Tricuspid Regurgitation and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. / Insuficiência Tricúspide e Mortalidade em Pacientes Submetidos à Troca da Valva Aórtica Transcateter: Uma Revisão Sistemática e Metanálise.

BACKGROUND: The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear. OBJECTIVES: To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality. METHODS: Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%). RESULTS: Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92). CONCLUSIONS: Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario.

FUNDAMENTO: A extensão do dano cardíaco associada à estenose aórtica tem importantes implicações prognósticas após a substituição da valva aórtica transcateter (TAVR). Contudo, ainda não está claro qual é o papel da insuficiência tricúspide (IT) nesse cenário clínico. OBJETIVOS: Explorar a associação entre IT e mortalidade em pacientes submetidos a TAVR e avaliar as alterações na gravidade da IT após a TAVR e sua relação com mortalidade de curto e médio prazo. MÉTODOS: Foram feitas pesquisas em bases de dados relevantes de artigos publicados do início até agosto de 2020. Dos 414 estudos triados, selecionamos 24 que relataram o grau de IT pré- ou pós-TAVR. O desfecho primário foi mortalidade por todas as causas, e foram conduzidos modelos de metanálise de efeitos aleatórios (a um nível de significância de 5%). RESULTADOS: Dezessete estudos relataram associações entre IT pré-TAVR e mortalidade por todas as causas (> 45.000 participantes), e 13 avaliaram a gravidade da IT pós-TAVR (709 participantes). A IT basal moderada/grave foi associada a maior mortalidade por todas as causas em 30 dias [razão de risco (RR) 1,65; intervalo de confiança (IC) 95% 1,20-2,29] e 1,2 ano (RR 1,56; IC95% 1,31-1,84). Após a TAVR, 43% dos pacientes apresentaram redução de pelo menos um grau na IT (30 dias, IC95% 30-56%), que se sustentou em 12,5 meses em 44% dos participantes (IC95% 35-52%).A persistência de IT significativa foi associada a um aumento de duas vezes na mortalidade por todas as causas (RR 2,12; IC95% 1,53-2,92). CONCLUSÕES: A IT significativa pré-TAVR está associada a maior mortalidade. Ainda que a gravidade da IT possa melhorar, a persistência de IT significativa após a TAVR está fortemente associada ao aumento da mortalidade. Nossos achados destacam a importância de uma avaliação detalhada da IT pré- e pós-TAVR e podem ajudar a identificar pacientes que possam se beneficiar de uma vigilância mais cuidadosa nesse cenário.

Insuficiência Tricúspide e Mortalidade em Pacientes Submetidos à Troca da Valva Aórtica Transcateter: Uma Revisão Sistemática e Metanálise / Tricuspid Regurgitation and Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Resumo Fundamento A extensão do dano cardíaco associada à estenose aórtica tem importantes implicações prognósticas após a substituição da valva aórtica transcateter (TAVR). Contudo, ainda não está claro qual é o papel da insuficiência tricúspide (IT) nesse cenário clínico. Objetivos Explorar a associação entre IT e mortalidade em pacientes submetidos a TAVR e avaliar as alterações na gravidade da IT após a TAVR e sua relação com mortalidade de curto e médio prazo. Métodos Foram feitas pesquisas em bases de dados relevantes de artigos publicados do início até agosto de 2020. Dos 414 estudos triados, selecionamos 24 que relataram o grau de IT pré- ou pós-TAVR. O desfecho primário foi mortalidade por todas as causas, e foram conduzidos modelos de metanálise de efeitos aleatórios (a um nível de significância de 5%). Resultados Dezessete estudos relataram associações entre IT pré-TAVR e mortalidade por todas as causas (> 45.000 participantes), e 13 avaliaram a gravidade da IT pós-TAVR (709 participantes). A IT basal moderada/grave foi associada a maior mortalidade por todas as causas em 30 dias [razão de risco (RR) 1,65; intervalo de confiança (IC) 95% 1,20-2,29] e 1,2 ano (RR 1,56; IC95% 1,31-1,84). Após a TAVR, 43% dos pacientes apresentaram redução de pelo menos um grau na IT (30 dias, IC95% 30-56%), que se sustentou em 12,5 meses em 44% dos participantes (IC95% 35-52%).A persistência de IT significativa foi associada a um aumento de duas vezes na mortalidade por todas as causas (RR 2,12; IC95% 1,53-2,92). Conclusões A IT significativa pré-TAVR está associada a maior mortalidade. Ainda que a gravidade da IT possa melhorar, a persistência de IT significativa após a TAVR está fortemente associada ao aumento da mortalidade. Nossos achados destacam a importância de uma avaliação detalhada da IT pré- e pós-TAVR e podem ajudar a identificar pacientes que possam se beneficiar de uma vigilância mais cuidadosa nesse cenário.

Abstract Background The extent of cardiac damage associated with aortic stenosis has important prognostic implications after transcatheter aortic valve replacement (TAVR). However, the role of tricuspid regurgitation (TR) in this clinical setting is still unclear. Objectives To explore the association between TR and mortality in patients undergoing TAVR and assess changes in TR severity post TAVR and its relationship with short and mid-term mortality. Methods Relevant databases were searched for articles published from inception until August 2020. Out of 414 screened studies, we selected 24 that reported the degree of TR pre or post TAVR. The primary outcome was all-cause mortality, and random effects meta-analysis models were conducted (at a significance level of 5%). Results Seventeen studies reported associations between pre-TAVR TR and all-cause mortality (> 45,000 participants) and thirteen accessed TR severity post TAVR (709 participants). Moderate/severe baseline TR was associated to higher all-cause mortality both at 30 days (HR 1.65; 95% CI, 1.20-2.29) and 1.2 years (HR 1.56; 95% CI, 1.31-1.84). After TAVR, 43% of patients presented a decrease of at least one grade in TR (30 days, 95% CI, 30-56%), sustained at 12.5 months in 44% of participants (95% CI, 35-52%). Persistence of significant TR was associated with a two-fold increase in all-cause mortality (HR 2.12; 95% CI, 1.53-2.92). Conclusions Significant TR pre TAVR is associated with higher mortality. Although TR severity may improve, the persistence of significant TR post TAVR is strongly associated with increased mortality. Our findings highlight the importance of a detailed assessment of TR pre and post TAVR and might help identify patients who may benefit from more careful surveillance in this scenario.

Decellularized Wharton Jelly Implants Do Not Trigger Collagen and Cartilaginous Tissue Production in Tracheal Injury in Rabbits.

BACKGROUND: Tracheal lesions are pathologies derived from the most diverse insults that can result in a fatal outcome. Despite the number of techniques designed for the treatment, a limiting factor is the extent of the extraction. Therefore, strategies with biomaterials can restructure tissues and maintain the organ's functionality, like decellularized Wharton's jelly (WJ) as a scaffold. The aim is to analyze the capacity of tracheal tissue regeneration after the implantation of decellularized WJ in rabbits submitted to a tracheal defect. METHODS: An in vivo experimental study was undertaken using twenty rabbits separated into two groups (n = 10). Group 1 submitted to a tracheal defect, group 2 tracheal defect, and implantation of decellularized WJ. The analyses were performed 30 days after surgery through immunohistochemistry. RESULTS: Inner tracheal area diameter (p = 0.643) didn't show significance. Collagen type I, III, and Aggrecan highlighted no significant difference between the groups (both collagens with p = 0.445 and the Aggrecan p = 0.4). CONCLUSION: The scaffold appears to fit as a heterologous implant and did not trigger reactions such as rejection or extrusion of the material into the recipient. However, these results suggested that although the WJ matrix presents several characteristics as a biomaterial for tissue regeneration, it did not display histopathological benefits in trachea tissue regeneration.

Achievement of LDL-Cholesterol Goals after Acute Myocardial Infarction: Real-World Data from the City of Curitiba Public Health System. / Alcance das Metas de Colesterol LDL após Infarto Agudo do Miocárdio: Dados Reais do Sistema Público de Saúde da Cidade de Curitiba.

BACKGROUND: Reduction of LDL-cholesterol (LDL-c) levels is the cornerstone in risk reduction, but many high-risk patients are not achieving the recommended lipid goals, even in high-income countries. OBJECTIVE: To evaluate whether patients seen in the city of Curitiba public health system are reaching LDL-c goals after an acute myocardial infarction (AMI). METHODS: This retrospective cohort explored the data of patients admitted with AMI between 2008 and 2015 in public hospitals from the city of Curitiba. In order to evaluate the attainment of the LDL-c target, we have used the last value registered in the database for each patient up to 2016. For those who had at least one LDL-c registered in the year before AMI, percentage of reduction was calculated. The level of significance adopted for statistical analysis was p<0.05. RESULTS: Of 7,066 patients admitted for AMI, 1,451 were followed up in an out-patient setting and had at least one evaluation of LDL-c. Mean age was 60.8±11.4 years and 35.8%, 35.2%, 21.5%, and 7.4% of patients had LDL-c levels ≥100, 70-99, 50-69 and <50 mg/dL, respectively. Of these, 377 patients also had at least one LDL-c evaluation before the AMI. Mean LDL-c concentrations were 128.0 and 92.2 mg/dL before and after AMI, with a mean reduction of 24.3% (35.7 mg/dL). LDL-c levels were reduced by more than 50% in only 18.3% of the cases. CONCLUSION: In the city of Curitiba public health system patients, after myocardial infarction, are not achieving adequate LDL-c levels after AMI.

FUNDAMENTO: A redução dos níveis de colesterol LDL é a pedra angular na redução de risco, mas muitos pacientes de alto risco não estão atingindo as metas lipídicas recomendadas, mesmo em países de alta renda. OBJETIVO: Avaliar se os pacientes atendidos na rede pública de saúde da cidade de Curitiba estão atingindo as metas de colesterol LDL após infarto agudo do miocárdio (IAM). MÉTODOS: Esta coorte retrospectiva explorou os dados de pacientes internados com IAM entre 2008 e 2015 em hospitais públicos da cidade de Curitiba. Para avaliar o atingimento da meta de colesterol LDL, utilizamos o último valor registrado no banco de dados para cada paciente até o ano de 2016. Para aqueles que tinham pelo menos um valor de colesterol LDL registrado no ano anterior ao IAM, calculou-se o percentual de redução. O nível de significância adotado para a análise estatística foi p<0,05. RESULTADOS: Dos 7.066 pacientes internados por IAM, 1.451 foram acompanhados em ambiente ambulatorial e tiveram pelo menos uma avaliação de colesterol LDL. A média de idade foi 60,8±11,4 anos e 35,8%, 35,2%, 21,5% e 7,4% dos pacientes apresentavam níveis de colesterol LDL≥100, 70­99, 50­69 e <50 mg/dL, respectivamente. Destes, 377 pacientes também tiveram pelo menos uma avaliação de colesterol LDL antes do IAM. As concentrações médias de colesterol LDL foram 128,0 e 92,2 mg/dL antes e após o IAM, com redução média de 24,3% (35,7 mg/dL). Os níveis de colesterol LDL foram reduzidos em mais de 50% em apenas 18,3% dos casos. CONCLUSÃO: Na cidade de Curitiba, pacientes do sistema público de saúde, após infarto do miocárdio, não estão atingindo níveis adequados de colesterol LDL após IAM.

Challenges faced by patients with dyslipidemia and systemic arterial hypertension in Brazil: a design of the patient journey.

BACKGROUND AND OBJECTIVE: Non-communicable diseases like systemic arterial hypertension (SAH) and dyslipidemia are poorly studied in terms of patient journey aspects. This semi-systematic review provides evidence synthesis for the management of SAH and dyslipidemia in Brazil and also discusses challenges faced by patients at the local level along with a suggested care approach by local experts. METHODS: A semi-systematic review using both structured literature databases (Embase and Medline) and unstructured scientific records (WHO, IPD, MOH and Google) on hypertension and dyslipidemia in the English language from 2010 to 2019 was performed by reviewers. After two-level screening based on pre-defined criteria, patient journey touchpoints and prevalence information were extracted from the included articles. Data gaps were bridged through the insights of local experts. RESULTS: Prevalence of hypertension and dyslipidemia in Brazil were 23% and 40.8%, respectively. Awareness of dyslipidemia was found in a larger proportion (58.1%) than in SAH (22.2%). Similarly, screening for hypertension (97%) and dyslipidemia (55.4%) were found to be effective, while treatment was (62.9%) and (30.0%) for hypertension and dyslipidemia, respectively. CONCLUSION: There were important gaps on patient awareness and treatment of dyslipidemia and hypertension. Limited patient education, regional disease distribution, and treatment allocation, along with limited resources for diagnosis and treatment are the key challenges.

Alcance das Metas de Colesterol LDL após Infarto Agudo do Miocárdio: Dados Reais do Sistema Público de Saúde da Cidade de Curitiba / Achievement of LDL-Cholesterol Goals after Acute Myocardial Infarction: Real-World Data from the City of Curitiba Public Health System

Resumo Fundamento A redução dos níveis de colesterol LDL é a pedra angular na redução de risco, mas muitos pacientes de alto risco não estão atingindo as metas lipídicas recomendadas, mesmo em países de alta renda. Objetivo Avaliar se os pacientes atendidos na rede pública de saúde da cidade de Curitiba estão atingindo as metas de colesterol LDL após infarto agudo do miocárdio (IAM). Métodos Esta coorte retrospectiva explorou os dados de pacientes internados com IAM entre 2008 e 2015 em hospitais públicos da cidade de Curitiba. Para avaliar o atingimento da meta de colesterol LDL, utilizamos o último valor registrado no banco de dados para cada paciente até o ano de 2016. Para aqueles que tinham pelo menos um valor de colesterol LDL registrado no ano anterior ao IAM, calculou-se o percentual de redução. O nível de significância adotado para a análise estatística foi p<0,05. Resultados Dos 7.066 pacientes internados por IAM, 1.451 foram acompanhados em ambiente ambulatorial e tiveram pelo menos uma avaliação de colesterol LDL. A média de idade foi 60,8±11,4 anos e 35,8%, 35,2%, 21,5% e 7,4% dos pacientes apresentavam níveis de colesterol LDL≥100, 70-99, 50-69 e <50 mg/dL, respectivamente. Destes, 377 pacientes também tiveram pelo menos uma avaliação de colesterol LDL antes do IAM. As concentrações médias de colesterol LDL foram 128,0 e 92,2 mg/dL antes e após o IAM, com redução média de 24,3% (35,7 mg/dL). Os níveis de colesterol LDL foram reduzidos em mais de 50% em apenas 18,3% dos casos. Conclusão Na cidade de Curitiba, pacientes do sistema público de saúde, após infarto do miocárdio, não estão atingindo níveis adequados de colesterol LDL após IAM.

Abstract Background Reduction of LDL-cholesterol (LDL-c) levels is the cornerstone in risk reduction, but many high-risk patients are not achieving the recommended lipid goals, even in high-income countries. Objective To evaluate whether patients seen in the city of Curitiba public health system are reaching LDL-c goals after an acute myocardial infarction (AMI). Methods This retrospective cohort explored the data of patients admitted with AMI between 2008 and 2015 in public hospitals from the city of Curitiba. In order to evaluate the attainment of the LDL-c target, we have used the last value registered in the database for each patient up to 2016. For those who had at least one LDL-c registered in the year before AMI, percentage of reduction was calculated. The level of significance adopted for statistical analysis was p<0.05. Results Of 7,066 patients admitted for AMI, 1,451 were followed up in an out-patient setting and had at least one evaluation of LDL-c. Mean age was 60.8±11.4 years and 35.8%, 35.2%, 21.5%, and 7.4% of patients had LDL-c levels ≥100, 70-99, 50-69 and <50 mg/dL, respectively. Of these, 377 patients also had at least one LDL-c evaluation before the AMI. Mean LDL-c concentrations were 128.0 and 92.2 mg/dL before and after AMI, with a mean reduction of 24.3% (35.7 mg/dL). LDL-c levels were reduced by more than 50% in only 18.3% of the cases. Conclusion In the city of Curitiba public health system patients, after myocardial infarction, are not achieving adequate LDL-c levels after AMI.

Association between anthropometric measures and insulin resistance in Brazilian adolescents: data from the national study of cardiovascular risk factors in adolescents - ERICA.

OBJECTIVES: To evaluate anthropometric measures (AM) and insulin resistance (IR) association in adolescents aged 12-17 years and investigates how body mass index (BMI) interrelates with specific indicators of fat distribution in this association. METHODS: This analysis is from the Study of Cardiovascular Risks in Adolescents (ERICA) study, a national, cross-sectional study. AM was categorized by quartiles, and their means and 95% confidence intervals (95% CI) were estimated. The prevalence of IR was estimated for each AM according to the quartiles. The associations between AM and homeostatic model assessment of insulin resistance (HOMA-IR) levels were analyzed using Poisson models. RESULTS: 37,892 adolescents were included. IR prevalence tended to increase as quartiles increased for each AM. The association of BMI with IR persisted with the adjustment for others AM. The greatest reduction in the association's strength was achieved with the adjustment by the waist circumference (WC) and the waist-to-height ratio (WHtR). Most other AM were also associated with IR. CONCLUSION: AM has a positive association with the prevalence of IR, and the joint effect of BMI and central adiposity measures should be considered in cardiometabolic risk evaluation in adolescents.

Obesity and COVID-19 in Latin America: A tragedy of two pandemics-Official document of the Latin American Federation of Obesity Societies.

In May 2020, Latin America became the epicenter of the COVID-19 pandemic, a region already afflicted by social disparities, poor healthcare access, inadequate nutrition and a large prevalence of noncommunicable chronic diseases. Obesity and its comorbidities are increasingly prevalent in Latin America, with a more rapid growth in individuals with lower income, and currently a disease associated with COVID-19 severity, complications and death. In this document, the Latin American Association of Obesity Societies and collaborators present a review of the burden of two pandemics in Latin America, discuss possible mechanisms that explain their relationship with each other and provide public health and individual recommendations, as well as questions for future studies.

Association Between Abdominal Waist Circumference and Blood Pressure In Brazilian Adolescents With Normal Body Mass Index: Waist circumference and blood pressure in Adolescents.

Obesity is the most common chronic disease in adolescents. In adults, waist circumference (WC) is associated with the presence of cardiovascular risk factors and is also a better predictor of cardiovascular (CV) risk than body mass index (BMI). The association between WC and CV risk factors in adolescents has been poorly explored so far, mainly in those within the normal BMI range. Objective: To evaluate the association between WC and elevated blood pressure (BP) in adolescents with a normal BMI. Methods: Cross-sectional analysis of 73,399 scholars between 12 and 17 years old from the ERICA study, a school-based, national representative study with Brazilian adolescents. Only those within the normal range of BMI were included. The WC was categorized into quartiles for sex and age (Q1 to Q4). For the analysis, BP values ≥ 90th percentile were considered to indicate elevated BP, what includes hypertension and pre-hypertension. The Poisson Regression model was used and the prevalence ratio was estimated. Results: A total of 53,308 adolescents with normal BMI were included. Prevalence of elevated BP in the overall group was 18.0%. In female adolescents with WC in the lowest quartile for their age, the prevalence of elevated BP was 7.3% (12-14 years) and 6.9% (15-17 years), increasing in the upper quartile to 15.2% and 19.5% respectively, with a prevalence ratio (PR) indicating chance at least two times higher for elevated BP in Q4 (p < 0.001). Similarly, this was observed in boys, with a prevalence of elevated BP of 10.0% and 18.9% in Q1, increasing to 21.4% and 49.6% in Q4 (p < 0.001). Conclusion: In adolescents, there is a strong association of increased WC with BP elevation, even when the BMI is adequate.

Stem Cells and Platelet-Rich Plasma Enhance the Healing Process of Tendinitis in Mice.

OBJECTIVE: Achilles tendon pathologies occur frequently and have a significant socioeconomic impact. Currently, there is no evidence on the best treatment for these pathologies. Cell therapy has been studied in several animal models, and encouraging results have been observed with respect to tissue regeneration. This study is aimed at evaluating the functional and histological effects of bone marrow stem cell or platelet-rich plasma implantation compared to eccentric training in the treatment of Achilles tendinopathy in rats. METHODS: Fourty-one male Wistar rats received collagenase injections into their bilateral Achilles tendons (collagenase-induced tendinopathy model). The rats were randomly divided into four groups: stem cells (SC), platelet-rich plasma (PRP), stem cells+platelet-rich plasma (SC+PRP), and control (eccentric training (ET)). After 4 weeks, the Achilles tendons were excised and subjected to biomechanical and histological analyses (Sirius red and hematoxylin-eosin staining). RESULTS: Biomechanical assessments revealed no differences among the groups in ultimate tensile strength or yield strength of the tendons (p = 0.157), but there were significant differences in the elastic modulus (MPa; p = 0.044) and maximum tensile deformation (p = 0.005). The PRP group showed the greatest maximum deformation, and the SC group showed the highest Young's modulus (elasticity) measurement. In histological analysis (hematoxylin-eosin and Sirius red staining), there were no differences among the groups. CONCLUSION: PRP and SC+PRP yielded better biomechanical results than eccentric training, showing that these treatments offer better tend function outcomes. This theoretical rationale for the belief that cell therapies can serve as viable alternatives to current treatments chronic fibrotic opens the door for opportunities to continue this research.

Regeneration of Tracheal Tissue in Partial Defects Using Porcine Small Intestinal Submucosa.

BACKGROUND: Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. METHODS: Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). RESULTS: The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. CONCLUSIONS: Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.

Impact of a High-Intensity Training on Ventricular Function in Rats After Acute Myocardial Infarction / Repercussão do Treinamento de Alta Intensidade sobre a Função Ventricular de Ratos após Infarto Agudo do Miocárdio

Abstract Background: Physical exercise should be part of the treatment of post-acute myocardial infarction (AMI) patients. Objective: To evaluate the effects of two training prescription models (continuous x interval) and its impact on ventricular function in rats after AMI with normal ventricular function. Methods: Forty Wistar rats were evaluated by echocardiography 21 days after the AMI. Those with LVEF = 50% (n = 29) were included in the study and randomized to control group (CG n = 10), continuous training group (CTG n = 9) or interval training group (ITG, n = 10). Then, a swimming test with control of lactate production was performed. Based on its result, the lactate threshold (LT) was established to define the training intensities. After six weeks, the animals were reassessed by echocardiography and lactate production. Outcome measures were end-diastolic diameter (EDD), end-systolic diameter (ESD), left ventricular ejection fraction (LVEF, %) lactate at rest, lactate without overload, and lactate with 12g and 13.5g of additional load. Group comparisons of quantitative variables of the study were performed by one-factor analysis of variance (ANOVA). The Newman-Keuls test was used for multiple comparisons of the groups. Within-group comparisons of dependent variables between the two training protocols were performed by Student's t-test. Normality of the variables was tested by the Shapiro-Wilks test. Values of p < 0.05 indicated statistical significance. Results: EDD, ESD, and LVEF before and after the training period were similar in within-group comparisons. However, EDD was significantly different (p=0.008) in the CG. Significant differences were found for L12g (p=0.002) and L13.5g (p = 0.032) in the ITG, and for L12g (p = 0.014) in the CG. No differences were found in the echocardiographic parameters between the groups. Significant differences were found in lactate without overload (p = 0.016) and L12 (p = 0.031) in the second assessment compared with the first, and between the groups - ITG vs. CG (p = 0.019) and CTG vs. CG (p = 0.035). Conclusion: Both methods produced a training effect without altering ventricular function.

Resumo Fundamento: O exercício físico deve fazer parte do tratamento de pacientes pós-infarto agudo do miocárdio (IAM). Objetivo: Avaliar os efeitos de treinamento produzidos por dois modelos distintos (contínuo x intervalado) e sua repercussão sobre a função ventricular de ratos pós-IAM com função ventricular normal. Métodos: Quarenta ratos Wistar pós-IAM foram avaliados ecocardiograficamente 21 dias após o evento. Aqueles com FEVE = 50% (n = 29) foram incluídos e randomizados: controle (GC n = 10), treinamento contínuo (GTC n = 9) e treinamento intervalado (GTI n = 10). Após, foi realizado um teste de natação com controle de lactato. A partir do resultado foi definido o limiar de lactato (LL) para determinar as intensidades do treinamento. Após seis semanas, foram reavaliados com ecocardiografia e controle de lactato. Como desfecho, foram avaliados: diâmetros diastólico e sistólico final (DDF, DSF, mL), fração de ejeção do ventrículo esquerdo (FEVE, %), lactato de repouso, livre de carga (LC), lactato com 12 g e 13,5 g de carga adicional. Para a comparação dos grupos em relação às variáveis quantitativas do estudo, foi considerado o modelo de análise da variância com um fator (ANOVA). Nas comparações múltiplas dos grupos foi usado o teste de Newman-Keuls. Na comparação entre as duas avaliações, dentro de cada grupo, foi usado o teste t de Student para amostras dependentes. A condição de normalidade das variáveis foi avaliada pelo teste de Shapiro-Wilks. Valores de p < 0,05 indicaram significância estatística. Resultados: Com relação à análise intragrupos, entre o período pré- e pós-treinamento foi identificado semelhança para DDF, DSF, FEVE, porém o GC apresentou diferença significativa para a variável DDF (p = 0,008). Houve diferença do GTI para L12g (p = 0,002) e L13,5g (p = 0,032) e para o GTC na variável L12g (p = 0,014). Não houve diferença para as variáveis ecocardiográficas entre os grupos. Houve diferença nas variáveis LC e L12g na segunda avaliação (p = 0,016 e p = 0,031, respectivamente) e entre os grupos: GTI vs. GC (p = 0,019) e GTC vs. GC (p = 0,035). Conclusão: Os dois métodos produziram efeito de treinamento sem alterar a função ventricular.

A randomized controlled trial to compare the effects of sulphonylurea gliclazide MR (modified release) and the DPP-4 inhibitor vildagliptin on glycemic variability and control measured by continuous glucose monitoring (CGM) in Brazilian women with type 2 diabetes.

AIMS: This study aims to evaluate whether there is a difference between the effects of vildagliptin and gliclazide MR (modified release) on glycemic variability (GV) in women with type 2 diabetes (T2DM) as evaluated by continuous glucose monitoring (CGM). METHODS: An open-label, randomized study was conducted in T2DM women on steady-dose metformin monotherapy which were treated with 50 mg vildagliptin twice daily or 60-120 mg of gliclazide MR once daily. CGM and GV indices calculation were performed at baseline and after 24 weeks. RESULTS: In total, 42 patients (age: 61.9 ±â€¯5.9 years, baseline glycated hemoglobin (HbA1c): 7.3 ±â€¯0.56) were selected and 37 completed the 24-week protocol. Vildagliptin and gliclazide MR reduced GV, as measured by the mean amplitude of glycemic excursions (MAGE, p = 0.007 and 0.034, respectively). The difference between the groups did not reach statistical significance. Vildagliptin also significantly decreased the standard deviation of the mean glucose (SD) and the mean of the daily differences (MODD) (p = 0.007 and 0.030). CONCLUSIONS: Vildagliptin and gliclazide MR similarly reduced the MAGE in women with T2DM after 24 weeks of treatment. Further studies are required to attest differences between vildagliptin and gliclazide MR regarding glycemic variability.

Impact of a High-Intensity Training on Ventricular Function in Rats After Acute Myocardial Infarction.

BACKGROUND: Physical exercise should be part of the treatment of post-acute myocardial infarction (AMI) patients. OBJECTIVE: To evaluate the effects of two training prescription models (continuous x interval) and its impact on ventricular function in rats after AMI with normal ventricular function. METHODS: Forty Wistar rats were evaluated by echocardiography 21 days after the AMI. Those with LVEF = 50% (n = 29) were included in the study and randomized to control group (CG n = 10), continuous training group (CTG n = 9) or interval training group (ITG, n = 10). Then, a swimming test with control of lactate production was performed. Based on its result, the lactate threshold (LT) was established to define the training intensities. After six weeks, the animals were reassessed by echocardiography and lactate production. Outcome measures were end-diastolic diameter (EDD), end-systolic diameter (ESD), left ventricular ejection fraction (LVEF, %) lactate at rest, lactate without overload, and lactate with 12g and 13.5g of additional load. Group comparisons of quantitative variables of the study were performed by one-factor analysis of variance (ANOVA). The Newman-Keuls test was used for multiple comparisons of the groups. Within-group comparisons of dependent variables between the two training protocols were performed by Student's t-test. Normality of the variables was tested by the Shapiro-Wilks test. Values of p < 0.05 indicated statistical significance. RESULTS: EDD, ESD, and LVEF before and after the training period were similar in within-group comparisons. However, EDD was significantly different (p=0.008) in the CG. Significant differences were found for L12g (p=0.002) and L13.5g (p = 0.032) in the ITG, and for L12g (p = 0.014) in the CG. No differences were found in the echocardiographic parameters between the groups. Significant differences were found in lactate without overload (p = 0.016) and L12 (p = 0.031) in the second assessment compared with the first, and between the groups - ITG vs. CG (p = 0.019) and CTG vs. CG (p = 0.035). CONCLUSION: Both methods produced a training effect without altering ventricular function.

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

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

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

Achieved systolic blood pressure in older people: a systematic review and meta-analysis.

BACKGROUND: It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment. METHODS: We searched 8 databases to identify randomized controlled trials (RCTs) and post-hoc analyses or subanalyses of RCTs reporting the effects of attaining different SBP levels <150 mmHg on the risk of stroke, acute myocardial infarction, heart failure, cardiovascular mortality and all-cause mortality in participants aged ≥60 years. We performed random-effects meta-analyses stratified by study design. RESULTS: Eleven studies (> 33,600 participants) were included. Compared with attaining SBP levels ≥140 mmHg, levels of 130 to <140 mmHg were not associated with lower risk of outcomes in the meta-analysis of RCTs, whereas there was an associated reduction of cardiovascular mortality (RR 0.72, 95% CI 0.59-0.88) and all-cause mortality (RR 0.86, 95% CI 0.75-0.99) in the meta-analysis of post-hoc analyses or subanalyses of RCTs. Limited and conflicting data were available for the SBP levels of <130 mmHg and 140 to <150 mmHg. CONCLUSIONS: Among older people, there is suggestive evidence that achieving SBP levels of 130 to <140 mmHg is associated with lower risks of cardiovascular and all-cause mortality. Future trials are required to confirm these findings and to provide additional evidence regarding the <130 and 140 to <150 mmHg SBP levels.

Waist Circumference is Associated with Blood Pressure in Children with Normal Body Mass Index: A Cross-Sectional Analysis of 3, 417 School Children / Circunferência da Cintura está Associada à Pressão Arterial em Crianças com Índice de Massa Corpórea Normal: Avaliação Transversal de 3 417 Crianças Escolares

Abstract Background: The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children. Objective: Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges. Methods: Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant. Results: Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17). Conclusion: In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.

Resumo Fundamento: A prevalência da obesidade infantil e condições associadas, tal como a hipertensão, tornou-se um grande problema de saúde pública. Embora a circunferência da cintura (CC) seja um marcador de risco cardiovascular em adultos, não está claro se esse índice está associado a fatores de risco cardiovascular em crianças. Objetivo: Avaliar a associação entre CC aumentada e pressão arterial (PA) elevada em crianças com índice de massa corpórea (IMC) normal. Métodos: Avaliação transversal de estudantes com idade entre 6 e 11 anos com IMC normal. A CC foi categorizada por quartil para cada faixa etária. PA normal foi definida como valores < percentil 90. Níveis acima dessa faixa foram considerados elevados. Valores de p<0,05 foram considerados estatisticamente significantes. Resultados: Das 5037 crianças inicialmente avaliadas, 404 (8%) foram excluídas por estarem abaixo do peso e 1216 (24,1%) foram excluídas por estarem com sobrepeso ou obesidade. Uma amostra final de 3417 crianças foi avaliada. A prevalência de PA elevada foi de 10,7%. Em crianças com CC no quartil mais baixo, a prevalência de PA elevada foi de 8,1%. Essa prevalência aumentou em quartis superiores: 10,6% no segundo, 12,4% no terceiro e 12,1% no quartil mais alto. Assim, nesse grupo, estar no quartil mais alto de CC associou-se com uma probabilidade 57% maior de apresentar PA elevada em comparação aos quartis mais baixos (Q4 vs. Q1; OR 1,57 - IC95% 1,14 - 2,17). Conclusão: Em crianças de 6 a 11 anos, circunferência da cintura aumentada está associada à PA elevada, mesmo quando o IMC é normal. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Waist Circumference is Associated with Blood Pressure in Children with Normal Body Mass Index: A Cross-Sectional Analysis of 3,417 School Children.

BACKGROUND: The prevalence of childhood obesity and associated conditions, such as hypertension, has become a major problem of public health. Although waist circumference (WC) is a marker of cardiovascular risk in adults, it is unclear whether this index is associated with cardiovascular risk factors in children. OBJECTIVE: Our aim was to evaluate the association between increased WC and elevated blood pressure (BP) in children with normal body mass index (BMI) ranges. METHODS: Cross-sectional evaluation of students between 6 and 11 years with normal BMI. WC was categorized by quartile for each age group. Normal BP was defined as values < 90th percentile, and levels above this range were considered elevated. Values of p < 0.05 were considered statistically significant. RESULTS: Of the 5,037 children initially assessed, 404 (8%) were excluded for being underweight and 1,216 (24.1%) were excluded for being overweight or obese. A final sample of 3,417 children was evaluated. The prevalence of elevated BP was 10.7%. In children with WC in the lowest quartile, the prevalence of elevated BP was 8.1%. This prevalence increased in upper quartiles: 10.6% in the second, 12.4% in third and 12.1% in the upper quartile. So, in this group, being in the highest WC quartile was associated with a 57% higher likelihood to present elevated BP when compared to those in the lowest quartile (Q4 vs Q1; OR 1.57 - 95%CI 1.14 - 2.17). CONCLUSION: In children aged 6 to 11 years, increased waist circumference is associated with elevated BP even when BMI is normal.