed in a referral hospital in Salvador, Bahia. Records from patients with rheumatic disease who underwent double valve replacement surgery during the years 2007-2011 were analyzed. Results: The studied sample comprises 104 patients and 60 (57.7%) were male. The mean age was 38.04±14.45. Sixty five bioprostheses and 38 mechanical prostheses were used in these patients at the time of surgery. There were statistically significant differences between the two groups, when we analyzed the following variables: the mean age (36.30±13.03 vs. 45.35±17.8 years-old, P=0.011), mean hemoglobin (11.10±2.19 vs. 9.22±2.26 g/dL, P=0.002), mean hematocrit (34.22±5.86 vs. 28.44±6.62%, P<0.001). New York Heart Association functional class III and IV (NYHA) (P=0.022) was statistically associated with mortality. Conclusion: We concluded that the mean hemoglobin/hematocrit level and the NYHA functional class was the major variables associated to the mortality among these patients. Based on these data one may concern about the patient best moment for surgery and the patient hemoglobin level. .

Objetivo: Descrever a mortalidade hospitalar em pacientes reumáticos submetidos à cirurgia de dupla troca valvar e sua relação com variáveis clínicas e ecocardiográficas. Métodos: Trata-se de um estudo de corte transversal. Foram estudados pacientes maiores que 18 anos, com valvopatia reumática que foram submetidos à cirurgia de DTV do período de janeiro de 2007 a dezembro de 2011 no Hospital Ana Nery - Salvador - Bahia. A coleta de dados se deu por meio de consulta aos prontuários dos pacientes. Resultados: Foram estudados 104 pacientes, 60 (57,7%) eram do sexo masculino. A média de idade da população estudada foi de 38,04±14,45 anos. Foram utilizadas 65 próteses biológicas e 38 próteses metálicas. Houve diferença estatisticamente significante entre os grupos comparados, pacientes que obtiveram alta versus pacientes que foram a óbito, em relação às seguintes variáveis: média de idade dos pacientes que receberam alta para casa e foram a óbito, respectivamente (36,30±13,03 vs. 45,35±17,8, P=0,011); média de hemoglobina, (11,10±2,19 vs. 9,22±2,26 g/dL, P=0,002); média do hematócrito, (34,22±5,86 vs. 28,44±6,62%, P<0,001). As classes funcionais III e IV (New York Heart Association) estiveram associadas estatisticamente com a mortalidade (P=0.022). Conclusão: Os dados encontrados no estudo apresentam uma população pouco estudada na qual os principais achados foram a média do nível de hemoglobina/hematócrito e classe funcional NYHA. Deve se levar em conta esses dados para a escolha do melhor momento de cirurgia para essa população. .

Influencia de la etiología sobre la mortalidad en la insuficiencia cardíaca con función sistólica preservada en una población con alta prevalencia de cardiopatía chagásica / Influence of Etiology on Heart Failure With Preserved Systolic Function Mortality in a Population With High Prevalence of Chagas Cardiomyopathy

Introducción La insuficiencia cardíaca con función sistólica preservada es un síndrome clínico con los mismos signos y síntomas de la insuficiencia cardíaca clásica. La enfermedad de Chagas es una causa importante de insuficiencia cardíaca en América Latina, que se asocia con miocardiopatía dilatada y deterioro progresivo de la función sistólica. No existen estudios previos que hayan evaluado pacientes con insuficiencia cardíaca y función sistólica preservada de una zona endémica en la cual la enfermedad de Chagas es la causa principal de insuficiencia cardíaca. Objetivo Comparar las características clínicas y la evolución de la insuficiencia cardíaca en pacientes con disfunción sistólica y con función sistólica preservada en una población con alta prevalencia de enfermedad de Chagas. Material y métodos Se realizó una evaluación prospectiva de los pacientes con diagnóstico clínico de insuficiencia cardíaca que ingresaron a un centro de referencia en Salvador, Bahía (Brasil). Se consideró función sistólica preservada a una fracción de eyección del ventrículo izquierdo mayor del 45% por ecocardiograma. Se realizó seguimiento al año a través de contacto telefónico o entrevista personal en el consultorio de insuficiencia cardíaca. Resultados Se incluyeron 383 pacientes durante un período de 16 meses; el 52,5% eran hombres y la edad media fue de 54,2 años. La función sistólica estuvo preservada en 138 pacientes (36%). La enfermedad de Chagas fue la principal etiología de ambos tipos de insuficiencia cardíaca (45,3% con disfunción sistólica y 44,2% con función sistólica preservada). El 93,5% (358) de los pacientes completaron un año de seguimiento. Los pacientes con enfermedad de Chagas y función sistólica preservada tuvieron menor mortalidad que los pacientes con disfunción sistólica (10% vs. 23,6%; p = 0,039). En los pacientes sin enfermedad de Chagas y función sistólica preservada, la mortalidad fue similar a la de aquellos con disfunción sistólica (10,4% vs. 15,8%; p = 0,307). Conclusiones La función sistólica preservada fue muy frecuente en nuestra población. La enfermedad de Chagas es la principal etiología de insuficiencia cardíaca independientemente de la fracción de eyección del ventrículo izquierdo. Los pacientes con enfermedad de Chagas y función sistólica preservada tienen mejor pronóstico que aquellos con disfunción sistólica, probablemente porque se encuentran en la fase inicial del compromiso cardíaco.

Background Heart failure with preserved systolic function is a clinical syndrome with the same signs and symptoms of classic heart failure. Chagas disease is a major cause of heart failure in Latin America, associated with dilated cardiomyopathy and progressive deterioration of systolic function. There are no previous assessment studies of patients with heart failure and preserved systolic function in an endemic area in which Chagas disease is the leading cause of heart failure. Objective The aim of this study was to compare clinical characteristics and evolution of heart failure in patients with systolic dysfunction and with preserved systolic function in a population with high prevalence of Chagas disease. Methods A prospective assessment was performed in patients with clinical diagnosis of heart failure admitted to a referral center in Salvador, Bahia (Brazil). Left ventricular ejection fraction > 45% by echocardiogram was considered as preserved systolic function. A one year follow-up was conducted through telephone or personal interview at the heart failure clinic. Results Three hundred and eighty three patients, 52.5% of whom were male, with an average age of 54.2 years, were included in this study over a period of 16 months. Systolic function was preserved in 138 patients (36%). Chagas disease was the main etiology of both types of heart failure (45.3% with systolic dysfunction and 44.2% with preserved systolic function). One year follow-up was completed by 93.5% (358) of patients. Patients with Chagas disease and preserved systolic function had lower mortality than patients with systolic dysfunction (10% vs. 23.6%; p=0.039). In patients without Chagas disease and preserved systolic function, mortality was similar to that of those with systolic dysfunction (10.4% vs. 15.8%; p=0.307). Conclusions Preserved systolic function was very common in our population. Chagas' disease is the leading cause of heart failure irrespective of left ventricular ejection fraction. Patients with Chagas disease and preserved systolic function have a better prognosis than those with systolic dysfunction, probably because they are in the initial phase of cardiac involvement.

Impacto do perfil socioeconômico na escolha da prótese valvar em cirurgia cardíaca / Impact of socio-economic profile on the prosthesis type choice used on heart surgery

INTRODUÇÃO: A doença cardíaca valvar é um grave problema de saúde pública, mais frequente em países em desenvolvimento, acometendo indivíduos em idade laboralmente produtiva. OBJETIVO: Avaliar o perfil socioeconômico e epidemiológico dos pacientes submetidos a cirurgia valvar e a sua relação com os tipos de próteses utilizadas em um centro de referência público de Salvador, BA, Brasil. MÉTODOS: Estudo de corte transversal descritivo de prevalência, no qual foram analisados retrospectivamente idade, sexo, procedência, tipo de valvopatia, cirurgia a qual o paciente foi submetido e o tipo de prótese utilizada em casos de trocas, em centro de referência público de cardiologia. RESULTADOS: Foram revisados 366 prontuários, de todos os pacientes submetidos a cirurgia de valva cardíaca, de janeiro de 2007 a dezembro de 2009. Em relação ao sexo, 52% dos pacientes eram do sexo feminino. A idade média ± DP foi de 41,70 ± 17,85 anos. Dentre os pacientes, 37,7% eram procedentes da capital e 62,3%, do interior do estado da Bahia (Brasil). A troca valvar foi realizada em 73% dos pacientes, enquanto que 7,38% realizaram plastia valvar e 18,3% realizaram tanto plastia quanto troca. Dos pacientes que realizaram troca valvar, 70% receberam bioprótese e 30% do tipo metálica, com predominância do uso bioprótese nas faixas etárias jovens (P<0,001). CONCLUSÃO: Próteses biológicas foram predominantemente usadas em jovens. Esse fato, possivelmente, pode ser atribuído ao baixo nível socioeconômico da população em questão, distância de centros urbanos, dificuldade de realização de exames para controle da anticoagulação e nível educacional ruim, inviabilizando o uso de valva metálica e a consequente terapia anticoagulante.

BACKGROUND: Valvar heart disease is an important public health problem, more common in developing countries, especially in younger. OBJECTIVE: To evaluate the epidemiological features of patients and its influence on the prosthesis type choice used on patients who underwent valve surgery. METHODS: Cross-sectional. Data such as age, sex, provenance, surgery procedure and prosthesis type were retrospectively analyzed. We reviewed 366 charts of all patients submitted to heart valve surgery during three years in a public health cardiovascular treatment center. RESULTS: 52% of patients were female. The age range was from 5 to 82, the median was 41 years old. In regards 37.7% of patients came from Salvador (Bahia, Brazil) and 62.3% from countryside. Valve replacement was performed in 73% of patients, whereas 7.38% underwent valvuloplasty and 18.3% underwent valve repair and replacement. Regarding type of prosthesis, 70.0% received bioprosthesis and 30.0% received metal prosthesis. On note bioprosthesis were more used in younger (P<0,001). CONCLUSION: Biological prostheses were used predominantly in younger. This might be possible due to a low social-economic status, avoiding metal valve implantation and the consequent anticoagulation therapy.

Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados / Prevalencia de anemia e insuficiencia renal en portadores de insuficiencia cardiaca no hospitalizados / Prevalence of anemia and renal insufficiency in non-hospitalized patients with heart failure

FUNDAMENTOS: Insuficiência cardíaca (IC) é uma doença comum com alta taxa de mortalidade. Anemia e insuficiência renal (IR) são frequentemente encontradas em portadores de IC associadas com maior gravidade da doença cardíaca e pior prognóstico. OBJETIVO: Avaliar a prevalência de anemia e insuficiência renal, bem como a associação entre esses dois quadros, em portadores de IC não hospitalizados. MÉTODOS: Foram observados pacientes acompanhandos na clínica de IC de um hospital universitário de julho de 2003 a novembro de 2006. Anemia foi definida como níveis de hemoglobina abaixo de 13 mg/dl para homens e de 12 mg/dl para mulheres. A função renal foi avaliada por meio da taxa de filtração glomerular (TFG), calculada pela fórmula simplificada do estudo MDRD (Modification of Diet in Renal Disease). RESULTADOS: Dos trezentos e quarenta e cinco pacientes incluídos neste estudo, 26,4 por cento (n = 91) tinham anemia e 29,6 por cento tinham insuficiência renal moderada a grave (TFG < 60 ml/min). A associação entre anemia e maior prevalência de insuficiência renal foi estatisticamente significante (41,8 por cento vs. 25,2 por cento; p = 0,005). Os pacientes em classe funcional III e IV apresentaram maior incidência de anemia (39,0 por cento vs. 19,4 por cento; p <0,001) e insuficiência renal (38,2 por cento vs. 24,8 por cento; p = 0,007). Não foi observada associação entre anemia ou insuficiência renal e história de hipertensão, diabetes, função sistólica ou etiologia de insuficiência cardíaca. CONCLUSÃO: A prevalência de anemia e insuficiência renal foi elevada nessa população e foi associada com a gravidade da insuficiência cardíaca (classes funcionais III e IV).

BACKGROUND: Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE: To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS: Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS: Of the 345 patients included in this study, 26.4 percent (n = 91) had anemia and 29.6 percent had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8 percent vs. 25.2 percent; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0 percent vs. 19.4 percent; p <0.001) and renal failure (38.2 percent vs. 24.8 percent; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION: The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

FUNDAMENTO: La insuficiencia cardiaca (IC) es una enfermedad común con alta tasa de mortalidad. La anemia y la insuficiencia renal (IR), encontradas frecuentemente en portadores de IC, son asociadas a mayor severidad de la enfermedad cardiaca y peor pronóstico. OBJETIVO: Evaluar la prevalencia de anemia e insuficiencia renal, así como la asociación entre esos dos cuadros, en portadores de IC no hospitalizados. MÉTODOS: Se observaron a pacientes seguidos en la clínica de IC de un hospital universitario de julio de 2003 a noviembre de 2006. Se definió la anemia como niveles de hemoglobina abajo de 13 mg/dl para varones y de 12 mg/dl para mujeres. La función renal se evaluó por medio de la tasa de filtración glomerular (TFG), calculada por la fórmula simplificada del estudio MDRD (Modification of Diet in Renal Disease). RESULTADOS: Teniendo en cuenta los trescientos y cuarenta y cinco pacientes incluidos en este estudio, el 26,4 por ciento (n = 91) tenía anemia y el 29,6 por ciento presentaba insuficiencia renal de moderada a severa (TFG < 60 ml/min). La asociación entre anemia y mayor prevalencia de insuficiencia renal fue estadísticamente significante (el 41,8 por ciento vs el 25,2 por ciento; p = 0,005). Los pacientes en clase funcional III e IV presentaron mayor incidencia de anemia (el 39,0 por ciento vs el 19,4 por ciento; p <0,001) e insuficiencia renal (el 38,2 por ciento vs el 24,8 por ciento; p = 0,007). No se observó asociación entre anemia o insuficiencia renal e historia de hipertensión, diabetes, función sistólica o etiología de insuficiencia cardiaca. CONCLUSIÓN: La prevalencia de anemia e insuficiencia renal se elevó en esa población y se asoció con la severidad de la insuficiencia cardiaca (clases funcionales III e IV).

Frequência de prescriçäo de anti-hipertensivos por via oral precedendo elevaçäo da pressäo arterial sistêmica em pacientes hospitalizados / Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients

OBJECTIVE: To evaluate the frequency of oral antihypertensive medication preceding the increase in blood pressure in patients in a university hospital, the drug of choice, and the maintained use of antihypertensive medication. METHODS: Data from January to June 1997 from the University Hospital Professor Edgard Santos Pharmacy concerning the prescriptions of all inpatients were used. Variables included in the analysis were: antihypertensive medication prescription preceding increase in blood pressure, type of antihypertensive medication, gender, clinical or surgical wards, and the presence of maintained antihypertensive medication. RESULTS: The hospital admitted 2,532 patients, 1,468 in surgical wards and 818 in medical wards. Antihypertensive medication prescription preceding pressure increase was observed in 578 patients (22.8 percent). Nifedipine was used in 553 (95.7 percent) and captopril in 25 (4.3 percent). In 50.7 percent of patients, prescription of antihypertensive medication was not associated with maintained antihypertensive medication. Prescription of antihypertensive drugs preceding elevation of blood pressure was significantly (p<0.001) more frequent on the surgical floor (27.5 percent; 405/1468) than on the medical floor (14.3 percent; 117/818). The frequency of prescription of antihypertensive drugs preceding elevation of blood pressure without maintained antihypertensive drugs and the ratio between the number of prescriptions of nifedipine and captopril were greater in surgical wards. CONCLUSION: The use of antihypertensive medication, preceding elevation of blood pressure (22.8 percent) observed in admitted patients is not supported by scientific evidence. The high frequency of this practice may be even greater in nonuniversity hospitals