Cardiovascular Benefits of GLP-1 Receptor Agonists in Patients Living with Obesity or Overweight: A Meta-analysis of Randomized Controlled Trials.

BACKGROUND: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD - 4.76 mmHg; 95% CI - 6.03, - 3.50; p < 0.001; I2 = 100%) and diastolic blood pressure (MD - 1.41 mmHg; 95% CI - 2.64, - 0.17; p = 0.03; I2 = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; p < 0.001; I2 = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; p = 0.16; I2 = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; p = 0.38; I2 = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; p = 0.19; I2 = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; p = 0.13; I2 = 0%). CONCLUSIONS: In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis. REGISTRATION: PROSPERO identifier number CRD42023475226.

Intracardiac echography-guided fluoroless ablation versus conventional fluoroscopy-guided ablation for cardiac arrhythmias: a systematic review and meta-analysis

BACKGROUND: Intracardiac echocardiography (ICE) has improved catheter ablation procedures, reducing reliance on fluoroscopy. Yet, the efficacy and safety of zero-fluoroscopy (ZF) procedures remain uncertain. METHODS: We conducted a systematic review and meta-analysis comparing ZF ablation procedures guided by ICE vs. conventional techniques regarding efficacy and safety outcomes. PubMed, Cochrane, and embase were searched. A random-effects model was used to calculate risk ratios (RRs), odds ratios (OR) and mean differences (MDs) with 95% confidence intervals (CI). RESULTS: We includedfourteen studies with 1,919 patients of whom 1,023 (58.72%) performed ZF ablation using ICE. We found a significant reduced ablation time (SMD -0.18; 95% CI -0.31;-0.04; p=0.009), procedure time (MD -7.54; 95% CI -14.68;-0.41; p=0.04), fluoroscopic time (MD -2.52; 95% CI -3.20;-1.84; p<0.001) in patients treated with ZF approach compared with NZF approach. However, there was no significant difference between the two groups in acute success rate (RR 1.00; 95% CI 0.99-1.01; p=0.85), long-term success rate (RR 0.99; 95% CI 0.93-1.05; p=0.77) and complications (RR 0.84, 95% CI: 0.48-1.46; p = 0.54). CONCLUSION: Our findings suggest that among patients undergoing arrhythmia ablation, fluoroscopy-free ICE-guided technique reduces procedure time and radiation exposure with comparable short and long-term success rates and complications.

Cardiovascular benefits of GLP-1 receptor agonists in patients who are obese or overweight: a meta-analysis of randomized controlled

Backgroun|D: GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in cardiovascular endpoints among patients who are obese or overweight requires additional investigation. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs vs. placebo in patients who are obese or overweight. PubMed, Cochrane, and Embase were searched. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). RESULTS: A total of 12 RCTs were included, with 12,908 patients. Compared with placebo, GLP-1 RAs were associated with significant reductions in systolic blood pressure (MD -4.45 mmHg; 95% CI -5.31, -3.60; p<0.01) and diastolic blood pressure (MD -1.43 mmHg; 95% CI -2.63, -0.22; p=0.02). There were no significant differences between groups for unstable angina (UA) (RR 0.90; 95% CI 0.29-2.84; p=0.86), stroke (RR 0.65; 95% CI 0.28-1.49; p=0.30), atrial fibrillation (AF) (RR 0.87; 95% CI 0.33-2.30; p=0.78), myocardial infarction (MI) (RR 0.57; 95% CI 0.17-1.90; p=0.36), or deep vein thrombosis (RR 0.45; 95% CI 0.08-2.65; p=0.38). CONCLUSION: In patients who are overweight or obese, GLP-1 receptor agonists reduce systolic and diastolic blood pressure, with a neutral effect on the incidence of UA, stroke, AF, MI, and deep vein thrombosis.

Cardiovascular impact of cancer in patients with atrial fibrillation on warfarin: a systematic review and meta-analysis

BACKGROUND: The impact of cancer on patients with atrial fibrillation (AF) on warfarin remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis exploring the effect of cancer in patients with AF on warfarin. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Five trials comprising 90,572 patients were included, of whom 12,239 (13.5%) had a personal history of cancer. The patient population had an average age of 72.7 years and 59.6% were male. A history of cancer was associated with a significant increase in any bleeding (RR 1.33; 95% CI 1.15- 1.53; p<0.01). There were no significant differences between groups for stroke (RR 1.05; 95% CI 0.86- 1.29; p=0.61), major bleeding (RR 1.44; 95% CI 0.95-2.18; p=0.09), cardiovascular (CV) death (RR 0.91; 95% CI 0.59-1.41; p=0.67), myocardial infarction (MI) (RR 1.42; 95% CI 0.96-2.10; p=0.08), gastrointestinal (GI) bleeding (RR 1.74; 95% CI 0.77-3.92; p=0.18), or all-cause death (RR 1.57; 95% CI 0.99-2.49; p=0.06). CONCLUSION: Among patients with AF on warfarin, a history of cancer is associated with an increased risk of any bleeding, with no significant effect on stroke, major bleeding, CV death, MI, GI bleeding, and all-cause death.

Complete versus culprit-only revascularization for older adults with acute coronary syndromes: a meta-analysis and systematic review

BACKGROUND: Randomized studies support complete over culprit-only revascularization for patients with acute coronary syndrome (ACS) However,whether these findings extend to elderly patients has not been thoroughly explored. METHODS: We conducted a systematic review and meta-analysis comparing clinical outcomes of elderly individuals (defined as age > 75 years) with ACS and multivessel coronary artery disease submitted to complete vs. culprit-only percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane were searched. We computed pooled hazard ratios (HRs) with 95% confidence intervals (CI) to preserve time-to-event data RESULTS: We included 7 studies, of which 2 were randomized controlled trials (RCTs), comprising 7,409 patients, of whom 3225 (43.5%) underwent complete revascularization. As compared with culprit lesion only PCI, complete revascularization was associated with a lower risk of all-cause mortality (HR 0.76; 95% CI 0.68-0.85; p<0.001), cardiovascular mortality (HR 0.67; 95% CI 0.54-0.82; p<0.001), and recurrent myocardial infarction (MI) (HR 0.65; 95% CI 0.50-0.85; p=0.002). There was no significant difference between the groups regarding the risk of recurrent revascularizations (HR 0.79; 95% CI 0.54-1.16; p=0.23). CONCLUSION: Among elderly patients with ACS and multivessel CAD, complete revascularization is associated with a lower risk of all-cause mortality, cardiovascular mortality, and recurrent MI.

Cardioneuroablation for reflex syncope: a systematic review and single-arm meta-analysis

BACKGROUND: Reflex syncope reduces quality of life and leads to fall-related injuries, with no highly effective treatment. In this context, cardioneuroablation (CNA) presents as a promising therapy for these patients. METHODS: We searched PubMed, Embase and Cochrane Central for studies that evaluated safety and efficacy outcomes related to CNA procedures. Two reviewers independently performed study selection, data extraction and assessment of bias. Generalized linear mixed models was used. We performed a single-arm meta-analysis using R version 4.2.3. RESULTS: A total of 25 studies comprising 871 patients were included. The mean follow-up ranged from 8 to 40 months. Mean age ranged from 32.9 to 53.9 years and 541 (62.1%) were female. The ablation target was biatrial in 302 patients (34%), left atrium only in 433 (49%), and right atrium only in 136 (15%). The freedom from syncope was 94% (95% confidence interval (CI) 90.13-97.00; P<0.01). Left and right atrial CNA was associated with a significant higher freedom from syncope (96.03%; 95% CI 93.13-97.73) than left atrial ablation only (94.61%; 95% CI 82.88-98.45) and right ablation only (84.53%; 95% CI 74.30-91.18). Peri-procedural adverse event occurred on 1.4% (95% CI 0.44- 4.50). CONCLUSION: Our findings suggest that in patients with reflex syncope, CNA is a procedure associated with a significant reduction in syncope incidence and with low complication rates. Among the procedures used, both right and left ablation were more effective.

Cardiac myosin inhibitors in obstructive hypertrophic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Selective cardiac myosin inhibitors (CMI) are promising therapies for obstructive hypertrophic cardiomyopathy (HCM). Yet, the extent of their benefits remains unclear due to the limited population studied. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CMI vs. placebo in patients with obstructive HCM. PubMed, Cochrane, and embase were searched. We calculated risk ratios (RRs), mean differences (MDs) and standardized mean differences (SMDs) with 95% confidence intervals (CI). RESULTS: Four RCTs with 485 patients with obstructive HCM were included, of whom 261 (53.8%) were prescribed CMI (10.7% were aficamten and 89.3% were mavacamten). CMI significantly reduced resting left ventricular outflow tract (LVOT) gradient (SMD -1.4, 95% CI -1.6,-1.2, p<0.001), but also reduced left ventricular ejection fraction (LVEF) (MD -5.1%, 95% CI -7.6,-2.6, p<0,001). Patients receiving CMI had a higher rate of study-defined complete hemodynamic response (RR 16.8, CI 95% 5.5, 51.4, p<0,001; Figure 1A) with a number needed to treat (NNT) of 8; and improvement of at least one point in NYHA functional class (RR 2.29, CI 95% 1.8,2.9, p<0,001; Figure 1B). Conclusion: In this meta-analysis of RCTs including patients with obstructive HCM, CMI led to a significant reduction in LVOT gradient and symptomatic improvement. The NNT to achieve one complete hemodynamic response was 8. There was a significant, albeit modest, decrease in LVEF in the CMI group.

Effects of anabolic androgenic steroids in athletes on left ventricle systolic and diastolic function: a systematic review and meta-analysis

BACKGROUND: The use of anabolic androgenic steroids (AAS) among athletes has been linked to pathological structural and functional cardiac changes. However, the studies are small, and the results are inconsistent. METHODS: We conducted a systematic review and meta-analysis of echocardiographic outcomes comparing athletes with prolonged use of AAS (at least 2 years of use) versus sex and age- matched athletes who were did not use AAS. PubMed, Cochrane, and embase were searched. A random-effects model was used to calculate mean differences (MDs), with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1. RESULTS: We included 17 studies comprising 1,023 athletes, of whom 543 (53%) were AAS users. The mean age ranged to 24.2 to 43 years. Compared with non-AAS users, athletes who used AAS exhibited a significant increase in interventricular septal wall thickness (MD 1.33 mm; 95% CI [0.8,1.89], p<0.001), a reduction in left ventricular ejection fraction (MD 2.77 %; 95% CI [-4.2,-1.34], p<0.001;Figure 1B) , and worsening of global longitudinal strain (MD 3.39%; 95% CI [2.88,3.91], p<0.001;Figure 1B). Additionally, there was a significant reduction in the E/A ratio (MD -0.21; 95% CI [-0.35,-0.07], p=0.003) and an increase in the E/e' ratio (MD 1.71; 95% CI [0.96,2.46], p<0.001). CONCLUSION: Our findings suggest that prolonged use of AAS in athletes is associated with increased left ventricular wall thickness and worsening of systolic and diastolic parameters.

Venoarterial extracorporeal membrane oxygenation versus impella for cardiogenic shock in acute myocardial infarction: a systematic review and meta-analysis

BACKGROUND: Acute myocardial infarction (AMI) is an important cause of cardiogenic shock (CS). There is lack of evidence regarding the safety and efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) compared with Impella in this population. METHODS: We systematically searched PubMed, EMBASE, and Cochrane Library for studies comparing VA-ECMO with Impella in patients with CS related to AMI. The systematic review and meta-analysis followed Cochrane recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used R version 4.3.1 for all statistical analyses. Odds ratios (OR) and 95% confidence intervals (CI) were pooled with a random-effects model. RESULTS: We included seven observational studies with 15.903 patients, of whom 12.943 (81.3%) were treated with Impella. There was no significant difference between groups regarding in-hospital mortality (OR 0.79; 95% CI 0.37-1.69; p=0.54; Figure 1A), ischemic stroke (OR 0.69; 95% CI 0.14-3.35; p=0.64; Figure 1B), acute kidney injury (OR 1.22; 95% CI 0.55-2.70; p=0.62), renal replacement therapy or dialysis (OR 1.02; 95% CI 0.33-3.19; p=0.97; Figure 1C), and blood transfusion (OR 0.52; 95% CI 0.16-1.72; p=0.28). CONCLUSION: In this meta-analysis, there was no significant difference between VA-ECMO and Impella among patients with CS and AMI for the outcomes of in-hospital mortality, ischemic stroke, acute kidney injury, renal replacement therapy, or blood transfusion.

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

BACKGROUND: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. Random-effects model was used to calculate the risk ratios (RRs), with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: Six RCTs comprising 20,574 patients with ACS were included, of whom 10,259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (RR 0.93; 95% CI 0.90-0.97; p<0.01) and non-fatal myocardial infarction (RR 0.88; 95% CI 0.81-0.95; p<0.01). There was no significant difference between groups for revascularization (RR 0.94; 95% CI 0.88-1.01; p=0.07), all-cause death (RR 0.87; 95% CI 0.63-1.21; p=0.42), or unstable angina (RR 1.05; 95% CI 0.86-1.27; p=0.64). CONCLUSION: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and non-fatal myocardial infarction, compared with statin monotherapy.

Cardiovascular impact of cancer in patients with atrial fibrillation on direct oral anticoagulants: a systematic review and meta-analysis

BACKGROUND: The impact of cancer on patients with atrial fibrillation (AF) on direct oral anticoagulants (DOACs) remains a matter of debate. METHODS: We conducted a systematic review and meta-analysis exploring the effect of personal history of cancer in patients with AF on DOACs. PubMed, Embase, and Cochrane databases were searched for relevant studies. We used the random-effects model to calculate the risk ratio (RR) and 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3. RESULTS: A total of six studies were included, with 63,177 patients. The mean age was 74.0 years. In this population of individuals who had AF and took DOACs, a history of cancer was associated with a significant increase in major bleeding (RR 1.72; 95% CI 1.24-2.38; p<0.01), gastrointestinal (GI) bleeding (RR 2.11; 95% CI 1.25-3.57; p<0.01), and any bleeding (RR 1.54; 95% CI 1.39-1.70; p<0.01). Additionally, all-cause death was significantly higher in patients with AF and a history of cancer (RR 1.93; 95% CI 1.35-2.76; p<0.01). There was no significant difference between groups in stroke (RR 1.77; 95% CI 0.66-4.73; p=0.25), cardiovascular (CV) death (RR 0.84; 95% CI 0.57-1.23; p=0.36), or myocardial infarction (MI) (RR 1.21; 95% CI 0.82-1.79; p=0.34). CONCLUSION: Our findings suggest that major bleeding, GI bleeding, any bleeding, and all-cause mortality significantly increased in patients with AF on DOACs who have a personal history of cancer, as compared with those who do not.

Raríssimo caso de pericardite constritiva: sangramento pericárdico póstraumático por causa inusitada / Very rare case of constrictive pericarditis: post-traumatic pericardial bleeding due to an unusual cause

INTRODUÇÃO: Há poucos relatos na literatura relacionando pericardite constritiva a trauma torácico fechado, com a maior parte associado ao trauma da pericardiectomia cirúrgica. CASO: Paciente do sexo masculino, 69 anos, tabagista, hígido, apresenta dispneia e sinais de insuficiência cardíaca direita. Foi realizado ecocardiograma com evidência de massa adjacente ao ventrículo direito (VD), de difícil caracterização, causando compressão extrínseca com diminuição da distensibilidade do VD, além de áreas de intensa calcificação pericárdica com distribuição desigual (parede livre de VD, segmento basal da parede lateral de VE, parede inferior do VE) e padrão hemodinâmico de constrição. Realizada tomografia de tórax que evidenciou calcificações pericárdicas, com imagem de "pseudotumor" adjacente ao VD com contorno irregular, calcificação intensa e conteúdo heterogêneo. Submetido a pericardiectomia e ressecção do tumor, com observação intraoperatória de intensa calcificação pericárdica. Em seguimento, paciente referiu trauma torácico fechado há 10 anos por contusão com bovino. Foi descartado tuberculose, neoplasias e doença reumatológica. Em ausência de outra etiologia plausível, assumiu-se o hemopericárdico por contusão cardíaca como causa provável de pericardite constritiva. CONCLUSÃO: Neste caso, destacam-se intensa calcificação pericárdica com efeito de massa compressiva adjacente ao VD e sua distribuição heterogênea, podendo corresponder a distribuição pós-traumática do sangramento. Em conclusão, é crucial expandir a compreensão das causas de pericardite constritiva, especialmente considerando possibilidade de ocorrência subestimada de pericardite constritiva crônica por hemopericárdio associada a trauma por animais, considerando vasta população de trabalhadores rurais no Brasil.

Evolução intra-hospitalar e tardia após primeiro infarto agudo do miocárdio: um estudo de mundo real comparando coortes de mulheres e homens no brasil, na rede colaborativa trinetx / In-hospital and late evolution after the first acute myocardial infarction: a real world study comparing cohorts of women and men in brazil, in the trinetx collaborative network

INTRODUÇÃO: Diversos estudos demonstram piores desfechos em mulheres após infarto agudo do miocárdio (IAM) quando comparados ao sexo masculino, mesmo após ajuste para covariáveis. As justificativas para essa desigualdade não são bem esclarecidas. Um fator inegável é a baixa representatividade feminina nos estudos clínicos randomizados e observacionais, e a consequente lacuna no conhecimento sobre as particularidades nessa população. No Brasil, apenas um registro comparou coortes de homens e mulheres após internação por síndrome coronariana aguda, com resultados conflitantes em relação à literatura global, mais extensa e robusta. OBJETIVO: Comparar, com base em dados de mundo real, a ocorrência de eventos cardiovasculares (ECV) entre mulheres e homensinternados por primeiro IAM em hospitais brasileiros. MÉTODOS: Estudo de coorte retrospectivo, com dados extraídos da plataforma global TriNetX, alimentada por prontuários eletrônicos de 13 instituições brasileiras, incluindo pacientes de ambos os sexos com diagnóstico confirmado de IAM pela classificação internacional de doenças (CID) versão 11, código I21. O desfecho primário avaliado foi o composto de óbito, choque cardiogênico (CC), edema agudo pulmonar, e parada cardiorrespiratória (PCR) ressuscitada durante internação hospitalar. Os desfechossecundários avaliados foram óbito, insuficiência cardíaca (ICC), ou hospitalização por novo IAM após 5 anos da alta hospitalar. Resultados plotados em Odds Ratio (OR) com intervalo de confiança (IC) de 95%, e teste de significância em 5%, e curvas de Kaplan-Meier com teste de log-rank para significância (Figura). Análise sobre procedimentos de revascularização miocárdica e ajuste após pareamento por escore de propensão serão apresentados a posteriori. RESULTADOS: O estudo incluiu 11.605 pacientes, com 7.442 homens (64,1%) e 4.163 (35,9%) mulheres. O desfecho primário ocorreu em 439 homens (5,9%) e 307 mulheres (7,4%). O sexo masculino foi associado à menor ocorrência do desfecho primário em relação ao feminino [OR 0,8 (0,68-0,92), p=0.02]. Após 5 anos, 435 homens (5,8%) e 309 mulheres (7,4%) apresentaram ICC [OR 0,77 (0,66-0,90), p=0.001], e 1.007 homens (13,5%) e 520 mulheres (12,5%) apresentaram novo IAM [OR 1,096 (0,98-1,23), p=0.112]. CONCLUSÕES: Nesta coorte brasileira de IAM, o sexo feminino foi associado à maior ocorrência de ECV (óbito, CC, edema agudo pulmonar e PCR ressuscitada) durante internação hospitalar e menor sobrevida livre de ECV após 5 anos do primeiro evento.

The importance of a close follow up for athletes with congenital third degree block

Congenital third degree block (CHB) is a relative rare disorder. The manifestations of CHB can vary according to many aspects, including ventricular rate of the escape rhythm and ventricular function. The main therapeutic decision is the need for and the ideal timing of permanent pacemaker insertion. Patients with adequate ventricular heart rate increasing appropriately during exertion and no symptoms such as syncope or near syncope and a structurally normal heart and cardiac function can usually be followed without intervention, and therefore, they can selectively participate in competitive sports. Although, this is not a permanent recommendation, and these patients should be followed closely. Case report: 13-year-old asymptomatic male patient, with a previous diagnosis of CHB, who practices competitive soccer, in yearly follow up at the sports cardiology outpatient clinic, who presented a normal echocardiography, without structural alterations, normal Left Ventricle (LV) dimensions, a Left Ventricle End Diastolic Diameter (LVEDD) of 48 mm, and preserved LV function. His exercise test showed an excellent functional capacity (15 METS) despite a chronotropic insufficiency. However, on the 2021 clinical evaluation, he presented a significant worsening of the tests results, although remained asymptomatic. The new echocardiography presented LV dilatation with a LVEDD of 63 mm, but with preserved ejection fraction. The exercise test showed a worse functional capacity of 11 METS and chronotropic deficit. Therefore, it was indicated the insertion of a pacemaker. New tests were performed two months after the procedure. The echocardiography showed normal LV dimensions (LVEDD: 46 mm). At the cardiopulmonary exercise test, the patient reached 103% of the predicted VO2, showing a normal functional capacity. Although all these improvements, the practice of soccer was contraindicated due to the high risk of thoracic trauma. Nevertheless, the patient still may participate of other competitive and high intensity activities with low risk of lead dislocation and thoracic trauma. In CONCLUSION, the CHB is not a prohibitive condition of high intensity sports, as long as the patient remains without structural cardiac alterations, normal LV function, asymptomatic and with a normal functional capacity. However, these conditions can change in a relative short period, so the follow up must be done closely.

Derrame pericárdico após Covid 19 ­ sempre miopericardite? / Pericardial effusion after Covid 19 ­ always myopericarditis?

RELATO DE CASO: Paciente 44 anos, sexo feminino com história de COVID-19 há 4 meses, inicialmente com sintomas leves e sem necessidade de internação hospitalar. Há cerca de 6 semanas após resolução de quadro, apresentou dispneia progressiva a esforços, tendo sido diagnosticada com tromboembolismo pulmonar após angiotomografia de tórax e iniciada anticoagulação. À admissão em Pronto-Socorro de hospital terciário, apresentava-se dispneica, com turgência jugular e hipofonese de bulhas. Ecocardiograma na urgência confirmou a presença de derrame pericárdico importante com comprometimento hemodinâmico, tendo sido corroborado diagnóstico de tamponamento cardíaco. Foi realizada pericardiocentese e estabilização clínica. Após, prosseguida investigação diagnóstica com ressonância magnética (RM) que evidenciou miocardiopatia restritiva com padrão de endomiocardiofibrose. DISCUSSÃO: Ainda que no último ano tenha sido frequente o relato de casos de miopericardite, inclusive com ocorrência de derrame pericárdico, relacionados à infecção pelo Sars-Cov2, é necessário reforçar a importância da perseguição diagnóstica em casos de insuficiência cardíaca e/ou derrames cavitários recém-descobertos. A utilização de adequados métodos complementares, como o ecocardiograma transtorácico e a RM permitem o estabelecimento de diagnóstico etiológico adequado de endomiocardiofibrose, corroborando para seguimento e tratamento dos pacientes portadores desta entidade clínica.

Trombose coronariana em paciente jovem levando a disfunção cardíaca grave apesar de tripla terapia antitrombótica / Coronary thrombosis in a young patient leading to severe cardiac dysfunction despite triple antithrombotic therapy

A COVID-19 é amplamente conhecida pelo comprometimento pulmonar bilateral severo. No entanto é, de fato, uma doença multissistêmica, inflamatória e pró-coagulante, com espectro diverso de apresentação clínica e que não se limita ao acometimento grave de pacientes idosos e com múltiplas comorbidades. Apresentamos um caso de IAMCSST por trombose coronariana em paciente jovem levando a disfunção cardíaca importante apesar uso de tripla terapia antitrombótica. Paciente masculino 28 anos, hipertenso, com história de infecção por COVID-19. Duas semanas após diagnóstico, procurou Pronto-Socorro com quadro de dor torácica anginosa com diagnóstico de IAM com supradesnivelamento de segmento ST em parede anterior e apical. Na ocasião paciente foi submetido a cateterismo coronariano que evidenciou oclusão total da artéria descendente anterior (ADA), com sinais alta carga trombótica e ventriculografia demonstrando disfunção ventricular grave. Realizado tentativa de angioplastia, sem sucesso. Após, realizado ressonância magnética que confirmou miocardiopatia isquêmica com fração e ejeção do ventrículo esquerdo de 16%. O paciente recebeu alta hospitalar com prescrição de NOAC, AAS, clopidogrel e terapia medicamentosa para insuficiência cardíaca. Após, repetido o estudo coronariano com manutenção de achados anteriores. Contudo, como persistia com angina CCS2 e dispneia CF III, foi encaminhado a hospital terciário para nova tentativa de intervenção percutânea e, nesse momento, obtido sucesso ­ realizada aspiração de trombo e angioplastia com stent farmacológico de lesão segmentar grave de ADA que se estendia do óstio ao terço médio, com resultado fluxo lento TIMI 2. Paciente recebeu alta hospitalar em uso de dupla antiagregação, otimização de terapia de IC e plano de seguimento ambulatorial em equipe de transplante cardíaco.