Prevalence and Related Characteristics of Patients with Brugada Pattern Electrocardiogram in Santa Catarina, Brazil. / Prevalência e Características Relacionadas de Pacientes com Eletrocardiograma com Padrão de Brugada em Santa Catarina, Brasil.

BACKGROUND: Brugada Syndrome is an inherited arrhythmogenic disorder characterized by the presence of specific electrocardiographic features with or without clinical symptoms. The patients present increased risk of sudden death due to ventricular fibrillation. The prevalence of this electrocardiographic pattern differs according to the studied region. However, epidemiological information including the Brazilian population is scarce. OBJECTIVES: To assess the prevalence of the electrocardiographic pattern of Brugada syndrome and the epidemiological profile associated with it. METHODS: Cross-sectional study that included 846,533 ECG records of 716,973 patients from the electrocardiogram (ECG) database from the Santa Catarina Telemedicine Network over a 4-year period. All tests were 12-lead conventional ECG (without V1 and V2 in high positions). The tests revealing "Brugada Syndrome" diagnosis (Types 1 and 2) were reviewed by a cardiac electrophysiologist. The level of significance was set at p<0.05. RESULTS: In total, 83 patients had a pattern potentially consistent with Brugada-type pattern ECG. Of these, 33 were confirmed having Brugada-type 1, and 22 with type 2 ECG after reevaluation. The prevalence of Brugada-type 1 ECG was 4.6 per 100,000 patients. Brugada-type 1 ECG was associated with the male gender (81.8% vs. 41.5%, p<0.001) and a lower prevalence of obesity diagnosis (9.1% vs. 26.4%, p=0.028). CONCLUSIONS: This study showed low prevalence of Brugada-type ECG in Southern Brazil. The presence of Brugada-type 1 ECG was associated with the male gender and lower prevalence of obesity diagnosis comparing to the general population.

FUNDAMENTO: A síndrome de Brugada é um distúrbio arritmogênico hereditário caracterizado pela presença de características eletrocardiográficas específicas com ou sem sintomas. Os pacientes apresentam risco aumentado de morte súbita por fibrilação ventricular. A prevalência desse padrão eletrocardiográfico difere de acordo com a região estudada. Porém, informações epidemiológicas, incluindo a população brasileira, são escassas. OBJETIVO: Avaliar a prevalência do padrão eletrocardiográfico da síndrome de Brugada e o perfil epidemiológico associado a ela. MÉTODOS: Estudo transversal que incluiu 846.533 registros ECG de 716.973 pacientes do banco de dados de eletrocardiograma (ECG) da Rede de Telemedicina de Santa Catarina por um período de quatro anos. Todos os exames foram ECG de 12 derivações convencionais (sem V1 e V2 em posições altas). Os exames identificados com o diagnóstico de "Síndrome de Brugada" (tipos 1 e 2) foram revisados por um eletrofisiologista. Foram considerados significativos valores de p<0,05. RESULTADOS: Apresentavam padrão potencialmente consistente com ECG do tipo Brugada 83 pacientes. Destes, 33 foram confirmados com padrão de Brugada tipo 1, e 22 com tipo 2, após reavaliação. A prevalência de ECG do tipo 1 de Brugada foi de 4,6 por 100.000 pacientes. O ECG do tipo Brugada 1 foi associado ao sexo masculino (81,8% vs. 41,5%, p<0,001) e menor prevalência de obesidade (9,1% vs. 26,4%, p=0,028). CONCLUSÕES: Este estudo mostrou baixa prevalência de ECG do tipo Brugada no sul do Brasil. A presença de ECG com padrão Brugada tipo 1 esteve associada ao sexo masculino e menor prevalência de obesidade que a população geral.

Prevalência e características relacionadas de pacientes com eletrocardiograma com padrão de brugada em Santa Catarina, Brasil / Prevalence and related characteristics of patients with brugada pattern electrocardiogram in Santa Catarina, Brazil

Resumo Fundamento: A síndrome de Brugada é um distúrbio arritmogênico hereditário caracterizado pela presença de características eletrocardiográficas específicas com ou sem sintomas. Os pacientes apresentam risco aumentado de morte súbita por fibrilação ventricular. A prevalência desse padrão eletrocardiográfico difere de acordo com a região estudada. Porém, informações epidemiológicas, incluindo a população brasileira, são escassas. Objetivo: Avaliar a prevalência do padrão eletrocardiográfico da síndrome de Brugada e o perfil epidemiológico associado a ela. Métodos: Estudo transversal que incluiu 846.533 registros ECG de 716.973 pacientes do banco de dados de eletrocardiograma (ECG) da Rede de Telemedicina de Santa Catarina por um período de quatro anos. Todos os exames foram ECG de 12 derivações convencionais (sem V1 e V2 em posições altas). Os exames identificados com o diagnóstico de "Síndrome de Brugada" (tipos 1 e 2) foram revisados por um eletrofisiologista. Foram considerados significativos valores de p<0,05. Resultados: Apresentavam padrão potencialmente consistente com ECG do tipo Brugada 83 pacientes. Destes, 33 foram confirmados com padrão de Brugada tipo 1, e 22 com tipo 2, após reavaliação. A prevalência de ECG do tipo 1 de Brugada foi de 4,6 por 100.000 pacientes. O ECG do tipo Brugada 1 foi associado ao sexo masculino (81,8% vs. 41,5%, p<0,001) e menor prevalência de obesidade (9,1% vs. 26,4%, p=0,028). Conclusões: Este estudo mostrou baixa prevalência de ECG do tipo Brugada no sul do Brasil. A presença de ECG com padrão Brugada tipo 1 esteve associada ao sexo masculino e menor prevalência de obesidade que a população geral.

Abstract Background: Brugada Syndrome is an inherited arrhythmogenic disorder characterized by the presence of specific electrocardiographic features with or without clinical symptoms. The patients present increased risk of sudden death due to ventricular fibrillation. The prevalence of this electrocardiographic pattern differs according to the studied region. However, epidemiological information including the Brazilian population is scarce. Objectives: To assess the prevalence of the electrocardiographic pattern of Brugada syndrome and the epidemiological profile associated with it. Methods: Cross-sectional study that included 846,533 ECG records of 716,973 patients from the electrocardiogram (ECG) database from the Santa Catarina Telemedicine Network over a 4-year period. All tests were 12-lead conventional ECG (without V1 and V2 in high positions). The tests revealing "Brugada Syndrome" diagnosis (Types 1 and 2) were reviewed by a cardiac electrophysiologist. The level of significance was set at p<0.05. Results: In total, 83 patients had a pattern potentially consistent with Brugada-type pattern ECG. Of these, 33 were confirmed having Brugada-type 1, and 22 with type 2 ECG after reevaluation. The prevalence of Brugada-type 1 ECG was 4.6 per 100,000 patients. Brugada-type 1 ECG was associated with the male gender (81.8% vs. 41.5%, p<0.001) and a lower prevalence of obesity diagnosis (9.1% vs. 26.4%, p=0.028). Conclusions: This study showed low prevalence of Brugada-type ECG in Southern Brazil. The presence of Brugada-type 1 ECG was associated with the male gender and lower prevalence of obesity diagnosis comparing to the general population.

Associação entre o índice de massa corporal e a gravidade e complexidade das lesões coronarianas em pacientes pós-infarto / Association of body mass index and coronary lesions severity and complexity in post-myocardial infarction patients

Objetivo: Avaliar a associação entre o índice de massa corporal e a gravidade das lesões coronarianas em pacientes com infarto agudo do miocárdio. Métodos: Coorte aninhada ao Catarina Heart Study que avaliou 350 indivíduos durante o primeiro evento de infarto agudo do miocárdio e o 30º dia pós-infarto. As variáveis qualitativas foram analisadas pelo teste do qui-quadrado. Após o resultado da distribuição, a avaliação de variáveis quantitativas foi feita pelo teste de t de Student, pela correlação de Pearson, pelo teste de Mann-Whitney e pela correlação de Spearman. Resultados: Indivíduos com obesidade G2 (15,4%) tiveram maior probabilidade de trombose em 30 dias em comparação a indivíduos com índice de massa corporal normal (1,1%), com p=0,005. Indivíduos com obesidade grau 1 (6,0%) e obesidade grau 2 (7,7%) tiveram mais eventos de infarto agudo do miocárdio em 30 dias em comparação a indivíduos com índice de massa corporal normal (0,0%), com p=0,019 e p=0,009, respectivamente. Nenhuma associação significativa foi encontrada em termos de fração de ejeção do ventrículo esquerdo, mortalidade e complexidade das lesões coronarianas (escore SYNTAX e TIMI frame count). Conclusão: A obesidade em diversos graus está diretamente associada a fatores de risco para doença cardiovascular, como hipertensão arterial sistêmica, dislipidemia e tabagismo. Não houve associação entre o índice de massa corporal com a gravidade das lesões coronarianas ou a fração de ejeção do ventrículo esquerdo. Não houve diferença na mortalidade comparando-se indivíduos com índice de massa corporal elevado a pacientes com índice de massa corporal normal. Pacientes com obesidade tiveram mais desfechos cardiovasculares, como trombose e novo evento de infarto agudo do miocárdio em 30 dias, ao serem comparados a pacientes com índice de massa corporal normal. Outros desfechos de seguimento em 30 dias não estiveram associados ao índice de massa corporal.

Objective: To evaluate the association between body mass index and severity of coronary lesions in patients with acute myocardial infarction. Methods: A cohort nested to Catarina Heart Study, which evaluated 350 individuals during the first event of myocardial infarction and the 30th day post-infarction. Qualitative variables were analyzed using the Chi-square test. After the distribution result, the evaluation of quantitative variables was done through Student's t-test, Pearson's correlation, Mann Whitney's test, and Spearman's correlation. Results: Individuals with G2 obesity (15.4%) had a greater probability of having thrombosis in 30 days compared to individuals with normal body mass index (1.1%), p=0.005. Individuals with G1 obesity (6.0%) and G2 obesity (7.7%) had more events of myocardial infarction in 30 days compared to individuals with normal body mass index (0.0%), with p=0.019 and p=0.009, respectively. No significant association was found in terms of left ventricle ejection fraction, mortality, and complexity of coronary lesions (SYNTAX score and TIMI frame count). Conclusion: Obesity in several degrees is directly associated with risk factors for cardiovascular disease, such as hypertension, dyslipidemia, and smoking. There was no association between the body mass index and the severity of coronary lesions or left ventricle ejection fraction. There was no difference in mortality comparing individuals with high body mass index to patients with normal body mass index. Patients with obesity had more cardiovascular outcomes, such as thrombosis and a new event of myocardial infarction in 30 days when compared to patients with normal body mass index. Other follow-up outcomes in 30 days were not associated with body mass index

Associação entre a razão de monócitos por HDL e TIMI frame count e a trombose de stent em pacientes com primeiro infarto do miocárdio / Association of the monocyte to HDL ratio and TIMI frame count and stent thrombosis in patients with first myocardial infarction

Objetivo: Avaliar a associação entre marcadores de gravidade e complexidade, assim como de desfechos em 30 dias, com a razão de monócitos por HDL em pacientes com primeiro infarto agudo do miocárdio. Métodos: Foram selecionados 580 pacientes com primeiro infarto agudo do miocárdio submetidos a questionário durante a internação e seguimento em 30 dias. Os dados laboratoriais foram obtidos de 312 pacientes na entrada e de 237 em 72 horas. A gravidade e a complexidade foram avaliadas pelo TIMI frame count, pela fração de ejeção do ventrículo esquerdo e pelo escore Syntax. Resultados: O estudo evidenciou correlação positiva entre a razão de monócitos por HDL em 72 horas e o TIMI frame count, com r de 0,219 (p=0,018). Também evidenciou maior mediana de razão de monócitos por HDL nos pacientes que apresentaram trombose de stent em até 30 dias da internação ­ 35,8 (30,0-43,9) ­ comparados àqueles que não apresentaram, com 18,27 (12,98-26,74), p=0,038. Não houve correlação significativa entre a razão de monócitos por HDL da entrada com TIMI frame count, escore SYNTAX ou fração de ejeção do ventrículo esquerdo. Conclusão: Houve correlação positiva entre a razão de monócitos por HDL em 72 horas e o TIMI frame count em pacientes com primeiro infarto agudo do miocárdio submetidos à angioplastia primária. Verificou-se, também, associação entre maiores níveis de razão de monócitos por HDL na entrada com trombose de stent em 30 dias.

Objective: To investigate the association between complexity and severity markers, as well as 30-day outcomes with the monocytes to HDL-cholesterol ratio in patients with first myocardial infarction. Methods: A total of 580 patients with first myocardial infarction was selected and answered a questionnaire during hospitalization and 30-day follow up. Laboratory data were obtained at admission for 312 patients and for 237 in 72 hours. Severity and complexity were assessed by TIMI frame count, left ventricular ejection fraction, and Syntax score. Results: The study showed that the monocyte to HDL ratio in 72 hours was significantly positively correlated with TIMI frame count, with r of 0.219 (p=0.018). It also showed higher monocyte to HDL ratio median in patients presenting stent thrombosis within 30 days of hospitalization ­ 35,8 (30,0-43,9) ­ compared to those who did not develop it 18,27 (12,98-26,74), p=0.038. No correlation was found between admission monocytes to HDL ratio and TIMI frame count, Syntax score, or left ventricular ejection fraction. Conclusion: There was a positive correlation between Monocytes to HDL ratio in 72 hours and TIMI frame count in patients with first myocardial infarction undergoing primary percutaneous coronary intervention. An association between higher levels of admission monocyte to HDL ratio and stent thrombosis in 30 days was also observed.

Associação de índices hematológicos com fatores de risco, gravidade e complexidade da lesão no infarto agudo do miocárdio / Association of hematological índices with risk factors, severity and complexity of lesion in the acute myocardium infarction

Objetivo: Avaliar a associação entre os índices hematológicos e os fatores de risco, a complexidade e a gravidade do infarto em relação aos desfechos cardiovasculares. Métodos: Trata-se de uma coorte prospectiva, aninhada ao Catarina Heart Study e realizada em um hospital público da Grande Florianópolis. Resultados: Entre 2016 e 2019, foram analisados 580 participantes. Os indivíduos diabéticos apresentaram valores de hemoglobina de 13,0g/dL (12,0 a 14,1g/dL), inferior aos não diabéticos, com valores de 14,0g/dL (12,7 a 15,0g/dL; p<0,001). Indivíduos dislipidêmicos apresentavam valores de hemoglobina e segmentados, respectivamente, de 13,3g/dL (12,1 a 14,4g/dL) e 6.910mm³ (5.990 a 7.807mm³), inferiores aos sem dislipidemia, que possuíam, respectivamente, 14,0g/dL (12,8 a 15,0g/dL; p<0,001) e 7.205mm³ (6.300 a 8.030mm³; p=0,038). A contagem de plaquetas foi maior nos que possuíam dislipidemia, 224.000mm³ (178.000 a 273.500mm³), quando comparados aos que não possuíam, 210.000mm³ (173.000 a 255.000mm³; p=0,029). Houve correlação entre o SYNTAX e a contagem de leucócitos (r=0,143; p=0,001) e segmentados (r=0,222; p<0,001). Houve correlação negativa entre a fração de ejeção ventricular e a contagem de leucócitos (r=-0,173; p<0,001) e dos segmentados (r=-0,255; p<0,001). Indivíduos reinternados em 30 dias apresentaram valores de segmentados de 7.440mm³ (6.590 a 8.360mm³), maior em relação aos não reinternados, com 7.100mm³ (6.100 a 8.022mm³), sendo p=0,05. Os participantes que morreram por qualquer causa possuíam hemoglobina de 12,0g/dL (11,4 a 13,7g/dL), inferior aos indivíduos que permaneceram vivos em 30 dias, cujos valores foram de 13,7g/dL (12,5 a 14,9g/dL), sendo p=0,021. Conclusão: A contagem maior de plaquetas está associada à dislipidemia. Valores de hemoglobina baixas estão associados a um pior prognóstico em 30 dias e aos fatores de risco cardiovasculares, como diabetes mellitus e dislipidemia. A contagem maior de leucócitos está associada à reinternação em 30 dias e correlacionada à gravidade e à complexidade da lesão do infarto.

Objective: To evaluate the association of hematological indices with risk factors, complexity, and severity of the acute myocardial infarction regarding cardiovascular outcomes. Methods: This is a prospective cohort, nested to Catarina Heart Study, performed in a public hospital of Florianópolis. Results: Between 2016 and 2019, 580 participants were analyzed. Diabetic individuals had hemoglobin levels of 13.0g/dL (12.0 to 14.1g/dL), lower than those in non-diabetic individuals, with values of 14.0g/dL (12.7 to 15.0g/dL; p<0.001). Individuals with dyslipidemia had hemoglobin and segmented leukocytes of, respectively, 13.3g/dL (12.1 to 14.4g/dL) and 6,910mm³ (5,990 to 7,807mm³), lower than in non-dyslipidemic individuals, who had, respectively, 14.0g/dL (12.8 to 15.0g/dL; p<0.001) and 7,205mm³ (6,300 to 8,030mm³; p=0.038). Platelet count was higher in those who had dyslipidemia, 224,000mm³ (178,000 to 273,500mm³), when compared to non-dyslipidemic, 210,000mm³ (173,000 to 255,000mm³; p=0.029). There was a correlation between Syntax and leukocyte count (r=0.143, p=0.001) and segmented (r=0.222; p<0.001). There was a negative correlation between ventricular ejection fraction and leukocytes count (r=-0.173; p<0.001) and segmented (r=-0.255; p<0.001). Individuals readmitted in 30 days had segmented values of 7,440mm³ (6,590 to 8,360mm³), higher compared to non-readmitted, with 7,100mm³ (6,100 to 8,022mm³), p=0,05. Individuals who died of any cause had hemoglobin of 12.0g/dL (11.4 to 13.7g/dL), lower than those that remained alive in 30 days, with values of 13.7g/dL (12.5 to 14.9g/dL), p=0.021. Conclusion: Higher platelet count is associated with dyslipidemia. Low hemoglobin values are associated with worse outcomes in 30 days and with cardiovascular risk factors, such as diabetes mellitus and dyslipidemia. Higher leukocyte count is associated with readmission in 30 days and is also correlated to the severity and complexity of acute myorcardial infarction.

Características do primeiro infarto agudo do miocárdio em indivíduos jovens / Characteristics of the first acute myocardial infarction in young adults

Objetivo: Avaliar o perfil de gravidade de pessoas muito jovens (<30 anos) e jovens (<40 anos) atendidas com o primeiro episódio de infarto agudo do miocárdio e relacionar os fatores de risco e as lesões coronarianas. Método: Realizou-se uma coorte prospectiva que avaliou 712 pessoas no período de agosto de 2016 a fevereiro de 2020, hospitalizadas pelo primeiro episódio de infarto agudo do miocárdio e atendidas na região da Grande Florianópolis. Foram avaliados fatores de risco, os escores Syntax e TIMI frame count, a fração de ejeção do ventrículo esquerdo, o valor de delta t e o tempo porta-balão. Foram considerados significativos os valores de p<0,05. Resultado: A hipertensão arterial sistêmica teve menor prevalência entre os participantes muito jovens (<30 anos) quando comparados aos com mais idade (0% versus 58,7%; p=0,012), o que se repete também no grupo dos jovens (<40 anos), quando comparados aos com mais idade (26,1% versus 59,3%; p=0,002). Houve maior prevalência de uso de álcool nos muito jovens (80% versus 33,3%; p=0,046), e a prevalência de drogadição neste grupo foi de 40%, quando comparados aos pacientes com 30 anos ou mais (3,3%; p=0,046), e, nos jovens (<40 anos), quando comparados aos com 40 anos ou mais, foi de 21,7% (versus 2,9%; p=0,011). Os menores de 40 anos tiveram mais eventos com supradesnivelamento de segmento ST quando comparados aos pacientes com mais idade ­ sendo que, no grupo dos muito jovem (<30 anos), 100% apresentaram essa alteração eletrocardiográfica versus 48,8% nos com 30 anos ou mais (p=0,028). Os jovens tiveram maior razão de chances de apresentar disfunção ventricular esquerda pós-infarto agudo do miocárdio (razão de chance de 4,24; p=0,026), além de apresentarem um fator protetor para melhor reperfusão coronariana pós-angioplastia (razão de chance de 0,135; p=0,063) e não obtiveram diferença significativa quanto ao delta t prolongado (razão de chance de 0,72; p=0,547) e ao tempo porta-balão prolongado (razão de chance de 0,86; p=0,776). Conclusão: Jovens têm menor prevalência de hipertensão arterial sistêmica e maior de uso de drogas e álcool. Em sua maioria, apresentaram infarto do miocárdio com supradesnivelamento do segmento ST e maior razão de chances de apresentar disfunção ventricular esquerda, apesar de um maior fluxo coronariano pós- -angioplastia. Não houve diferença quanto ao delta t e tempo porta-balão entre os participantes jovens e muito jovens.

Objective: To assess the severity profile of very young (<30 years old) and young (<40 years old) people seen with the first episode of myocardial infarction and to relate risk factors and coronary lesions. Method: A prospective cohort was performed that evaluated 712 individuals, from August 2016 to February 2020, admitted with first episode of myocardial infarction in hospitals in the metropolitan area of Florianópolis. Risk factors, Syntax scores, TIMI frame count, left ventricular ejection fraction, delta-t value, and door-to-balloon time were evaluated. Values of p<0.05 were considered significant. Result: Systemic arterial hypertension had a lower prevalence in very young (<30 years) when compared to the older ones (0% versus 58.7%; p=0.012), and is the same for the young group (<40 years) when compared to the older ones (26.1% versus 59.3%; p=0.002). There was a higher prevalence of alcohol use in the very young (80% versus 33.3%; p=0.046) and the prevalence of drug addiction in this group was of 40% when compared the participants of 30 years or more (versus 3.3%; p=0.046), and, in the young group (<40 years) when compared to those of 40 years or more was of 21.7% (versus 2.9%; p=0.011). The ones below 40 years had more ST-segment elevation myocardial infarction when compared to the older patients ­ and in the very young group (<30 years) 100% showed this electrocardiographic alteration versus 48.8% in those of 30 years or more (p=0.028). The young group had a higher odds ratio for left ventricular dysfunction after myocardial infarction (odds ratio of 4.24; p=0.026), and had a protecting factor for better post-angioplasty coronary reperfusion (odds ratio of 0.135; p=0.063) and showed no significant difference in terms of prolonged delta-t (odds ratio of 0.72; p=0.547) and prolonged door-to-balloon time (odds ratio of 0.86; p=0.776). Conclusion: Young people have a lower prevalence of systemic arterial hypertension and a higher prevalence of drug and alcohol abuse. Most of them had ST-segment elevation myocardial infarction and a higher odds ratio for presenting left ventricular dysfunction, despite a greater coronary flow after angioplasty. There was no difference regarding delta-t and door-to-balloon time among young and very young participants.

ASSESSMENT OF WEIGHT LOSS AFTER NON-ADJUSTABLE AND ADJUSTABLE INTRAGASTRIC BALLOON USE.

BACKGROUND: Intragastric balloon (IGB) use is indicated for patients whose BMI precludes the option of bariatric surgery or who need to lose weight prior to undergoing surgery. It is a minimally invasive procedure and currently there are two main models of IGBs in use, the non-adjustable intragastric balloon (NIB), implanted for six months, and the adjustable intragastric balloon (AIB), implanted for up to 12 months. OBJECTIVE: Analyze clinical characteristics between patients receiving non-adjustable gastric balloon and the adjustable (prolonged implantation) intragastric balloon. METHODS: This was a cross-sectional study of 470 patients diagnosed as obese or overweight who had balloon implantation from October 2011 to July 2018. The associations between percentage excess weight loss versus clinical and demographic variables were calculated using the chi-squared test. Independent samples were submitted to the Student's t test to determine the quantitative variables, with a confidence interval of 95%. Calculation of excess weight was based on an estimated ideal weight that would correspond to a BMI of 24.99 kg/m2. RESULTS: A total of 414 patients completed the treatment achieving an average total body weight loss (%TBWL) of 15.4±7 with the NIB and 15.5±9.6 with the AIB. Overweight patients achieved higher excess weight loss (%EWL) values using AIBs (157.2±82.5) and obese patients did so with NIB use (56±29.7). Women achieved higher %EWL values (65.6±62.2) than men (48±27.1). Individuals who attended >4 consultations with a nutritionist (60.8%) achieved TBWL >18%. All of those P-values were <0.001. CONCLUSION: Obese individuals and women registered the greatest weight losses. Overweight patients achieved greater losses using AIB and obese patients did so using NIBs. NIB use was associated with higher EWL percentages. Nutritional accompaniment had a positive impact on the %TBWL.

Avaliação de perda de peso após o uso de balão intragástrico não ajustável e ajustável / Assessment of weight loss after non-adjustable and adjustable intragastric balloon use

ABSTRACT BACKGROUND: Intragastric balloon (IGB) use is indicated for patients whose BMI precludes the option of bariatric surgery or who need to lose weight prior to undergoing surgery. It is a minimally invasive procedure and currently there are two main models of IGBs in use, the non-adjustable intragastric balloon (NIB), implanted for six months, and the adjustable intragastric balloon (AIB), implanted for up to 12 months. OBJECTIVE: Analyze clinical characteristics between patients receiving non-adjustable gastric balloon and the adjustable (prolonged implantation) intragastric balloon. METHODS: This was a cross-sectional study of 470 patients diagnosed as obese or overweight who had balloon implantation from October 2011 to July 2018. The associations between percentage excess weight loss versus clinical and demographic variables were calculated using the chi-squared test. Independent samples were submitted to the Student's t test to determine the quantitative variables, with a confidence interval of 95%. Calculation of excess weight was based on an estimated ideal weight that would correspond to a BMI of 24.99 kg/m2. RESULTS: A total of 414 patients completed the treatment achieving an average total body weight loss (%TBWL) of 15.4±7 with the NIB and 15.5±9.6 with the AIB. Overweight patients achieved higher excess weight loss (%EWL) values using AIBs (157.2±82.5) and obese patients did so with NIB use (56±29.7). Women achieved higher %EWL values (65.6±62.2) than men (48±27.1). Individuals who attended >4 consultations with a nutritionist (60.8%) achieved TBWL >18%. All of those P-values were <0.001. CONCLUSION: Obese individuals and women registered the greatest weight losses. Overweight patients achieved greater losses using AIB and obese patients did so using NIBs. NIB use was associated with higher EWL percentages. Nutritional accompaniment had a positive impact on the %TBWL.

RESUMO CONTEXTO: O uso do balão intragástrico (BIG) é indicado para pacientes cujo IMC contraindica a cirurgia bariátrica ou que necessitam perder peso antes da cirurgia. É um procedimento minimamente invasivo e atualmente existem dois modelos principais de BIG - o balão intragástrico não ajustável (BINA), implantado por seis meses, e o balão intragástrico ajustável (BIA), por até 12 meses. OBJETIVO: Analisar os fatores associados aos resultados clínicos comparando o uso de balão intragástrico não ajustável com o uso de balão intragástrico ajustável. MÉTODOS: Estudo transversal em 470 pacientes, com sobrepeso ou obesidade, submetidos ao tratamento entre outubro 2011 e julho de 2018. A associação entre as porcentagens da perda de excesso de peso (%PEP) e da perda do peso total (%PPT) com as variáveis demográficas e clínicas foram calculados com o teste qui-quadrado (P<0,05). Foi utilizado o teste t de Student para amostras independentes para comparar variáveis quantitativas, com IC 95%. O cálculo do excesso de peso foi estimado em peso ideal correspondente a um IMC de 24.99 kg/m2. RESULTADOS: Um total de 414 pacientes realizaram o tratamento até o final, com %PPT média de 15,4±7 no BINA e 15,5±9,6 no BIA. Os com sobrepeso apresentaram maiores %PEP no BIA (157,2±82,5) e os obesos maiores %PEP no BINA (56±29,7), com P<0,001. Mulheres (65,6±62,2) apresentaram maiores %PEP do que homens (48±27,1), com P<0,001. Os indivíduos que atenderam a >4 consultas com nutricionista obtiveram %PPT >18% (60,8%), com P<0,001. CONCLUSÃO: Obesos e mulheres tiveram maiores perdas ponderais. Maior perda de peso foi identificada em pacientes com sobrepeso que utilizaram BIA e em obesos os quais utilizaram BINA. O BINA esteve associado com maiores taxas de %PEP. O acompanhamento nutricional impactou positivamente na %PPT.

Association Between Chocolate Consumption and Severity of First Infarction

Abstract Background: Cardiovascular diseases, such as acute myocardial infarction, are the main causes of death in the world. The flavonoids present in chocolate can have benefits for people who have risk factors to the development of cardiovascular diseases and have a coadjuvant effect on known therapies. Objective: To analyze the association between chocolate consumption, severity of coronary lesions, risk factors and severity of the first infarction in patients attended at the Cardiology Institute of Santa Catarina and other hospitals in the State of Santa Catarina. Methods: Subanalysis of the Catarina Heart Study cohort, evaluated 350 patients with first myocardial infarction. We evaluated clinical, echocardiographic, hemodynamic laboratorial variables. We used chi square test to evaluate qualitative variables, t student test in the case of parametric variables and U Mann Whitney test in non-parametric variables. We considered significant p < 0,05. Results: Lower prevalence of hypertension (43.2% % vs. 62.3% p = 0.003), diabetes mellitus (13.5% vs. 25.7%, p = 0.027) and smoking (24.3% vs. 37.7%, p = 0.032) among those who consume chocolate. Higher use of alcohol (40.5% vs. 26.4%, p = 0.018) and drugs (9.5% vs. 3.3%, p = 0.023) among those who consumed chocolate. Among the patients who consumed chocolate, there was a negative correlation between amount consumed and Syntax (r = -0.296, p = 0.019). Conclusion: There was association between chocolate consumption and lower prevalence of hypertension, diabetes and smoking. There was no association between amount of chocolate consumed and post-infarction ventricular function and TIMI frame count. Higher prevalence of alcohol and drug use among those who consume chocolate. Negative correlation between Syntax and the amount of chocolate consumed.

Association between Smoking and Alcohol Consumption and the Severity of Coronary Artery Injuries in Patients with AMI

Smoking is the most important risk factor for coronary heart disease (CHD) and ischemic events; alcohol consumption, on the other hand, appears to have a protective role. Objective: Assess the association between smoking and alcohol consumption with the severity of coronary artery injuries in patients with acute myocardial infarction (AMI). Methods: Cross-sectional study, performed in Santa Catarina. Variables were evaluated using the Chi-squared T/Fisher's exact test, Kendall's correlation coefficient, Student's t test or Mann-Whitney U test. Values of p < 0.05 were considered significant. Results: Between August 2016 to June 2017, 226 patients were evaluated with first episode of AMI. There was a difference in sex distribution, showing that 59.7% of men and 85.4% of women were not alcoholic (p < 0.001). There was a higher prevalence of non-hypertensive patients who consumed alcohol than hypertensive ones (40.7% vs. 24.4% and p = 0.010) and patients without diabetes who had drinking habits than those diabetic (36.4% vs. 12.0% and p = 0.001). There was also a higher prevalence of non-diabetic patients who smoked than diabetic ones (38.1% vs. 22.0% and p = 0.035). A weak and negative correlation was found between the number of cigarettes per day and the pack-year with the TIMI frame count (r = -0.174 and p = 0.041 and r = -0.192 and p = 0.027, respectively). The other associations did not show statistical significance. Conclusion: The study showed that the number of cigarettes consumed per day and the pack-year is related to a smaller TIMI frame count, i.e., to a better coronary flow, which may be related to the Smoker's Paradox. There was no correlation between the beverage type and quantity with the SYNTAX score, Ejection fraction and TIMI frame count

Correlation between Clinical and Educational Factors and Delayed Hospital Arrival in Myocardial Infarction

Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital

Correlação entre fatores clínicos e educacionais e atraso na chegada ao hospital no infarto agudo do miocárdio / Corelation between clinical and educational factors and delayed hospital arrival in myocardial infarction

Background: Acute myocardial infarction is one of the main causes of morbidity and mortality in the world, and one of the factors with the greatest prognostic impact is early specialist care, but there are still many factors that delay patient's arrival at the hospital. Objective: To correlate social, educational, cognitive and clinical factors with time to hospital arrival after the onset of acute myocardial infarction's first symptoms. Methods: Time interval to search for medical care was measured by patient's report of the onset of infarction's first symptoms and hospital admission verified through electronic medical data of the emergency service. The correlation between delta-T and other variables was performed through Kendall's correlation. Values of p < 0.05 were considered statistically significant. Results: There was no correlation between delta-T and scholarity, or between delta - T and Mini Mental State Examination performance, as well as no association between the presence of hypertension, diabetes mellitus, dyslipidemia, family history, sedentary lifestyle or smoking with arrival time at the hospital. Comparisons between delta-T and marital status were also not statistically significant. Transfer from another health service and city of origin were the most determinant delay factors in our population's arrival at the hospital. Conclusion: The present study suggests that, in our population, educational, social and cognitive factors are not directly related to the delay in arriving at the hospital

Fundamentos: O infarto agudo do miocárdio se configura como uma das principais causas de morbimortalidade no mundo, e um dos fatores de maior impacto prognóstico é o atendimento especializado precoce, porém ainda existem inúmeros fatores que retardam a chegada do paciente até o hospital. Objetivo: Correlacionar fatores sociais, educacionais, cognitivos e clínicos com o tempo para a chegada no hospital após os primeiros sintomas de infarto agudo do miocárdio. Métodos: O tempo para a busca de atendimento médico foi mensurado entre o início dos primeiros sintomas de infarto relatado pelo paciente e o registro da admissão hospitalar em prontuário eletrônico do serviço de emergência. A correlação entre o delta T e outras variáveis foi verificada por meio da correlação de Kendall. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: Não houve correlação entre delta T e escolaridade, e nem entre delta T e desempenho no Mini-Exame do Estado Mental, assim como não houve associação entre a presença de hipertensão arterial sistêmica, diabetes melito, dislipidemia, sedentarismo, história familiar ou tabagismo com o tempo de chegada no hospital. Comparações entre delta T e estado civil também não foram estatisticamente significativas. A transferência de outro serviço de saúde e a região de procedência foram os fatores que mais determinaram atraso no atendimento especializado de nossa população. Conclusão: Fatores educacionais, sociais e cognitivos não estiveram diretamente relacionados ao atraso na chegada ao hospital

Correlação entre atividade física e variáveis de pacientes com infarto agudo do miocárdio / Correlation between physical activity and clinical variables in patients with acute myocardial infarction

Fundamentos: A atividade física reduz o risco de doença coronariana, uma das principais causas de morte no mundo. Objetivos: Este estudo pretende correlacionar as atividades físicas com variáveis clínicas de pacientes internados em hospitais públicos de Santa Catarina após o primeiro infarto agudo do miocárdio. Métodos: Os pacientes selecionados foram submetidos a questionário que engloba diferentes variáveis clínicas. A atividade física foi mensurada através do Escore de Baecke. Os dados obtidos foram tabulados e analisados através do software SPSS 13.0 for Windows. A avaliação da normalidade foi realizada pelo teste de Kolmogorov-Smirnov. A correlação entre duas variáveis quantitativas foi avaliada pela Correlação de Pearson. Foram considerados significativos valores de p < 0,05. Resultados: O estudo evidenciou uma correlação positiva fraca entre o escore de Baecke e anos de escolaridade com r = 0,361 (p = 0,001). Houve uma correlação negativa fraca entre o escore de Baecke e o escore de depressão PHQ9 com r = -0,252 (p = 0,009). O estudo também apresentou correlação negativa fraca entre o escore de depressão PHQ9 e o Mini Mental com r = -0,258 (p = 0,007), assim como uma correlação negativa fraca entre o PHQ9 e os anos de escolaridade com r = -0,199 (p = 0,039). Conclusões: Existe uma correlação positiva entre atividade física e anos de escolaridade em pacientes internados com o primeiro infarto agudo do miocárdio. Há também uma correlação negativa entre atividade física e depressão nesses pacientes, assim como uma correlação negativa entre depressão e o Mini-Mental, e depressão e anos de escolaridade

Background: Physical activity reduces the risk of coronary heart disease, one of the leading causes of death in the world. Objectives: This study intends to correlate physical activity and clinical variables of the patients hospitalized in public hospitals of Santa Catarina after the first acute myocardial infarction. Methods: The selected patients answered a questionnaire on different clinical variables. Physical activity was measured using the Baecke's questionnaire. Data were tabulated and analyzed using the SPSS 13.0 for Windows software. Normality was assessed using the Kolmogorov­Smirnov test. Correlations between two quantitative variables were evaluated by Pearson's correlation. Values of p < 0.05 were considered statistically significant. Results: The study showed a weak positive correlation between the Baecke score and years of schooling (r = 0.361; p = 0.001). There was a weak negative correlation between the Baecke score and the PHQ9 depression score (r = ­0.252; p = 0.009). The study also showed a weak negative correlation between the PHQ9 depression score and the Mini Mental score (r = ­0.258; p = 0.007), as well as a weak negative correlation between PHQ9 and schooling years with (r = ­0.199, p = 0.039). Conclusions: There is a positive correlation between physical activity and years of schooling in hospitalized patients with first acute myocardial infarction. Negative correlations were found between physical activity and depression, between depression and the Mini­Mental State Examination, and between depression and years of schooling in these patients

MethotrexaTE THerapy in ST-Segment Elevation MYocardial InfarctionS: A Randomized Double-Blind, Placebo-Controlled Trial (TETHYS Trial).

PURPOSE: Methotrexate is an anti-inflammatory drug that has been shown to have anti-ischemic effects. Our aim was to evaluate if methotrexate could reduce infarct size in patients with ST-segment elevation myocardial infarction (STEMI). METHODS: We randomly assigned patients with STEMI to receive either methotrexate or placebo. Primary outcome was infarct size determined by calculating the area under the curve (AUC) for creatine kinase (CK) release. Secondary outcomes were AUC of CK MB (CK-MB) and AUC of troponin I; peak CK, peak CK-MB, and troponin I; B-type natriuretic peptide (BNP) level, high-sensitivity C-reactive protein (hsCRP) result, and erythrocyte sedimentation rate (ESR); left ventricular ejection fraction (LVEF); thrombolysis in myocardial infarction (TIMI) frame count; Killip score; mortality and reinfarction incidence; and incidence of adverse reactions. RESULTS: We included 84 patients. Median AUC of CK was 78 861.0 in the methotrexate group and 68 088.0 in the placebo group ( P = .10). Patients given methotrexate and placebo exhibited, respectively, median AUC for CK-MB of 9803.4 and 8037.0 ( P = .42); median AUC for troponin of 3691.1 and 2132.6 ( P = .09); peak CK of 2806.0 and 2147.0 ( P = .05); peak CK-MB of 516.0 and 462.3 ( P = .25); and peak troponin of 121.0 and 85.1 ( P = .06). At 3 months, LVEF was lower in patients who received methotrexate (49.0% ± 14.1%) than in patients given placebo (56.4% ± 10.0%; P = .01). There were no differences in hsCRP, ESR, BNP, Killip scores, TIMI frame count, reinfarction, and mortality rates. There was a higher median serum glutamic-pyruvic transaminase levels in the methotrexate group. CONCLUSION: Methotrexate did not reduce infarction size and worsened LVEF at 3 months ( Clinicaltrials.gov identifier NCT01741558).

Fatores associados ao óbito intra-hospitalar em pacientes internados por infarto agudo do miocárdio / Factors associated with death intra-hospital in hospitalized patients for acute myocardial infarction

As doenças do aparelho circulatório são importantes causas de internação hospitalar. Dentre elas, o infarto agudo do miocárdio destaca-se pela sua morbimortalidade e seus custos gerados no Sistema Único de Saúde. Estudos que possam esclarecer quais são os fatores que estão associados a este desfecho podem delinear estratégias de conduta que futuramente possam mudar esta situação. O objetivo do estudo foi analisar os fatores associados ao óbito intra-hospitalar em pacientes internados por IAM no Instituto de Cardiologia de Santa Catarina (ICSC). Estudo de coorte não-concorrente realizado no ICSC em São José, SC. A população incluiu 349 pacientes internados com diagnóstico de IAM no período de janeiro de 2013 à janeiro de 2014. Os dados foram extraídos por meio do uso do instrumento de coleta de dados desenvolvido para o estudo. A análise estatística foi feita no programa Stata® versão 10 e aplicaram-se os testes do qui-quadrado ou exato de Fisher, com p<0,05. O risco relativo foi estimado com intervalo de confiança de 95%. Aprovado no CEP UNISUL e ICSC. Dos 349 pacientes incluídos no estudo, 4,58% foram a óbito. A maioria da população era do sexo masculino (67,62%) com idade entre 51-70 anos. As variáveis com significância estatística foram: acometimento de TCE (p=0,001), classificação de Killip (p=0,001), PCR (p=0,001), diabetes (p=0,01). Os fatores associados ao óbito intra-hospitalar em pacientes internados por IAM foram: acometimento de TCE, classificação de Killip, PCR nas primeiras 48 horas com sucesso na reanimação, tempo de internação e diabetes.

Cardiovascular diseases are major causes of hospitalization. Among them, acute myocardial infarction (AMI) is distinguished by its morbidity and costs generated in the Health System. Studies that can clarify what are the factors that are associated with this outcome can devise management strategies that may eventually change this situation. The objective of this study is to analyze the factors associated with in-hospital death risk in patients hospitalized with AMI in Instituto de Cardiologia de Santa Catarina (ICSC). A retrospective cohort study was conducted in ICSC in São José, SC. The population included 349 patients hospitalized with AMI between January 2013 and January 2014. Data were extracted by the use of the data collection instrument developed for the study. Statistical analysis was performed in Stata® version 10 and have applied the chi-square or Fisher exact test, with p <0.05. The relative risk was estimated with a confidence interval of 95%. Approved in Ethical Committee in Research of UNISUL and ICSC. Of the 349 patients included in the study, 4.58% died. The majority of the population was male (67,62%) aged 51-70 years. The statistically significant variables were: impairment of the left main coronary artery (p=0,001), Killip classification (p= 0,001), cardiac arrest (p<0,001), diabetes (p=0,01). The factors associated with in-hospital death in patients hospitalized for AMI were: involvement of the left main coronary artery, Killip classification, cardiac arrest within 48 hours with successful resuscitation, hospitalization time and diabetes.

Correlation between leukocyte count and infarct size in ST segment elevation myocardial infarction.

INTRODUCTION: Regarding the inflammatory mechanisms involved in ischemic heart disease, currently the leukocyte count is the subject of studies related to its association with the prognosis and mortality of ST segment elevation myocardial infarction (STEMI). Our aim is correlate the leukocyte count rise with the size of STEMI, evaluated with the area under the curve (AUC) and the peak of necrosis markers release. MATERIAL AND METHODS: This study is a sub-analysis of the TETHYS trial, a clinical trial that evaluated the effects of methotrexate in STEMI. We evaluated the correlation between quantitative variables with Pearson's correlation, and the variables that did not follow a normal distribution were subjected to logarithmic transformation to base 10. The value of p < 0.05 indicated statistical significance. RESULTS: Males accounted for 73% of the participants, who had an average age of 59 years. A total of 58% were hypertensive and 53% smokers. The leukocyte count at hospital admission was significantly correlated with the AUC creatine kinase (CK) (r = 0.256, p = 0.021), troponin AUC (r = 0.247, p = 0.026), peak CK (r = 0.270, p = 0.015) and troponin peak (r = 0.233, p = 0.037). The leukocyte count at 72 h was significantly correlated with CK AUC (r = 0.238, p = 0.032), AUC of MB portion of CK (r = 0.240, p = 0.031) and peak CK (r = 0.224, p = 0.045). CONCLUSIONS: White blood cell count correlates with STEMI size assessed by serial cardiac biomarker levels.

Prevalência de dislipidemia em pacientes que utilizam terapia antirretroviral em centros terciários do sul do Brasil / Prevalence of dyslipidemia in patients using highly active antiretroviral therapy in terciary centers of southern Brazil

OBJETIVO: Analisar a prevalência e os fatores associados à dislipidemia em pacientes que utilizam a Highly Active Antiretroviral Therapy (HAART). MÉTODOS: Estudo observacional transversal que incluiu 100 pacientes que realizam acompanhamento em ambulatórios de Infectologia de Santa Catarina. Os dados foram obtidos por meio de revisão de prontuários e analisados no programa Statistical Package for Social Science (SPSS), versão 13.0. Utilizou-se o teste qui quadrado de Pearson ou teste exato de Fisher para as variáveis qualitativas. A associação entre as variáveis quantitativas foi avaliada por meio do teste t de Student. O nível de significância estabelecido foi p<0,05. RESULTADOS: Homens corresponderam a 51% e a média de idade foi de 42,90±11,39 anos. A prevalência de dislipidemia foi de 75% nos pacientes que utilizavam HAART e de 85% nos pacientes antes de iniciá-la. O colesterol total médio dos pacientes antes de iniciar HAART encontrou-se em 171,33±37,12, a HDL média em 41,01±14,57 e o LDL médio em 98,05±32,35. Já o colesterol total médio dos pacientes que utilizam HAART ficou em 199,97±42,47 (p<0,01), o HDL médio em 46,93±16,34 (p<0,01) e o LDL médio em 118,88±36,57 (p<0,01). Houve menor média de linfócitos TCD4+ pré-HAART entre pacientes com HDL reduzido (p=0,04) ou qualquer dislipidemia (p=0,01). CONCLUSÃO: Há alta prevalência de dislipidemia em pacientes infectados pelo HIV que utilizam ou não HAART.

OBJECTIVE: To assess the prevalence and factors associated with dyslipidemia in patients using the Highly Active Antiretroviral Therapy (HAART). METHODS: Cross-sectional observational study that included 100 patients who are being followed in infectious diseases clinics of the state of Santa Catarina. Data was obtained through the review of medical records and analyzed using SPSS 13.0 software. Chi-square test or Fisher's exact test were used for qualitative variables. Student's t test was used for the association of quantitative variables.The significance level was p<0.05. RESULTS: Men were 51% and the average age was 42.90±11.39 years. The prevalence of dyslipidemia was 75% in patients using Highly Active Antiretroviral Therapy and 85% before the beginning of therapy. The average total cholesterol of patients before starting Highly Active Antiretroviral Therapy was 171.33±37.12, average highdensity lipoprotein (HDL) was 41.01±14.57 and the average low-density lipoprotein was 98.05±32.35. The average total cholesterol of patients using Highly Active Antiretroviral Therapy remained at 199.97±42.47 (p<0.01), the average high-density lipoprotein at 46.93±16.34 (p<0.01) and the average low-density lipoprotein at 118.88±36.57 (p<0.01). There was a lower averagem of TCD4+ lymphocytes counts pre-Highly Active Antiretroviral Therapy among patients with low high-density lipoprotein (p=0.04) or any dyslipidemia (p=0.01). CONCLUSION: There is high prevalence of dyslipidemia in HIV-infected patients using or not the Highly Active Antiretroviral Therapy.

Mozart, but not the Beatles, reduces systolic blood pressure in patients with myocardial infarction.

INTRODUCTION: Music reduces systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) in various clinical situations, but it is unclear whether these changes occur in post-infarction patients. AIM: The aim is to evaluate the effects of music on patients with acute myocardial infarction (MI). METHODS: We evaluated patients with MI and we measured SBP, DBP, HR and double product (DP) two times before the intervention and one time every fifteen minutes with an ambulatory blood pressure monitor. We divided the patients into 3 groups: a group listening to music by Mozart; another listening to a Beatles collection and a third one listening to the radio news. Outcomes were the change in mean SBP, DBP, HR and DP with intervention. RESULTS: We enrolled 60 patients (20 in each group). SBP was significantly reduced in the Mozart group (variation of ­7.2 ± 8.5 mmHg) compared to the Beatles group (­1.3 ± 6.2 mmHg) (P = 0.021) and the radio news group (0.6 ± 8.7 mmHg) (P = 0.003). DP was significantly reduced in the Mozart group compared with the News group (­668.5 ± 773.2 vs 31.6 ± 722.1 mmHg) (P = 0.006). There were no differences in DBP and HR. CONCLUSION: Patients with MI who listened Mozart had a reduction in SBP and DP compared to those who listened to the Beatles or the news.

Correlação entre RDW, tamanho do infarto e fluxo coronariano após angioplastia primária / Correlation between RDW, infarct size and coronary flow after primary angioplasty

Fundamentos: RDW é um parâmetro laboratorial que mede o índice de anisocitose. Sua elevação pode estarrelacionada com a inflamação, que também é considerada a principal responsável pela redução do fluxo coronariano após angioplastia.Objetivos: Correlacionar o RDW de pacientes que apresentam infarto agudo do miocárdio (IAM) com supradesníveldo segmento ST com o fluxo coronariano, o tamanho do infarto e a função ventricular pós-angioplastia.Métodos: O tamanho do IAM foi avaliado através das áreas sob a curva (AUC) e picos de biomarcadores. A correlação entre RDW na admissão e em 72 horas e outras variáveis numéricas foi realizada pelo coeficiente de correlação de Pearson para dados normais ou correlação de Kendall para dados não normais. Valores de p<0,05 foram considerados significativos.Resultados: Observou-se correlação negativa entre o RDW na admissão e o tamanho do IAM avaliado pelo pico deCK-MB massa, r=-0,15 (p=0,04). Os outros parâmetros utilizados para medir a área do infarto não demonstraram relação significativa com RDW. Não foram encontradas correlações significativas entre o RDW e o fluxo coronariano pósangioplastia,nem com a fração de ejeção ventricular esquerda (FEVE), nem com desfechos cardiovasculares negativos. Conclusões: Existe uma fraca correlação negativa entre RDW e o tamanho do IAM avaliado pelo pico de CK-MB massa, mas não há correlação entre RDW e o pico de CK ou troponina I, bem como do RDW e AUC de CK, CKMB massa ou troponina I. Não há correlação entre RDW e TIMI frame count ou entre RDW e FEVE.

Background: RDW is a laboratory parameter that measures the anisocytosis index. Its elevation may be related to inflammation, which is also considered primarily responsible for the reduction of post-angioplasty coronary flow. Objectives: To correlate the RDW of patients with ST segment elevation acute myocardial infarction (AMI) and coronary flow, infarction size and post-angioplasty ventricular function.Methods: The IAM size was measured by the areas under the curve (AUC) and biomarker peaks. The correlation between RDW on admission and in 72 hours and other numerical variables was performed using Pearson’s correlation coefficient for normal data or Kendall’s correlation for non-normal data. In this study, p values <0.05 were considered statistically significant. Results: There was a negative correlation between the RDW on admission and the AMI size assessed by peak of CK-MB mass,r=-0.15 (p=0.04). The other parameters used to measure the area of infarction showed no significant relationship with RDW. There were no significant correlations between the RDW and post-angioplasty coronary flow, or with left ventricular ejection fraction(LVEF) or with negative cardiovascular outcomes. Conclusions: There is a weak negative correlation between RDW and the AMI size assessed by CK-MB mass peak, but there is no correlation between RDW and CK or troponin I peak, or RDW and CK AUC, CK-MB mass or troponin I. There is no correlationbetween RDW and TIMI frame count or between RDW and LVEF.