Highlights from the Tenth International Symposium of Thrombosis and Anticoagulation (ISTA X), September 22 and 23, 2017, Salvador, Bahia, Brazil.

To discuss and share knowledge about advances in the care of patients with thrombotic disorders, the Tenth International Symposium of Thrombosis and Anticoagulation was held in Salvador, Bahia, Brazil, on September 22 and 23, 2017. This scientific program was developed by clinicians for clinicians and was promoted by two major clinical research institutes-the Brazilian Clinical Research Institute and the Duke Clinical Research Institute of the Duke University School of Medicine. Comprising academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, thought-leaders, and dedicated clinician-scientists. This paper summarizes the symposium proceedings.

Highlights from the Ninth International Symposium of Thrombosis and Anticoagulation (ISTA IX), October 15, 2016, Salvador, Bahia, Brazil.

To discuss and share knowledge about advances in the care of patients with thrombotic disorders, the Ninth International Symposium of Thrombosis and Anticoagulation was held in Salvador, Bahia, Brazil, on October 15, 2016. This scientific program was developed by clinicians for clinicians and was promoted by two major clinical research institutes-the Brazilian Clinical Research Institute and the Duke Clinical Research Institute of the Duke University School of Medicine. Comprising academic presentations and open discussion, the symposium had as its primary goal to educate, motivate, and inspire internists, cardiologists, hematologists, and other physicians by convening national and international visionaries, thought-leaders, and dedicated clinician-scientists. This paper summarizes the symposium proceedings.

Lipoprotein metabolism in patients with type 1 diabetes under intensive insulin treatment.

BACKGROUND: Type 1 diabetes (T1DM) is frequently accompanied by dyslipidemia related with insulin-dependent steps of the intravascular lipoprotein metabolism. T1DM dyslipidemia may predispose to precocious cardiovascular disease and the lipid status in T1DM under intensive insulin treatment has not been sufficiently explored. The aim was to investigate the plasma lipids and the metabolism of LDL and HDL in insulin-treated T1DM patients with high glycemic levels. METHODS: Sixteen male patients with T1DM (26 ± 7 yrs) with glycated hemoglobin >7%, and 15 control subjects (28 ± 6 yrs) were injected with a lipid nanoemulsion (LDE) resembling LDL and labeled with (14)C-cholesteryl ester and (3)H-free-cholesterol for determination of fractional clearance rates (FCR, in h-1) and cholesterol esterification kinetics. Transfer of labeled lipids from LDE to HDL was assayed in vitro. RESULTS: LDL-cholesterol (83 ± 15 vs 100 ± 29 mg/dl, p=0.08) tended to be lower in T1DM than in controls; HDL-cholesterol and triglycerides were equal. LDE marker 14C-cholesteryl ester was removed faster from plasma in T1DM patients than in controls (FCR=0.059 ± 0.022 vs 0.039 ± 0.022h-1, p=0.019), which may account for their lower LDL-cholesterol levels. Cholesterol esterification kinetics and transfer of non-esterified and esterified cholesterol, phospholipids and triglycerides from LDE to HDL were also equal. CONCLUSION: T1DM patients under intensive insulin treatment but with poor glycemic control had lower LDL-cholesterol with higher LDE plasma clearance, indicating that LDL plasma removal was even more efficient than in controls. Furthermore, HDL-cholesterol and triglycerides, cholesterol esterification and transfer of lipids to HDL, an important step in reverse cholesterol transport, were all normal. Coexistence of high glycemia levels with normal intravascular lipid metabolism may be related to differences in exogenous insulin bioavailabity and different insulin mechanisms of action on glucose and lipids. Those findings may have important implications for prevention of macrovascular disease by intensive insulin treatment.

Heart failure survival score in patients with Chagas disease: correlation with functional variables.

INTRODUCTION AND OBJECTIVES: Chagas disease is a prevalent cause of heart failure in Latin America, and its prognosis is worse than other etiologies. The Heart Failure Survival Score has been used to assess prognosis in patients with heart failure; however, this score has not yet been studied in patients with Chagas cardiopathy. METHODS: The Heart Failure Survival Score was calculated in 55 patients with severe left ventricular systolic dysfunction due to Chagas disease. Correlations were assessed between the Heart Failure Survival Score and variables obtained from, cardiopulmonary exercise tests, quality-of-life measures, and 6-minute walking tests. RESULTS: Patients were distributed among New York Heart Association classes II-IV; 89% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 62% were taking beta-blockers, 86% were taking diuretics, and 74% were taking aldosterone receptor blockers. The mean Heart Failure Survival Score was 8.75 (0.80). The score correlated well with cardiopulmonary test variables such as peak oxygen uptake (0.662; P<.01), oxygen uptake at the anaerobic threshold (0.644; P<.01), ventilation carbon dioxide efficiency slope (-0.417; P<.01), oxygen pulse (0.375; P<.01), oxygen uptake efficiency slope (0.626; P<.01), 6-minute walking test (0.370; P<.01), left ventricle ejection fraction (0.650; P=.01), and left atrium diameter (-0.377; P<.01). There was also a borderline significant correlation between the Heart Failure Survival Score and quality of life (-0.283; P<.05). CONCLUSIONS: In heart failure patients with Chagas disease, the Heart Failure Survival Score correlated well with the main prognostic functional test variables.

Puntuación Heart Failure Survival Score en pacientes con enfermedad de Chagas: correlación con variables funcionales / Heart failure survival score in patients with chagas disease: correlation with functional variables

Introducción y objetivos. La enfermedad de Chagas es una causa frecuente de insuficiencia cardiaca en Latinoamérica, y su pronóstico es peor que el de otras etiologías. La puntuación de supervivencia en la insuficiencia cardiaca (Heart Failure Survival Score) se ha utilizado para evaluar el pronóstico de los pacientes con insuficiencia cardiaca; sin embargo, dicha puntuación no se ha evaluado todavía en pacientes con cardiopatía chagásica. Métodos. Se calculó la puntuación Heart Failure Survival Score en 55 pacientes con disfunción sistólica ventricular izquierda grave debida a enfermedad de Chagas. Se evaluaron las correlaciones entre la Heart Failure Survival Score y las variables derivadas de las ecocardiografías, las pruebas de esfuerzo cardiorrespiratorias, las medidas de la calidad de vida y las pruebas de distancia recorrida en 6 min. Resultados. Se distribuyó a los pacientes según las clases II-IV de la New York Heart Association; un 89% recibía tratamiento con inhibidores de la enzima de conversión de la angiotensina o antagonistas de los receptores de la angiotensina II; un 62%, con bloqueadores beta; un 86%, con diuréticos y un 74%, con antagonistas de los receptores de aldosterona. La media de la puntuación Heart Failure Survival Score fue de 8,75±0,80. La puntuación mostró buena correlación con las variables derivadas de la prueba cardiorrespiratoria, como la captación de oxígeno máxima (0,662; p<0,01), la captación de oxígeno en el umbral anaeróbico (0,644; p<0,01), la pendiente de eficiencia ventilatoria de dióxido de carbono (-0,417; p<0,01), el pulso de oxígeno (0,375; p<0,01), la pendiente de eficiencia de captación de oxígeno (0,626; p<0,01), la prueba de distancia recorrida en 6 min (0,370; p<0,01), la fracción de eyección ventricular izquierda (0,650; p=0,01) y el diámetro de la aurícula izquierda (-0,377; p<0,01). Se observó también una correlación en el límite de la significación estadística entre la puntuación Heart Failure Survival Score y la calidad de vida (-0,283; p<0,05). Conclusiones. En pacientes con enfermedad de Chagas que presentaban insuficiencia cardiaca, la puntuación Heart Failure Survival Score mostró buena correlación con las principales variables de las pruebas funcionales pronósticas (AU)

Introduction and objectives. Chagas disease is a prevalent cause of heart failure in Latin America, and its prognosis is worse than other etiologies. The Heart Failure Survival Score has been used to assess prognosis in patients with heart failure; however, this score has not yet been studied in patients with Chagas cardiopathy. Methods. The Heart Failure Survival Score was calculated in 55 patients with severe left ventricular systolic dysfunction due to Chagas disease. Correlations were assessed between the Heart Failure Survival Score and variables obtained from echocardiograms, cardiopulmonary exercise tests, quality-of-life measures, and 6-minute walking tests. Results. Patients were distributed among New York Heart Association classes II-IV; 89% were taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, 62% were taking beta-blockers, 86% were taking diuretics, and 74% were taking aldosterone receptor blockers. The mean Heart Failure Survival Score was 8.75 (0.80). The score correlated well with cardiopulmonary test variables such as peak oxygen uptake (0.662; P<.01), oxygen uptake at the anaerobic threshold (0.644; P<.01), ventilation carbon dioxide efficiency slope (−0.417; P<.01), oxygen pulse (0.375; P<.01), oxygen uptake efficiency slope (0.626; P<.01), 6-minute walking test (0.370; P<.01), left ventricle ejection fraction (0.650; P=.01), and left atrium diameter (−0.377; P<.01). There was also a borderline significant correlation between the Heart Failure Survival Score and quality of life (−0.283; P<.05). Conclusions. In heart failure patients with Chagas disease, the Heart Failure Survival Score correlated well with the main prognostic functional test variables (AU)