O polimorfismo AGT*M235T na disfunção cardíaca de etiologia isquêmica aguda: projeto gisca / AGT*M235T polymorphism in acute ischemic cardiac dysfunction: the gisca project

FUNDAMENTO: O polimorfismo AGT*M235T tem sido associado a elevados níveis séricos de angiotensinogênio (AGT), hipertensão arterial sistêmica e disfunção cardíaca (DC). OBJETIVO: Testar a hipótese de haver associação entre polimorfismo AGT*M235T e o risco de desenvolver disfunção cardíaca (insuficiência cardíaca ou disfunção sistólica ventricular esquerda assintomática) pós-síndrome coronariana aguda (SCA), durante o período de internação hospitalar. MÉTODOS: Foram estudados 363 pacientes (idade média 62 ± 12 anos), sendo 233 (64 por cento) homens e 130 (36 por cento) mulheres, todos da mesma coorte, internados por SCA. Compararam-se dados clínicos e genéticos dos 117 (32,2 por cento) que evoluíram com disfunção cardíaca (grupo caso) com os dos 246 (67,8 por cento), que não desenvolveram tal condição (grupo controle). O polimorfismo AGT*M235T foi determinado por análise de sequenciamento e estava em equilíbrio de Hardy-Weinberg. RESULTADOS: Houve diferença significativa na distribuição dos genótipos nas mulheres, com predomínio do genótipo *235MM no grupo controle (p = 0,001) e do alelo *235T no grupo caso. Em ambos os sexos, nos modelos de regressão logística, o diagnóstico de infarto de parede anterior na admissão foi fator de incremento no risco de DC, enquanto angina instável na admissão, ausência do alelo *235T, glicemia < 100 mg/dl, uso de betabloqueador, creatinina sérica < 1,5 mg/dl, faixa de frequência cardíaca > 60 e < 90 bpm e tabagismo atual foram fatores de redução do risco de DC. CONCLUSÃO: Este estudo sugere que a ausência do alelo *235T do AGT contribui para a redução do risco de disfunção cardíaca pós-síndrome coronariana aguda.

BACKGROUND: AGT*M235T polymorphism has been associated with high serum angiotensinogen (AGT) levels, systemic hypertension and cardiac dysfunction (CD). OBJECTIVE: To test the hypothesis of AGT*M235T polymorphism being associated with the risk of developing cardiac dysfunction (heart failure or asymptomatic left ventricular systolic dysfunction) after acute coronary syndrome (ACS) during hospitalization. METHODS: A total of 363 patients (mean age of 62 ± 12 years), of whom 233 (64 percent) were men and 130 (36 percent) were women, all from the same cohort and hospitalized for ACS, were studied. Clinical and genetic data from the 117 (32.2 percent) patients who developed cardiac dysfunction (case group) were compared to those of the 246 (67.8 percent) who did not develop this condition (control group). The AGT*M235T polymorphism was determined by sequence analysis and was in Hardy-Weinberg equilibrium. RESULTS: There was a significant difference in the distribution of genotypes among women, with a predominance of the *235MM genotype in the control group (p = 0.001) and of the *235T allele in the case group. In the logistic regression models, the diagnosis of anterior wall myocardial infarction at admission was related to an increased risk of CD in both genders, whereas unstable angina at admission.; absence of the *235T allele; blood glucose <100 mg/dl; use of betablocker; serum creatinine level < 1.5 mg/dl;heart rate range > 60 and < 90 bpm; and current cigarette smoking were related to a lower risk of CD. CONCLUSION: This study suggests that the absence of the AGT *235T allele contributes to a reduced risk of cardiac dysfunction after acute coronary syndrome.

AGT*M235T polymorphism in acute ischemic cardiac dysfunction: the gisca project.

BACKGROUND: AGT*M235T polymorphism has been associated with high serum angiotensinogen (AGT) levels, systemic hypertension and cardiac dysfunction (CD). OBJECTIVE: To test the hypothesis of AGT*M235T polymorphism being associated with the risk of developing cardiac dysfunction (heart failure or asymptomatic left ventricular systolic dysfunction) after acute coronary syndrome (ACS) during hospitalization. METHODS: A total of 363 patients (mean age of 62 ± 12 years), of whom 233 (64%) were men and 130 (36%) were women, all from the same cohort and hospitalized for ACS, were studied. Clinical and genetic data from the 117 (32.2%) patients who developed cardiac dysfunction (case group) were compared to those of the 246 (67.8%) who did not develop this condition (control group). The AGT*M235T polymorphism was determined by sequence analysis and was in Hardy-Weinberg equilibrium. RESULTS: There was a significant difference in the distribution of genotypes among women, with a predominance of the *235MM genotype in the control group (p = 0.001) and of the *235T allele in the case group. In the logistic regression models, the diagnosis of anterior wall myocardial infarction at admission was related to an increased risk of CD in both genders, whereas unstable angina at admission.; absence of the *235T allele; blood glucose <100 mg/dl; use of betablocker; serum creatinine level < 1.5 mg/dl;heart rate range > 60 and < 90 bpm; and current cigarette smoking were related to a lower risk of CD. CONCLUSION: This study suggests that the absence of the AGT *235T allele contributes to a reduced risk of cardiac dysfunction after acute coronary syndrome.

Severity of angiographic coronary obstruction and the apolipoprotein E polymorphism in acute coronary syndromes.

BACKGROUND: There is evidence of the association between the apolipoprotein E (APOE) and coronary disease; however, there are controversies. OBJECTIVE: To evaluate the association between the number of coronary vessels with significant obstruction defined by angiography, the APOE polymorphism and clinical variables. METHODS: This was a cross-sectional, multicenter study with 207 patients (138 men), with acute coronary syndrome (ACS), in the city of Niteroi, state of Rio de Janeiro, Brazil, who underwent coronary angiography and genotype determination for the APOE *2*3*4 polymorphism by the Restriction Fragment Length Polymorphism (RFLP) method. RESULTS: The frequency of the alleles was APOE *2 - 6.8%, *3 - 82.5%, *4 - 10.7%. Regarding the number of affected vessels, 27% of patients presented monoarterial obstruction, 33.8% biarterial and 39.1% triarterial and/or left coronary trunk. The degree of multivascular lesion did not correlate with the presence of the *4 allele (p= 0.78), but with age > 55 years (p=0.025), being an ex-smoker (p=0.004) and dyslipidemia (p=0.05) at the multivariate analysis and also with previous coronary artery disease (CAD) (p=0.05), diabetes (p=0.038) and metabolic syndrome (p=0.021) at the univariate analysis. The prevalence of dyslipidemia, diabetes and systemic arterial hypertension (SAH) was elevated regarding similar studies, with progressive increases in the prevalence of SAH (p=0.59) and diabetes (p=0.06), according to the number of affected vessels. CONCLUSION: The APOE polymorphism was not associated with the number of coronary vessels with significant obstruction at any age range. On the other hand, age > 55 years, being an ex-smoker and dyslipidemia associated with the multivascular lesion.

Gravidade da lesão angiográfica coronariana e polimorfismo da APOE nas síndromes coronarianas agudas / Severidad de la lesión angiográfica coronaria y polimorfismo de la APOE en los síndromes coronarios agudos / Severity of angiographic coronary obstruction and the apolipoprotein E polymorphism in acute coronary syndromes

FUNDAMENTO: Existem evidências de associação entre o polimorfismo da apolipoproteína E (APOE) e a doença coronariana, entretanto há controvérsias. OBJETIVO: Avaliar a associação entre o número de vasos coronarianos acometidos por obstrução significativa definida por angiografia, o polimorfismo da APOE e as variáveis clínicas. MÉTODOS: Estudo transversal multicêntrico que envolveu 207 pacientes (138 homens) com síndrome coronariana aguda (SCA) em Niterói (RJ - Brasil), os quais realizaram angiografia coronariana e determinação do genótipo para o polimorfismo APOE *2*3*4, pelo método de Restriction Fragment Length Polymorphism (RFLP). RESULTADOS: A frequência dos alelos APOE *2 foi de 6,8 por cento, *3 foi de 82,5 por cento, e *4 foi de 10,7 por cento. Quanto ao número de vasos lesados, 27 por cento dos pacientes apresentavam obstrução uniarterial, 33,8 por cento, biarterial, e 39,1 por cento, triarterial ou de tronco da coronária esquerda. O grau de lesão multivascular não se relacionou com a presença do alelo *4 (p = 0,78), mas com a idade > 55 anos (p = 0,025), o ex-tabagismo (p = 0,004) e a dislipidemia (p = 0,05) na análise multivariada e com doença arterial coronariana prévia (p = 0,05), diabete (p = 0,038) e síndrome metabólica (p = 0,021) na análise univariada. A prevalência de dislipidemia, diabete e hipertensão arterial sistêmica (HAS) foi elevada em relação a estudos semelhantes, com aumento progressivo da prevalência de HAS (p = 0,59) e de diabete (p = 0,06), de acordo com o número de vasos lesados. CONCLUSÃO: O polimorfismo da APOE não se associou ao número de vasos coronarianos com obstrução significativa em qualquer faixa etária. Por outro lado, a idade > 55 anos, o ex-tabagismo e a dislipidemia associaram-se à lesão multivascular.

BACKGROUND: There is evidence of the association between the apolipoprotein E (APOE) and coronary disease; however, there are controversies. OBJECTIVE: To evaluate the association between the number of coronary vessels with significant obstruction defined by angiography, the APOE polymorphism and clinical variables. METHODS: This was a cross-sectional, multicenter study with 207 patients (138 men), with acute coronary syndrome (ACS), in the city of Niteroi, state of Rio de Janeiro, Brazil, who underwent coronary angiography and genotype determination for the APOE *2*3*4 polymorphism by the Restriction Fragment Length Polymorphism (RFLP) method. RESULTS: The frequency of the alleles was APOE *2 - 6.8 percent, *3 - 82.5 percent, *4 - 10.7 percent. Regarding the number of affected vessels, 27 percent of patients presented monoarterial obstruction, 33.8 percent biarterial and 39.1 percent triarterial and/or left coronary trunk. The degree of multivascular lesion did not correlate with the presence of the *4 allele (p= 0.78), but with age > 55 years (p=0.025), being an ex-smoker (p=0.004) and dyslipidemia (p=0.05) at the multivariate analysis and also with previous coronary artery disease (CAD) (p=0.05), diabetes (p=0.038) and metabolic syndrome (p=0.021) at the univariate analysis. The prevalence of dyslipidemia, diabetes and systemic arterial hypertension (SAH) was elevated regarding similar studies, with progressive increases in the prevalence of SAH (p=0.59) and diabetes (p=0.06), according to the number of affected vessels. CONCLUSION: The APOE polymorphism was not associated with the number of coronary vessels with significant obstruction at any age range. On the other hand, age > 55 years, being an ex-smoker and dyslipidemia associated with the multivascular lesion.

FUNDAMENTO: Hay evidencias de asociación entre el polimorfismo de la apolipoproteína E (APOE) y la enfermedad coronaria, sin embargo hay controversias. OBJETIVO: Evaluar la asociación entre el número de vasos coronarios afectados por obstrucción significativa definida por angiografía, el polimorfismo de la APOE y las variables clínicas. MÉTODOS: Estudio transversal multicéntrico que implicó a 207 pacientes (138 varones) con síndrome coronario agudo (SCA) en la ciudad de Niterói (RJ - Brasil), los que realizaron angiografía coronaria, y determinación del genotipo para el polimorfismo APOE *2*3*4 mediante el método de Restriction Fragment Length Polymorphism (RFLP). RESULTADOS: La frecuencia de los alelos APOE *2 fue del 6,8 por ciento, *3 fue del 82,5 por ciento, y *4 fue del 10,7 por ciento. En cuanto al número de vasos lesionados, el 27 por ciento de los pacientes presentaban obstrucción uniarterial, el 33,8 por ciento, biarterial, y el 39,1 por ciento, triarterial o de tronco de la coronaria izquierda. El grado de lesión multivascular no se relacionó con la presencia del alelo *4 (p = 0,78), sino con la edad > 55 años (p = 0,025), el ex tabaquismo (p = 0,004) y la dislipidemia (p = 0,05) en el análisis multivariado y con la enfermedad arterial coronaria previa (p = 0,05), la diabetes (p = 0,038) y el síndrome metabólico (p = 0,021) en el análisis univariado. La prevalencia de dislipidemia, diabetes e hipertensión arterial sistémica (HAS) fue elevada con relación a estudios semejantes, con aumento progresivo de la prevalencia de HAS (p = 0,59) y de diabetes (p = 0,06), según el número de vasos lesionados. CONCLUSIÓN: El polimorfismo de la APOE no se asoció al número de vasos coronarios con obstrucción significativa en cualquier grupo de edad. Por otro lado, la edad > 55 años, el ex tabaquismo y la dislipidemia se asociaron a la lesión multivascular.

Síndrome coronariana aguda: morbimortalidade e prática clínica em pacientes do município de Niterói (RJ) / Acute coronary syndromes: morbidity / mortality and clinical practice in patients of Niterói, Rio de Janeiro State, Brazil

Fundamentos: As doenças cardiovasculares são a principal causa de óbito no Brasil. Objetivo: Analisar as características clínico-epidemiológicas, condutas diagnósticas e terapêuticas e morbimortalidade intra-hospitalar de pacientes com síndrome coronariana aguda (SCA) no município de Niterói (RJ), Brasil. Métodos: Foram acompanhados durante a internação, 411 pacientes com SCA em três hospitais públicos e dois particulares. Dados coletados: socioeconômicos, história patológica pregressa, fatores de risco cardiovascular, medicação prévia e na internação, exames complementares, procedimentos e evolução clínica intra-hospitalar. Resultados: Angina instável foi diagnosticada em 41,4 por cento e infarto agudo do miocárdio (IAM) em 58,6 por cento. Idade maior ou menor que 60 anos representou 55 por cento do total e sexo masculino, 63,7 por cento...

Divertículo gigante de sigmóide / Giant sigmoid diverticulum

Os autores relatam um caso de divertículo de sigmóide, complicaçao rara da doença diverticular do cólon. Estudam as teorias atuais que explicam sua fisiopatologia e comentam o quadro clínico, com os métodos de diagnóstico e as possibilidades terapêuticas a serem empregadas.