Myocardial protection: comparing histological effects of single-dose cardioplegic solutions-study protocol for a secondary analysis of the CARDIOPLEGIA trial.

Background: Myocardial protection is crucial for successful cardiac surgery, as it prevents heart muscle damage that can occur during the procedure. Prolonged hypoxia without proper protection can lead to adenosine triphosphate consumption, microvilli loss, blister formation, and edema. Custodiol, del Nido, and modified del Nido are single-dose cardioplegic solutions with proven safety and significance in modern surgery. While each has been independently assessed for patient outcomes, limited research directly compares them. This study aims to compare their myocardial protection using histological analysis. Methods: In a double-blind clinical trial, at least 90 patients will be randomly assigned to receive one of the three cardioplegic solutions. Myocardial biopsies will be collected before cardiopulmonary bypass and 15 minutes after reperfusion. The surgical, anesthetic and perfusion techniques will be the same for all patients, following the Institution's standard protocols. Discussion: The ideal cardioplegic solution does not exist, and its selection remains challenging for surgeons. In modern surgical practice, understanding the behavior of these solutions and the ischemic tissue damage caused during induced cardiac arrest allows for safer surgical procedures. The results of this clinical trial can help in understanding the behavior of cardioplegic solutions and their tissue effects. Thus, by selecting the best cardioplegic solution, ischemic damage can be minimized, enhancing the effectiveness of this essential technique in cardiac procedures. The study may aid in implementing clinical protocols in several institutions, aiming to choose the solution with a superior myocardial protection profile, increasing safety, and reducing expenses. Trial Registration: Brazilian Clinical Trials Registry (ReBEC, http://ensaiosclinicos.gov.br/): RBR-997tqhh. Registered: January 26th, 2022.

Adult patients admitted to a tertiary hospital for COVID-19 and risk factors associated with severity: a retrospective cohort study.

COVID-19 is a disease whose knowledge is still under construction, high transmissibility, with no consensual treatment available to everyone. Therefore, the identification of patients at higher risk of evolving to the critical form of the disease is fundamental. The study aimed to determine risk factors associated with the severity of COVID-19 in adults patients. This is an observational, retrospective study from a cohort of adult patients with COVID-19 admitted to a public hospital from March to August 2020, whose medical records were evaluated. For the association of possible severity predictors, a Poisson regression was used. The primary outcome was the critical form of the disease (need for admission to the Intensive Care Unit and/or invasive mechanical ventilation). We included 565 patients: mostly men; 55.5% of those who progressed to the critical form of the disease were over sixty years old. Hypertension, diabetes mellitus and obesity were the most frequent comorbidities. There were 39.8% of patients who progressed to the critical form of the disease. The hospital mortality rate was 22.1%, and that of critical patients was 46.7%. The independent factors associated with the severity of the disease were obesity [RR = 1.33 (95% CI 1.07 to 1.66; p = 0.011)], SpO2/FiO2 ratio ≤ 315 [RR = 2.20 (95% CI 1.79 to 2.71; p = 0.000)], C-reactive protein > 100 mg/L [RR = 1.65 (95% CI 1.33 to 2.06; p = 0.000)], and lymphocytes < 1,000/µL [RR = 1.44 (95% CI 1.18 to 1.75; p = 0.000)]. Advanced age and comorbidities were dependent factors strongly associated with the critical form of the disease.

Comparison between Custodiol, del Nido and modified del Nido in the myocardial protection - Cardioplegia Trial: a study protocol for a randomised, double-blind clinical trial.

INTRODUCTION: Myocardial protection is essential for successful cardiac surgery, and the search for an ideal cardioplegic solution has continued since its beginning. In this context, Custodiol, del Nido and modified del Nido are single-dose cardioplegic solutions with good safety profiles and great relevance in modern surgical practice. While these solutions have all been evaluated for their impact on patient outcomes independently, limited research exists comparing them directly. Thus, the present study aims to examine the effects of these cardioplegic solutions on myocardial protection and clinical outcomes in adult patients undergoing elective cardiac surgery. The assessment of the increase in myocardial injury biomarkers in patients submitted to all treatment methods may be considered a major strength of our study. METHODS AND ANALYSIS: This is a clinical trial study protocol that will compare myocardial protection and clinical outcomes among three patient groups based on which cardioplegic solution was used. Patients will be randomised to receive del Nido (n=30), modified del Nido (n=30) or Custodiol (n=30). Myocardial injury biomarkers will be measured at the baseline and 2 hours, 12 hours and 24 hours after the cardiopulmonary bypass. Clinical outcomes will be assessed during the trans operative period and the intensive care unit stay, in addition to other haematological parameters. ETHICS AND DISSEMINATION: This protocol and its related documents were approved by the Research Ethics Committee of the Hospital Nossa Senhora da Conceição, Brazil, registered under no. 4.029.545. The findings of this study will be published in a peer-reviewed journal in the related field. TRIAL REGISTRATION NUMBER: RBR-7g5s66.

Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index.

BACKGROUND: Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). METHODS AND RESULTS: In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. CONCLUSION: Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

Adult patients admitted to a tertiary hospital for COVID-19 and risk factors associated with severity: a retrospective cohort study

ABSTRACT COVID-19 is a disease whose knowledge is still under construction, high transmissibility, with no consensual treatment available to everyone. Therefore, the identification of patients at higher risk of evolving to the critical form of the disease is fundamental. The study aimed to determine risk factors associated with the severity of COVID-19 in adults patients. This is an observational, retrospective study from a cohort of adult patients with COVID-19 admitted to a public hospital from March to August 2020, whose medical records were evaluated. For the association of possible severity predictors, a Poisson regression was used. The primary outcome was the critical form of the disease (need for admission to the Intensive Care Unit and/or invasive mechanical ventilation). We included 565 patients: mostly men; 55.5% of those who progressed to the critical form of the disease were over sixty years old. Hypertension, diabetes mellitus and obesity were the most frequent comorbidities. There were 39.8% of patients who progressed to the critical form of the disease. The hospital mortality rate was 22.1%, and that of critical patients was 46.7%. The independent factors associated with the severity of the disease were obesity [RR = 1.33 (95% CI 1.07 to 1.66; p = 0.011)], SpO2/FiO2 ratio ≤ 315 [RR = 2.20 (95% CI 1.79 to 2.71; p = 0.000)], C-reactive protein > 100 mg/L [RR = 1.65 (95% CI 1.33 to 2.06; p = 0.000)], and lymphocytes < 1,000/µL [RR = 1.44 (95% CI 1.18 to 1.75; p = 0.000)]. Advanced age and comorbidities were dependent factors strongly associated with the critical form of the disease.

Increased ultrasensitive C-reactive protein is not associated with obesity in hospitalized heart failure patients.

OBJECTIVE:: To evaluate the association between obesity and levels of high-sensitivity C-reactive protein (hs-CRP) in patients with heart failure admitted to a tertiary hospital. METHODS:: Cross-sectional study with a consecutive sampling of hospitalized patients with heart failure. Sociodemographic and clinical data were collected, and the nutritional status was assessed through indicators such as body mass index (in kg/m2), waist circumference (in cm), waist-hip ratio, triceps skinfold (in mm) and subscapularis skinfold (in mm). Neck circumference (in cm) was measured as well as serum levels of hs-CRP, in mg/L. RESULTS:: Among 123 patients, the mean age was 61.9±12.3 years and 60.2% were male. The median of hs-CRP was 8.87mg/L (3.34 to 20.01). A tendency to an inverse correlation between neck circumference and hs-CRP was detected (r=-0.167; p=0.069). In the multiple linear regression analysis, after adjustment for age, disease severity (NYHA classification III and IV, low ejection fraction, left ventricular dysfunction during diastole), and infectious conditions there was an inverse association between hs-CRP and neck circumference (ß=-0.196; p=0.03) and subscapularis skinfold (ß=-0.005; p=0.01) in the total sample, which was not maintained after the stratification by sex. CONCLUSION:: Increased levels of hs-CRP in patients hospitalized for heart failure were not associated with obesity. OBJETIVO:: Avaliar a associação entre obesidade e níveis de proteína c-reativa ultrassensível (PCR-us) em pacientes com insuficiência cardiac admitidos em um hospital terciário. MÉTODOS:: Estudo transversal com amostragem consecutiva de pacientes com insuficiência cardíaca hospitalizados. Foram coletados dados sociodemográficos e clínicos, e o estado nutricional foi avaliado por meio de indicadores como índice de massa corporal (em kg/m2), circunferência da cintura (em cm), razão cintura-quadril, dobra cutânea tricipital (em mm) e dobra cutânea subescapular (em mm). Circunferência do pescoço (em cm) foi aferida bem como níveis séricos de PCR-us, em mg/L. RESULTADOS:: Em 123 pacientes, a média da idade foi 61,9±12,3 anos, e 60,2% eram do sexo masculino. A mediana de PCR-us foi de 8,87mg/L (3,34 a 20,01). Detectou-se tendência à correlação inversa entre circunferência do pescoço e PCR-us (r=-0,167; p=0,069). Na análise por regressão linear múltipla, após ajustes para idade, gravidade da doença (classificação NYHA III e IV, fração de ejeção baixa, disfunção ventricular esquerda durante a diástole) e quadros infecciosos, houve associação inversa entre PCR-us e circunferência do pescoço (ß=-0,196; p=0,03) e dobra cutânea subescapular (ß=-0,005; p=0,01) na amostra total, que não se manteve após estratificação para sexo. CONCLUSÃO:: O aumento dos níveis de PCR-us em pacientes hospitalizados por insuficiência cardíaca não se associou à obesidade.

HYPERTRIGLYCERIDEMIC WAIST (EWET), GLYCIDIC AND LIPID PROFILE IN PATIENTS WITH NEWLY DIAGNOSED HEART ATTACK.

INTRODUCTION: hypertriglyceridemic waist phenotype (EWET) has been poorly tested in patients with established cardiovascular disease. OBJECTIVES: to evaluate a possible association between EWET, glycidic and lipid profile in patients with newly diagnosed heart attack (HA). METHODS: cross-sectional study among 45 inpatients with myocardial infarction. Lipid profile (total cholesterol, HDL-c, LDL-c, serum triglycerides, TC/HDL-c ratio, non-HDL cholesterol) and glycidic profile (fasting glucose, serum insulin, glycated hemoglobin, HOMA-IR, glucose/insulin ratio) were obtained. Weight, height and waist circumferences (WC) were assessed; BMI and EWET were calculated. Analysis of Covariance Models (ANCOVA) was used to assess the objectives. RESULTS: mean age of participants was 58.75 ± 12.41 years and 55.6% (n = 25) were men. After adjustment for age, gender and BMI, EWET was significantly associated with lower HDL-c (p = 0.02), higher TC/HDL-c ratio (p = 0.003) and a trend toward fasting glucose (p = 0.11). CONCLUSION: EWET phenotype seems to be associated with a worse lipidic profile in patients with newly diagnosed HA.

Introducción: el fenotipo de la cintura hipertrigliceridémica (CHT) ha sido poco estudiado en pacientes con enfermedad cardiovascular establecida. Objetivos: evaluar la posible asociación entre el CHT, el perfil glicídico y los lípidos en pacientes con nuevo diagnóstico de infarto. Métodos: estudio transversal en 45 pacientes con infarto de miocardio. Se obtuvieron los lípidos (colesterol total, HDL-c, LDL-c, triglicéridos séricos, relación CT/ HDL-c, colesterol no-HDL) y el perfil glicídico (glucosa, insulina sérica, hemoglobina glucosilada, HOMA-IR, relación glucosa/insulina). Fueron evaluados peso, talla y circunferencia de la cintura (CC); se calcularon el IMC y el CHT. Se utilizó el análisis de los modelos de covarianza (ANCOVA) para evaluar los objetivos. Resultados: la media de edad de los participantes fue de 58,75 ± 12,41 años, y el 55,6% (n = 25) eran hombres. Tras ajustar por edad, sexo y el IMC, el CHT se asoció significativamente con una menor HDL-c (p = 0,02), mayor relación CT/HDL-c (p = 0,003) y una tendencia hacia la glucosa en ayunas (p = 0,11). Conclusión: el fenotipo CHT parece estar asociado con un peor perfil lipídico en pacientes con diagnóstico reciente de infarto.

Increased ultrasensitive C-reactive protein is not associated with obesity in hospitalized heart failure patients / Proteína C-reativa ultrassensível não se associa com obesidade em pacientes hospitalizados por insuficiência cardíaca

ABSTRACT Objective: To evaluate the association between obesity and levels of high-sensitivity C-reactive protein (hs-CRP) in patients with heart failure admitted to a tertiary hospital. Methods: Cross-sectional study with a consecutive sampling of hospitalized patients with heart failure. Sociodemographic and clinical data were collected, and the nutritional status was assessed through indicators such as body mass index (in kg/m2), waist circumference (in cm), waist-hip ratio, triceps skinfold (in mm) and subscapularis skinfold (in mm). Neck circumference (in cm) was measured as well as serum levels of hs-CRP, in mg/L. Results: Among 123 patients, the mean age was 61.9±12.3 years and 60.2% were male. The median of hs-CRP was 8.87mg/L (3.34 to 20.01). A tendency to an inverse correlation between neck circumference and hs-CRP was detected (r=-0.167; p=0.069). In the multiple linear regression analysis, after adjustment for age, disease severity (NYHA classification III and IV, low ejection fraction, left ventricular dysfunction during diastole), and infectious conditions there was an inverse association between hs-CRP and neck circumference (ß=-0.196; p=0.03) and subscapularis skinfold (ß=-0.005; p=0.01) in the total sample, which was not maintained after the stratification by sex. Conclusion: Increased levels of hs-CRP in patients hospitalized for heart failure were not associated with obesity.

RESUMO Objetivo: Avaliar a associação entre obesidade e níveis de proteína c-reativa ultrassensível (PCR-us) em pacientes com insuficiência cardiac admitidos em um hospital terciário. Métodos: Estudo transversal com amostragem consecutiva de pacientes com insuficiência cardíaca hospitalizados. Foram coletados dados sociodemográficos e clínicos, e o estado nutricional foi avaliado por meio de indicadores como índice de massa corporal (em kg/m2), circunferência da cintura (em cm), razão cintura-quadril, dobra cutânea tricipital (em mm) e dobra cutânea subescapular (em mm). Circunferência do pescoço (em cm) foi aferida bem como níveis séricos de PCR-us, em mg/L. Resultados: Em 123 pacientes, a média da idade foi 61,9±12,3 anos, e 60,2% eram do sexo masculino. A mediana de PCR-us foi de 8,87mg/L (3,34 a 20,01). Detectou-se tendência à correlação inversa entre circunferência do pescoço e PCR-us (r=-0,167; p=0,069). Na análise por regressão linear múltipla, após ajustes para idade, gravidade da doença (classificação NYHA III e IV, fração de ejeção baixa, disfunção ventricular esquerda durante a diástole) e quadros infecciosos, houve associação inversa entre PCR-us e circunferência do pescoço (ß=-0,196; p=0,03) e dobra cutânea subescapular (ß=-0,005; p=0,01) na amostra total, que não se manteve após estratificação para sexo. Conclusão: O aumento dos níveis de PCR-us em pacientes hospitalizados por insuficiência cardíaca não se associou à obesidade.

Resistência à insulina e indicadores antropométricos em pacientes com sindrome coronariana aguda / Insulin resistance and anthropometric indexes among patients with acute coronary syndrome

Fundamentos: Prevalências de resistência à insulina (RI) são elevadas em pacientes com síndrome coronariana aguda (SCA); entretanto sua associação com indicadores antropométricos específicos e a identificação do melhor parâmetro para detecção de RI nesses pacientes ainda não estão estabelecidos. Objetivos: Determinar a prevalência de RI através de diversos indicadores e correlacioná-los com parâmetros antropométricos em pacientes com SCA. Métodos: Estudo transversal incluindo 28 pacientes. Aferiu-se peso (kg), estatura (m), circunferências da cintura e do quadril e foram calculados índice de massa corporal (IMC), circunferência da cintura (CC), razão cintura-quadril (RCQ), razão cintura-estatura (RCEst) e body adiposity index (BAI). Exames bioquímicos foram obtidos através de prontuário médico e resistência à insulina foi determinada por razão glicose-insulina (RGI), índice HOMA-IR e critério clínico de Stern. Regressão linear múltipla e modelos lineares generalizados foram utilizados para associações. Resultados: As prevalências de resistência à insulina de acordo com os diferentes critérios foram: HOMA-IR 67,9 %; critério clínico 57,1 % e RGI 43,4 %. RCEst, CC e BAI se correlacionaram significativamente com HOMA e RGI. Em relação ao critério clínico de S t e r n , a p e n a s a C C a p r e s e n t o u m é d i a s significativamente diferentes, sendo inferior nos indivíduos classificados com não RI (95,8±9,9 vs. 106,4±12,5, p=0,02). Todos os índices antropométricos se associaram com RI após ajuste para idade, sexo e diagnóstico médico prévio de diabetes mellitus. Conclusões: As prevalências de RI são elevadas em pacientes com SCA independente do critério utilizado; entretanto HOMA-IR parece ser o melhor preditor. Indicadores de obesidade central, assim como BAI, apresentam melhor associação com RI.

Background: The prevalence of insulin resistance (IR) is high among patients with acute coronary syndrome (ACS); its association with specific anthropometric indicators has not been established, nor has the best parameter been identified for detecting IR among these patients. Objectives: To detect the prevalence of IR through assorted indicators and correlate them with anthropometric parameters for patients with ACS. Methods: Cross-sectional study of 28 patients, measuring their weight (kg), height (m), waist (WC) and hip circumferences and calculating their Body Mass Index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and Body Adiposity Index (BAI). Biochemical data were obtained from their medical records and IR was detected by the glucose-insulin ratio (GIR), HOMA-IR index and the Stern clinical criterion. Multiple linear regression and generalized linear models were used for associations. Results: The prevalence of IR based on different criteria was: HOMA-IR 67.9 %; GIR 57.1 % and clinical criteria 43.4 %. The WHtR, WC, and BAI were significantly correlated with HOMA and GIR. With regard to the Stern criterion, only the WC presented significantly different measurements, being lower among individuals classified as non-IR (95.8±9.9 vs. 106.4±12.5, p=0.02). All the anthropometric indexes were associated with IR after adjustments for age, gender and previous medical diagnosis of diabetes mellitus. Conclusions: The prevalence of insulin resistance is high among patients with ACS, regardless of the criteria used; however, HOMA-IR seems to be the best predictor. The central obesity and BAI indicators presented a better association with IR.

Índice tornozelo-braquial para avaliação do risco cardiovascular em hipertensão arterial / Ankle-brachial index for cardiovascular risk assessment in arterial hypertension

As doenças ateroscleróticas constituem a principal causa de mortalidade em todo o mundo. Na prevenção das doenças cardiovasculares, o manejo da hipertensão, diabetes mellitus e dislipidemia é fundamental. A doença arterial periférica é uma importante manifestação de aterosclerose sistêmica e poderosa preditora de futuros eventos cerebrovasculares e cardiovasculares, como infarto do miocárdio e acidente vascular cerebral. Vários estudos sugerem que o índice tornozelo-braquial, uma medida não-invasiva da doença arterial periférica, é altamente preditivo de subseqüente mortalidade e morbidade cardiovasculares em pacientes hipertensos. Um simples marcador de risco cardiovascular pode permitir screening populacional e estratificar pacientes que necessitam de tratamento mais intensivo. O índice tornozelo-braquial é de fácil obtenção, útil para melhorar a estratificação de risco cardiovascular e parece ter um lugar na rotina de avaliação clínica em pacientes hipertensos.