Factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria / Factors that influence health literacy in patients with coronary artery disease / Fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana

Objetivo: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. Método: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. Conclusión: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.

Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Objetivo: investigar os fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana. Método: estudo transversal, incluindo 122 pacientes com coronariopatias (60,7% do sexo masculino; 62,07±8,8 anos); letramento em saúde e conhecimento específico da doença foram avaliados por meio de entrevista com os participantes, pelo Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Os dados foram descritos por medidas de tendência central e frequências. Fatores que influenciam o letramento em saúde foram determinados por modelo de regressão linear. O nível de significância adotado foi de 5%. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: idade e hipertensão apresentaram uma relação inversa e significativa com letramento em saúde. Por outro lado, maior escolaridade e estar empregado associaram-se com maiores pontuações no instrumento de letramento em saúde. O conhecimento específico da doença não influenciou o letramento em saúde. As variáveis do modelo de regressão explicaram 55,3% do letramento inadequado. Conclusão: no presente estudo o conhecimento sobre a doença não influência o letramento em saúde, mas os profissionais devem considerar os fatores sociodemográficos e clínicos para planejar as intervenções.

Protection of side-branch ostium by the jailed balloon technique validated by three-dimensional optical coherence tomography / 中华心血管病杂志

Objective: To evaluate the protective effect of jailed balloon technique on side branch (SB) ostium using three-dimensional optical coherence tomography(OCT). Methods: This is a retrospective study. Consecutive coronary disease patients with coronary artery bifurcation lesions who underwent percutaneous coronary intervention (PCI) and completed pre-and post-procedural OCT examinations at the Chinese People's Liberation Army General Hospital from September 2019 to March 2022 were enrolled. Patients were divided into the jailed balloon technique group and the unprotected group according to the options applied for the SB. The SB ostium area difference was calculated from OCT images (SB ostium area difference=post-PCI SB ostium area-pre-PCI SB ostium area). The SB ostium area differences were compared between the two groups and compared further in the subgroup of true bifurcation lesions and non-true bifurcation lesions. In the jailed balloon group, the SB ostium area difference was compared between the active jailed balloon technique and the conventional jailed balloon technique, between the jailed balloon>2.0 mm diameter and the jailed balloon≤2.0 mm diameter, and between the higher balloon pressure (>4 atm, 1 atm=101.325 kPa) and the lower balloon pressure (≤4 atm). Multivariate linear regression analysis was used to explore the correlation between the technical parameters of the jailed balloon technique and the SB protection effect. Results: A total of 176 patients with 236 bifurcation lesions were enrolled, aged (60.7±9.3) years, and there were 128 male patients (72.7%). There were 67 patients in the jailed balloon technique group with 71 bifurcation lesions and 123 patients in the unprotected group with 165 bifurcation lesions. Fourteen patients had 2 to 3 lesions, which were treated in different ways, so they appeared in the unprotected group and the jailed balloon technique group at the same time. The area difference in SB ostium was greater in the jailed balloon group than in the unprotected group (0.07 (-0.43, 1.05)mm2 vs.-0.33 (-0.83, 0.26)mm2, P<0.001), and the results were consistent in the true bifurcation lesion subgroup (0.29 (-0.35, 0.96)mm2 vs.-0.26 (-0.64, 0.29)mm2, P=0.004), while the difference between the two groups in the non-true bifurcation lesion subgroup was not statistically significant (P=0.136). In the jailed balloon technique group, the SB ostium area difference was greater in patients treated with the active jailed balloon technique than in those treated with the conventional jailed balloon technique ((0.43±1.36)mm2 vs. (-0.22±0.52)mm2, P=0.013). The difference in SB ostium area was greater in those using>2.0 mm diameter jailed balloons than in those using≤2.0 mm diameter jailed balloons (0.25 (-0.51, 1.31) mm2 vs.-0.01 (-0.45, 0.63) mm2, P=0.020), while SB ostium area difference was similar between those endowed with higher balloon pressure (>4 atm) compared to those with lower balloon pressure (≤4 atm) (P=0.731). Multivariate linear regression analysis showed that there was a positive correlation between jailed balloon diameter and SB ostium area difference (r=0.344, P=0.019). Conclusions: The jailed balloon technique significantly protects SB ostium, especially in patients with true bifurcation lesions. The active jailed balloon technique and larger diameter balloons may provide more protection to the SB.

Drug-coated balloon-only strategy for percutaneous coronary intervention of de novo left main coronary artery disease: the importance of proper lesion preparation / 医学前沿

This retrospective single-center registry study included all consecutive patients who underwent percutaneous coronary intervention (PCI) for a de novo left main coronary artery lesion using drug coated-balloon (DCB)-only strategy between August 2011 and December 2018. To best of our knowledge, no previous studies of DCB-only strategy of treating de novo left main coronary artery disease, exist. The primary endpoint was major adverse cardiovascular events (MACEs) including cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). The cohort was divided into two groups depending on weather the lesion preparation was done according to the international consensus group guidelines. Sixty-six patients (mean age 75±8.6, 72% male), 52% of whom had acute coronary syndrome, underwent left main PCI with the DCB-only strategy. No procedural mortality and no acute closures of the treated left main occurred. At 12 months, MACE and TLR occurred in 24% and 6% of the whole cohort, respectively. If the lesion preparation was done according to the guidelines, the MACE and TLR rates were 21.2% and 1.9%. Left main PCI with the DCB only-strategy is safe leading to acceptable MACE and low TLR rates at one year, if the lesion preparation is done according to the guidelines.

Ejercicio aeróbico versus concurrente sobre la interleucina-6 en pacientes con enfermedad arterial coronaria: Una revisión sistemática / Aerobic Versus Concurrent Exercise on Interleukin-6 in Patients with Coronary Arterial Disease: A Systematic Review

Resumen El ejercicio aeróbico (EA) ha demostrado ser beneficioso para la supervivencia del paciente con enfermedad arterial coronaria (EAC) y la disminución de la interleucina 6 (IL-6). Sin embargo, hay poco evidencia del efecto del entrenamiento concurrente (EC). Propósito: Analizar el efecto del EA versus EC sobre la IL-6 en pacientes con EAC. Metodología: Se desarrolló con base en los acuerdos PRISMA, se realizó una búsqueda de los artículos científicos mediante bases de datos electrónicas. Los términos de búsqueda (frase booleana) fueron los siguientes: ("coronary artery disease" OR ''cardiac disease'' OR "cardiovascular disease") AND (''exercise'' OR ''training'' OR "cardiac rehabilitation") AND ("IL-6" OR "Interleukin-6" OR "inflammatory markers"). Las búsquedas se realizaron entre agosto y diciembre de 2019. Resultados: Se revisaron un total de 2516 estudios, de los cuales se incluyeron 10 estudios que cumplieron con los criterios de elegibilidad. Se analizaron un total de 413 pacientes. Se encontró una mejoría entre un 5% y un 74% con el EA y entre un 2.3% y 58.8% con el EC. Ambas modalidades disminuye significativamente la IL-6, independientemente de la edad, sesiones de entrenamiento semanales y de la etapa inicial de los pacientes con EAC, pero aquellos estudios que utilizaron una alta intensidad o un volumen superior a 30 minutos presentaron mayores beneficios. Conclusión: Tanto el EA como el EC son beneficiosos en la disminución de la IL-6 en pacientes con EAC. Esta revisión sistemática deja la posibilidad de continuar investigando el comportamiento de la alta intensidad en la disminución de la IL-6.

Abstract Aerobic exercise (AE) has been shown to be beneficial for the survival of patients with CAD and the decrease in interleukin 6 (IL-6). However, there is little evidence of the effect of concurrent training (CT). Purpose: To analyze the effect of AE versus CT on IL-6 in patients with CAD. Methodology: It was developed based on the PRISMA agreements; scientific articles were searched through electronic databases. The search terms (Boolean phrase) were the following: ("coronary artery disease" OR '' cardiac disease '' OR "cardiovascular disease") AND ('' exercise '' OR '' training '' OR "cardiac rehabilitation") AND ("IL-6" OR "Interleukin-6" OR "inflammatory markers") NOT ("animals" OR "rat"). The searches were conducted between August and December 2019. Results: A total of 2516 studies were reviewed, of which 10 studies that met the eligibility criteria were included. A total of 413 patients were analyzed. An improvement was found between 5% and 74% with the AE and between 2.3% and 58.8% with the CT. Both modalities significantly decrease IL-6, regardless of age, weekly training sessions, and the initial stage of patients with CAD; however, those studies that used a high intensity or a volume greater than 30 minutes showed greater benefits. Conclusion: Both EA and CT are beneficial in reducing IL-6 in patients with CAD. This systematic review leaves the possibility of continuing to investigate the behavior of high intensity in the decrease of IL-6.

Resumo O exercício aeróbio (EA) demonstrou beneficiar a sobrevivência dos pacientes com doença arterial coronária (DAC) e diminuir a interleucina 6 (IL-6). No entanto, há poucas evidências do efeito do treino simultâneo (TC). Objetivo: Analisar o efeito da EA versus TC na IL-6 em pacientes com DAC. Metodologia: Com base nos acordos PRISMA, foi realizada uma pesquisa de artigos científicos utilizando bases de dados eletrônicas. Os termos de busca (frase booleana) foram os seguintes: (''doença arterial coronária'' OU ''doença cardíaca'' OU ''doença cardiovascular'') E (''exercício'' OU ''treinamento'' OU ''reabilitação cardíaca'') E (''IL-6'' OU ''Interleucina-6'' OU ''marcadores inflamatórios''). As pesquisas foram realizadas entre agosto e dezembro de 2019. Resultados: Um total de 2516 estudos foram revistos, dos quais foram incluídos 10 estudos que preenchiam os critérios de elegibilidade. Foram analisados um total de 413 pacientes. A melhoria foi encontrada entre 5% e 74% com a EA e entre 2,3% e 58,8% com o TC. Ambas as modalidades diminuíram significativamente a IL-6, independentemente da idade, das sessões semanais de treinamento e do estágio inicial dos pacientes com DAC, mas os estudos que utilizaram alta intensidade ou volume superior a 30 minutos tiveram maiores benefícios. Conclusão: Tanto a EA como a TC são benéficas para a redução da IL-6 em pacientes com DAC. Esta revisão sistemática deixa espaço para uma investigação mais aprofundada sobre o comportamento de baixa intensidade da IL-6.

Clinical analysis of 5 cases of systemic juvenile idiopathic arthritis with coronary artery dilatation / 中华儿科杂志

Objective: To investigate the clinical characteristics of systemic juvenile idiopathic arthritis combined with coronary artery dilatation. Methods: A retrospective analysis was performed on the clinical data, including clinical manifestations, blood routine, inflammatory factors, echocardiography, vascular ultrasound and CT angiography, treatment and outcomes, etc, of 5 cases with systemic juvenile idiopathic arthritis combined with coronary artery dilation admitted to Department of Rheumatology in the affiliated Children's Hospital of Capital Institute of Pediatrics from May 2019 to June 2021. Results: There were 2 males and 3 females among 5 cases. The onset age ranged from 7 months to 4 years 7 months.The diagnostic time ranged from 1.5 months to 3.0 months.Four cases were diagnosed as atypical Kawasaki disease. Three cases showed unilateral coronary artery dilation.Two cases showed bilateral coronary artery dilation.Four cases developed multiple organ injuries.Three cases developed macrophage activation syndrome.Three cases developed lung injury.Two cases developed pericardial effusion.One case developed pulmonary hypertension.As for treatment, 3 cases treated with methylprednisolone pulse therapy and methotrexate combined with cyclosporine, improved after the final application of biological agents, and have stopped prednisone. The other 2 cases were treated with adequate oral prednisone and gradually reduced, and methotrexate was added at the same time, 1 case relapsed in the process of reduction. No other vascular involvement was found in 5 cases. Coronary artery dilation recovered completely after 1 to 3 months of treatment. Conclusions: Systemic juvenile idiopathic arthritis combined with coronary artery dilatation has the clinical characteristics of small onset age, long diagnostic time, prone to multiple organ injuries. Corticosteroids and conventional immunosuppressive agents are not sensitive, and biological agents should be used as soon as possible.The prognosis of coronary artery dilation is good after timely treatment.

Benefits and risks of prolonged dual antiplatelet therapy after percutaneous coronary intervention with drug-eluting stent in patients with stable coronary artery disease and diabetes / 中华心血管病杂志

Objective: To compare the efficacy and safety of prolonged dual antiplatelet therapy (DAPT>1 year) in patients with stable coronary artery disease (CAD) and diabetes who were event-free at 1 year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES) in a large and contemporary PCI registry. Methods: A total of 1 661 eligible patients were selected from the Fuwai PCI Registry, of which 1 193 received DAPT>1 year and 468 received DAPT ≤1 year. The primary endpoint was major adverse cardiac and cerebrovascular event (MACCE) and Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding, MACCE was defined as a composite of all-cause death, myocardial infarction or stroke. Multivariate Cox regression analysis and inverse probability of treatment weighting (IPTW) Cox regression analysis were performed. Results: After a median follow-up of 2.5 years, patients who received DAPT>1 year were associated with lower risks of MACCE (1.4% vs. 3.2%; hazard ratio (HR) 0.412, 95% confidence interval (CI) 0.205-0.827) compared with DAPT ≤1 year, which was primarily caused by the lower all-cause mortality (0.1% vs. 2.6%; HR 0.031, 95%CI 0.004-0.236). Risks of cardiac death (0.1% vs. 1.5%; HR 0.051, 95%CI 0.006-0.416) and definite/probable ST (0.3% vs. 1.1%; HR 0.218, 95%CI 0.052-0.917) were also lower in patients received DAPT>1 year than those received DAPT ≤ 1 year. No difference was found between the two groups in terms of BARC type 2, 3, or 5 bleeding (5.3% vs. 4.1%; HR 1.088, 95%CI 0.650-1.821). Conclusions: In patients with stable CAD and diabetes who were event-free at 1 year after PCI with DES, prolonged DAPT (>1 year) provides a substantial reduction in ischemic cardiovascular events, including MACCE, all-cause mortality, cardiac mortality, and definite/probable ST, without increasing the clinically relevant bleeding risk compared with ≤ 1-year DAPT. Further well-designed, large-scale randomized trials are needed to verify the beneficial effect of prolonged DAPT in this population.

Enfermedad coronaria en el paciente portador del virus de la inmunodeficiencia humana / Coronary artery disease in patients infected with HIV

RESUMEN: Las enfermedades cardiovasculares, particularmente la enfermedad coronaria (EC), resultan de especial interés y preocupación en pacientes portadores del virus de la inmunodeficiencia humana (VIH). La ateromatosis acelerada como causa del aumento de prevalencia de enfermedad coronaria ha sido reconocida desde hace varios años en estos pacientes. No obstante, los mecanismos fisiopatológicos involucrados son múltiples y complejos e incluyen factores virales, la respuesta inflamatoria e inmunológica desencadenada por el virus, factores de riesgo cardiovascular tradicionales y efectos de la terapia antirretroviral combinada. Esta revisión de la literatura aborda dichos mecanismos y hace una actualización de los principales estudios clínicos que los sustentan. Se comenta además la evaluación de riesgo cardiovascular y los lineamientos para la revascularización de pacientes con EC portadores de VIH.

ABSTRACT: Cardiovascular diseases, particularly coronary artery disease are relevant in patients with the human immunodeficiency virus (HIV). For several years accelerated atheromatosis, a cause of increased prevalence in coronary disease, has been recognized in these patients. However, the pathophysiological mechanisms involved are multiple and complex, including viral factors, the inflammatory and immune response triggered by the virus, traditional cardiovascular risk factors, and the effects of combined antiretroviral therapy. This review of the literature addresses these mechanisms and updates the main clinical studies that support them. Cardiovascular risk assessment and guidelines for revascularization of HIV patients with CHD are also discussed.

Cut-off values of lesion and vessel quantitative flow ratio in de novo coronary lesion post-drug-coated balloon therapy predicting vessel restenosis at mid-term follow-up / 中华医学杂志(英文版)

BACKGROUND@#Drug-coated balloons (DCBs) have emerged as potential alternatives to drug-eluting stents in specific lesion subsets for de novo coronary lesions. Quantitative flow ratio (QFR) is a method based on the three-dimensional quantitative coronary angiography and contrast flow velocity during coronary angiography (CAG), obviating the need for an invasive fractional flow reserve procedural. This study aimed to assess the serial angiographic changes of de novo lesions post-DCB therapy and further explore the cut-off values of lesion and vessel QFR, which predict vessel restenosis (diameter stenosis [DS] ≥50%) at mid-term follow-up.@*METHODS@#The data of patients who underwent DCB therapy between January 2014 and December 2019 from the multicenter hospital were retrospectively collected for QFR analysis. From their QFR performances, which were analyzed by CAG images at follow-up, we divided them into two groups: group A, showing target vessel DS ≥50%, and group B, showing target vessel DS <50%. The median follow-up time was 287 days in group A and 227 days in group B. We compared the clinical characteristics, parameters during DCB therapy, and QFR performances, which were analyzed by CAG images between the two groups, in need to explore the cut-off value of lesion/vessel QFR which can predict vessel restenosis. Student's t test was used for the comparison of normally distributed continuous data, Mann-Whitney U test for the comparison of non-normally distributed continuous data, and receiver operating characteristic (ROC) curves for the evaluation of QFR performance which can predict vessel restenosis (DS ≥50%) at mid-term follow-up using the area under the curve (AUC).@*RESULTS@#A total of 112 patients with 112 target vessels were enrolled in this study. Group A had 41 patients, while group B had 71. Vessel QFR and lesion QFR were lower in group A than in group B post-DCB therapy, and the cut-off values of lesion QFR and vessel QFR in the ROC analysis to predict target vessel DS ≥50% post-DCB therapy were 0.905 (AUC, 0.741 [95% confidence interval, CI: 0.645, 0.837]; sensitivity, 0.817; specificity, 0.561; P < 0.001) and 0.890 (AUC, 0.796 [95% CI: 0.709, 0.882]; sensitivity, 0.746; specificity, 0.780; P < 0.001).@*CONCLUSIONS@#The cut-off values of lesion QFR and vessel QFR can assist in predicting the angiographic changes post-DCB therapy. When lesion/vessel QFR values are <0.905/0.890 post-DCB therapy, a higher risk of vessel restenosis is potentially predicted at follow-up.

Uso de la litotripsia intracoronaria en el manejo de lesiones calcificadas: reporte de dos casos / Lithoplasty for calcified coronary artery lesiones

Recently, intravascular lithoplasty (IVL) has been introduced as a novel technique for treating calcified intracoronary artery lesions. There are no reports of this intervention in Latin America. We report 2 cases in which IVL was successfully used to treat this type of coronary artery lesions.

Efeito cardiovascular superior do modelo periodizado para prescrição de exercícios comparado ao convencional em coronariopatas / Superior cardiovascular effect of the periodized model for prescribed exercises as compared to the conventional one in coronary diseases

O exercício físico melhora a sobrevida e a qualidade de vida de pacientes coronarianos, mas a maneira ideal de prescrevê-lo é ainda controversa. Criar um modelo periodizado para prescrição de exercícios para pacientes coronarianos e compará-lo com o modelo convencional. Randomização de 62 pacientes coronarianos em tratamento farmacológico em dois grupos: treinamento convencional, não periodizado (GNP, n = 33) e periodizado (GP, n = 29). Os dois grupos foram submetidos aos mesmos exercícios durante as 36 sessões do programa, mas prescritos de maneira diferente. Todos os pacientes foram submetidos à seguinte avaliação: consulta médica admissional, teste de esforço cardiopulmonar, teste de 1 repetição máxima (1RM) e avaliação da composição corporal. O VO2 pico melhorou nos dois grupos, embora de maneira mais efetiva no GP (4% versus 1,7%, p < 0,001). Além disso, a capacidade funcional do GP aumentou em 13%, tendo havido significativa redução no percentual de gordura corporal (2,1%, p < 0,005) e no peso corporal (1,9 kg, p < 0,005). A força muscular nos dois grupos melhorou como diagnosticado pelo teste de 1RM para seis diferentes grupos musculares (quádriceps, isquiotibiais, bíceps, tríceps braquial, peitoral e grande dorsal), mas sem diferença significativa entre os grupos, tendo os dois modelos a mesma eficiência. O presente estudo mostrou que a periodização do treinamento de pacientes cardíacos pode melhorar a capacidade cardiorrespiratória e reduzir a porcentagem de gordura corporal mais efetivamente do que o modelo convencional

Physical exercise improves the survival and quality of life of coronary patients, but the ideal way of prescribing these exercises is still controversial. To create a new periodized model for the prescription of exercises for coronary patients and compare it with a conventional model. 62 coronary patients under pharmacological treatment were randomized into two groups: conventional (NPG, n = 33) and periodized (PG, n = 29) training. The two groups were submitted to the same exercises during the 36 sessions making up the program, but prescribed in different ways. All patients underwent an evaluation consisting of: medical admission consultancy, cardiopulmonary endurance testing, 1 maximum repetition test (1MR) and body composition evaluation. The VO2 peak improved in both groups, although more effectively in the PG (4% against 1.7%, p < 0.001). In addition, the functional capacity of this group improved by 13%, and there was a significant reduction in the percent body fat (2.1%, p < 0.005) and body weight (1.9 kg, p < 0.005). The muscle strength of both groups improved as diagnosed by the 1RM test for six different muscle groups (quadriceps, hamstrings, brachial biceps, brachial triceps, pectoral and large dorsal), and showed no significant difference between the groups, evidencing that the two models had the same efficiency. The present study showed that periodization of the training of cardiac patients can improve their cardiorespiratory capacity and reduce the percent body fat more effectively than the conventional one

Uso do GATED-SPECT para avaliação do dissincronismo ventricular em pacientes com insuficiência cardíaca submetidos à terapia de ressincronização cardíaca / Use of GATED-SPECT for ventricular desynchronization evaluation in patients with heart failure submitted to cardiac resynchronization therapy

Fundamentos: Cerca de 20 a 40% dos pacientes com insuficiência cardíaca não respondem à terapia de ressincronização. Para melhorar a seleção de pacientes, foi desenvolvida a análise de fase pela cintilografia de perfusão miocárdica (GSPECT). Objetivo: Avaliar a resposta clínica e cintilográfica de pacientes com insuficiência cardíaca submetidos à terapia de ressincronização pelo uso do GSPECT. Métodos: Estudo intervencionista, incluindo pacientes consecutivos que foram estudados pelo GSPECT 4 semanas antes da implantação da terapia de ressincronização cardíaca e 6 meses depois do implante. Estes pacientes responderam ao Questionário de Qualidade de Vida de Minnesota. A comparação das variáveis categóricas foi realizada com teste exato de Fisher e teste qui quadrado e, em variáveis numéricas, com o teste t de Student. O nível de significância estatística adotado foi de 5%. As variáveis cintilográficas analisadas foram fração de ejeção do ventrículo esquerdo, volume sistólico final, volume diastólico final, massa do ventrículo esquerdo, desvio padrão e largura de banda, assim como a duração do QRS e o escore do Questionário de Qualidade de Vida de Minnesota. A presença de dissincronismo mecânico foi definida como desvio padrão > 43º.Resultados: Foram incluídos nove pacientes no estudo. Após a terapia de ressincronização cardíaca, houve melhora significativa (p < 0,05) dos parâmetros volume sistólico final (206 ± 80 mL vs. 158 ± 108 mL), QRS (180 ± 18 ms vs. 120 ± 9 ms), massa do ventrículo esquerdo (248 ± 65 g vs. 193 ± 52 g) e Questionário de Qualidade de Vida de Minnesota (63 ± 16 vs. 34 ± 20). Todos os pacientes com critérios cintilográficos de dissincronismo mecânico apresentaram melhora clínica. Dois pacientes apresentavam apenas dissincronismo elétrico e não atingiram melhora clínica significativa, apesar de apresentarem redução da duração do QRS. Conclusão: O GSPECT foi capaz de diferenciar os pacientes com dissincronismo elétrico puro daqueles com dissincronismo mecânico associado, por meio dos parâmetros de dissincronismo intraventricular. A terapia de ressincronização cardíaca está associada à melhora tanto do dissincronismo mecânico quanto do elétrico. O GSPECT pré-implante identificou que os pacientes com dissincronismos elétrico e mecânico associados apresentaram melhor resposta à terapia de ressincronização cardíaca do que aqueles com dissincronismo elétrico puro

Background: Approximately 20 to 40% of patients with heart failure do not respond to cardiac resynchronization therapy (CRT). To improve patient selection, phase analysis by myocardial perfusion scintigraphy (GSPECT) was developed. Objectives: To evaluate the clinical and scintigraphic response of patients with heart failure (HF) submitted to CRT using GSPECT. Method: This was an interventional study that included consecutive patients assessed by GSPECT four weeks prior to CRT implantation and six months after it for comparison. These patients also answered the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The categorical variables were compared using Fisher's exact test and chi-square test, whereas Student's t-test was used for numerical variables. The level of statistical significance was set at 5%. The scintigraphic variables analyzed were left ventricular ejection fraction, end-systolic volume, end-diastolic volume, left ventricular mass, standard deviation and bandwidth, as well as QRS duration and the Minnesota Quality of Life Questionnaire score. The presence of mechanical dyssynchrony was defined as standard deviation > 43º. Results: Nine patients were included in the study. After the cardiac resynchronization therapy, there was a significant improvement (p <0.05) in the end-systolic volume (206 ± 80 mL vs. 158 ± 108 mL), QRS (180 ± 18 ms vs. 120 ± 9 ms), left ventricular mass (248 ± 65 g vs. 193 ± 52 g) and Minnesota Quality of Life Questionnaire score (63 ± 16 vs. 34 ± 20). All patients with scintigraphic criteria of mechanical dyssynchrony showed clinical improvement. Two patients had only electrical dyssynchrony and did not achieve significant clinical improvement, although they showed QRS duration reduction. Conclusion: GSPECT was able to differentiate patients with isolated electrical dyssynchrony from those with associated mechanical dyssynchrony, through the intraventricular dyssynchrony parameters. The cardiac resynchronization therapy is associated with the improvement of both mechanical and electrical dyssynchrony. Pre-implantation GSPECT showed that patients with associated electrical and mechanical dyssynchrony had a better response to cardiac resynchronization therapy than those with isolated electrical dyssynchrony

Estimated costs of hospitalization due to coronary artery disease attributable to familial hypercholesterolemia in the Brazilian public health system

ABSTRACT Objective: Cardiovascular diseases are the leading cause of death in Brazil, imposing substantial economic burden on the health care system. Familial hypercholesterolemia (FH) is known to greatly increase the risk of premature coronary artery disease (CAD). This study aimed to estimate the economic impact of hospitalizations due to CAD attributable to FH in the Brazilian Unified Health Care System (SUS). Subjects and methods: Retrospective, cross-sectional study of data obtained from the Hospital Information System of the SUS (SIHSUS). We selected all adults (≥ 20 years of age) hospitalized from 2012­-2014 with primary diagnoses related to CAD (ICD-10 I20 to I25). Attributable risk methodology estimated the contribution of FH in the outcomes of interest, using international data for prevalence (0.4% and 0.73%) and relative risk for events (RR = 8.56). Results: Assuming an international prevalence of FH of 0.4% and 0.73%, of the 245,981 CAD admissions/year in Brazil, approximately 7,249 and 12,915, respectively, would be attributable to an underlying diagnosis ­­of FH. The total cost due to CAD per year, considering both sexes and all adults, was R$ 985,919,064, of which R$ 29,053,500 and R$ 51,764,175, respectively, were estimated to be attributable to FH. The average cost per FH-related CAD event was R$ 4,008. Conclusion: Based on estimated costs of hospitalization for CAD, we estimated that 2.9-5.3% are directed to FH patients. FH can require early specific therapies to lower risk in families. It is mandatory to determine the prevalence of FH and institute appropriate treatment to minimize the clinical and economic impact of this disease in Brazil.

Evolução no tratamento da doença coronária estável - mais fisiológico, menos invasivo / Evolution of treatment for stable coronary artery disease - more physiological, less invasive

Ao longo das décadas, alguns conceitos mudaram radicalmente a respeito do tratamento clínico da doença arterial coronariana (DAC). Inicialmente focado na redução dos sintomas isquêmicos, hoje a otimização da terapêutica clínica é fundamental para a redução de eventos cardiovasculares. No mesmo período, houve um grande desenvolvimento das técnicas de revascularização. A angioplastia coronária tornou-se uma das intervenções terapêuticas mais frequentemente realizadas e as técnicas de revascularização miocárdica vêm sendo objeto de mais ensaios clínicos randomizados, do que qualquer outra intervenção em Medicina. Ainda mais, várias modalidades de imagem invasivas e não invasivas foram desenvolvidas, permitindo estudar com maior precisão a doença arterial coronariana, reconhecer novos marcadores prognóstico, avaliar mais claramente os pacientes e indicar mais acertadamente o tratamento

Some concepts regarding the clinical management of coronary artery disease (CAD) have radically changed over the past decades. Initially focused on improving ischemic symptoms, today, optimal medical therapy is fundamental for reducing cardiovascular events. In the same time frame, there has been an immense development in revascularization treatment. Coronary angioplasty has become one of the most frequently performed therapeutic interventions, and myocardial revascularization techniques have been the subject of more randomized clinical trials than any other intervention in medicine. Furthermore, several invasive and non-invasive imaging modalities have been developed, enabling more accurate study of coronary artery disease, recognition of prognostic markers, clearer patient evaluation, and earlier treatment indications

Approach to concurrent coronary and carotid artery disease: Epidemiology, screening and treatment / Abordagem da doença coronariana e carotídea concomitante: epidemiologia, rastreamento e tratamento

Summary The concomitance between coronary artery disease and carotid artery disease is known and well documented. However, it is a fact that, despite the screening methods for these conditions and the advances in surgical treatment, little has been achieved in terms of reducing the risk of complications in the perioperative period. Publications are scarce, being mostly composed of reports or case series. There is little agreement on the best initial therapeutic approach (myocardial versus carotid revascularization) or the best technique to be used (surgery with or without extracorporeal circulation, hybrid treatments, etc.). The authors performed a review of the evidence in this clinical scenario, raising pragmatic questions that help in the therapeutic decision.

Resumo A concomitância entre doença arterial coronária e doença carotídea é conhecida e já bem documentada. Fato é, porém, que, a despeito dos métodos de rastreio dessas condições e da evolução do tratamento cirúrgico, pouco se tem conseguido em termos de redução de risco de complicações no perioperatório. As publicações são escassas, sendo em sua maior parte compostas por relatos ou séries de caso. Há pouco consenso sobre qual a melhor abordagem terapêutica inicial (revascularização miocárdica versus carotídea), bem como sobre a melhor técnica a ser empregada (cirurgia com ou sem uso de circulação extracorpórea, tratamentos híbridos, etc.). Os autores realizaram uma revisão da evidência nesse cenário clínico, pontuando questões pragmáticas que ajudem na decisão terapêutica.