Daily ROX index can predict transitioning to mechanical ventilation within the next 24 h in COVID-19 patients on HFNC.

INTRODUCTION: High flow nasal cannula (HFNC) is used to prevent invasive ventilation in COVID-19-associated hypoxemia. The respiratory rate­oxygenation (ROX) index has been reported to predict failure of HFNC in patients with COVID-19 pneumonia during the intensive care unit stay when measured in first hours of therapy. However, the clinical course of ICU patients may change substantially in the first days of admission. The objective of this study was to investigate whether ROX index obtained in the first four days of ICU admission could predict the need for invasive respiratory support within the next 24 h of measurements. METHODS: A retrospective cross-sectional study was performed using a database that included adult patients with COVID-19 pneumonia treated in the ICU. Patients were followed from ICU admission and ROX index was calculated daily on HFNC. Receiver operating characteristics curves (ROCs) were performed. RESULTS: Two hundred forty-nine patients were enrolled, 48% of whom require mechanical ventilation (MV). The area under the ROC of the pooled 4-day values of the ROX index as a predictor of transition from HFNC to MV within 24 h of measurements was 0.86 (95%CI 0.83 to 0.88, P < 0.001) with a cutoff point of 4.06. CONCLUSION: In COVID-19 patients in high flow nasal cannula, daily ROX index measurements successfully predicted transition to mechanical ventilation within the next 24 h.

Influenza Vaccination as Prevention Therapy for Stable Coronary Artery Disease and Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials.

BACKGROUND: Influenza can cause a significant burden on patients with coronary artery disease. This meta-analysis assessed the effectiveness of influenza vaccination in patients with acute coronary syndrome and stable coronary artery disease. METHODS: We searched the Cochrane Controlled Register of Trials (CENTRAL), Embase, MEDLINE, www. CLINICALTRIALS: gov, and the World Health Organization International Clinical Trials Registry Platform from inception to September 2021. Estimates were summarized using the Mantel-Haenzel method and a random-effects model. To assess heterogeneity the I² statistic was used. RESULTS: Five randomized trials, comprising 4187 patients, were included, 2 of which included patients with acute coronary syndrome and 3 that included patients with stable coronary artery disease and acute coronary syndrome. Influenza vaccination significantly reduced the risk for all-cause mortality (relative risk [RR] = 0.56; 95% confidence interval [CI], 0.38-0.84), cardiovascular mortality (RR = 0.54; 95% CI, 0.37-0.80), major acute cardiovascular events (RR = 0.66; 95% CI, 0.49-0.88), and acute coronary syndrome (RR = 0.63; 95% CI, 0.44-0.89). On subgroup analysis, influenza vaccination remained effective for these outcomes in acute coronary syndrome but did not meet statistical significance in coronary artery disease. Furthermore, influenza vaccination did not reduce the risk for revascularization (RR = 0.89; 95% CI, 0.54-1.45), stroke or transient ischemic attack (RR = 0.85; 95% CI, 0.31-2.32), or heart failure hospitalization (RR = 0.91; 95% CI, 0.21-4.00). CONCLUSIONS: Influenza vaccine is a cheap and effective intervention to reduce the risk for all-cause mortality, cardiovascular mortality, major acute cardiovascular events, and acute coronary syndrome among coronary artery disease patients, especially in those with acute coronary syndrome.

Highlights of mechanisms and treatment of obesity-related hypertension.

The prevalence of obesity has increased two to three times from 1975 to 2015. Large-scale epidemiological and longitudinal prospective studies link obesity with hypertension. Research suggests that excessive weight gain, particularly when associated with visceral adiposity, may account for as much as 65% to 75% of the risk of incident hypertension. Also, exercise and bariatric/metabolic surgery significantly lowers blood pressure, whereas weight gain increases blood pressure, thus establishing a firm link between these two factors. The mechanisms underpinning obesity-related hypertension are complex and multifaceted, and include, but are not limited to, renin-angiotensin-aldosterone system/sympathetic nervous system overactivation, overstimulation of adipokines, insulin resistance, immune dysfunction, structural/functional renal, cardiac, and adipocyte changes. Though weight loss is the mainstay of treatment for obesity-related hypertension, it is often not a feasible long-term solution. Therefore, it is recommended that aggressive treatment with multiple antihypertensive medications combined with diet and exercise be used to lower blood pressure and prevent complications. The research regarding the mechanisms and treatment of obesity-related hypertension has moved at a blistering pace over the past ten years. Therefore, the purpose of this expert review is two-fold: to discuss the pathophysiological mechanisms underlying obesity-related hypertension, and to revisit pharmacotherapies that have been shown to be efficacious in patients with obesity-related hypertension.

Effects of phosphodiesterase 5 inhibition on cardiovascular function in resistant hypertension: A systematic review.

Approximately 12-18% of hypertensive patients are diagnosed with resistant hypertension (RH). The risk of having worse cardiovascular outcomes is twice higher in those patients. The low effectiveness of conventional antihypertensive drugs in RH emphasizes the need to evaluate complementary drug therapies to achieve blood pressure (BP) control. Previous studies have demonstrated that phosphodiesterase 5 (PDE-5) inhibitors improve hemodynamics and reduce BP on essential hypertension. So, the authors aimed to summarize current clinical trials-based evidence published concerning the use of PDE-5 inhibitors on BP, cardiovascular function, and hemodynamics of patients with RH. We searched MEDLINE, EMBASE, LILACS, ClinicalTrials.gov, and WHO International Clinical Trials Registry databases on May 15th, 2020 using pre-defined search terms. Two independent reviewers assessed and extracted data from clinical trials that evaluated the effect of PDE-5 inhibitors on BP. We have included five articles in this systematic review. Four of them developed a single-day protocol, while one has developed a 14-day study. The main findings indicate that PDE-5 inhibitors ameliorate BP, vascular hemodynamics, and diastolic function parameters. Some data demonstrated improvement of endothelial function, but it was not a consensus. The side effects seemed to be limited and well-tolerated. In brief, our systematic review highlights the potential of PDE-5 inhibitors as a therapeutic alternative in addition to the multiple-drug regime for RH. Larger studies are still needed to determine whether the beneficial effects of PDE-5 inhibitors on RH would be maintained with chronic administration.

Machine Learning Algorithms to Distinguish Myocardial Perfusion SPECT Polar Maps.

Myocardial perfusion imaging (MPI) plays an important role in patients with suspected and documented coronary artery disease (CAD). Machine Learning (ML) algorithms have been developed for many medical applications with excellent performance. This study used ML algorithms to discern normal and abnormal gated Single Photon Emission Computed Tomography (SPECT) images. We analyzed one thousand and seven polar maps from a database of patients referred to a university hospital for clinically indicated MPI between January 2016 and December 2018. These studies were reported and evaluated by two different expert readers. The image features were extracted from a specific type of polar map segmentation based on horizontal and vertical slices. A senior expert reading was the comparator (gold standard). We used cross-validation to divide the dataset into training and testing subsets, using data augmentation in the training set, and evaluated 04 ML models. All models had accuracy >90% and area under the receiver operating characteristics curve (AUC) >0.80 except for Adaptive Boosting (AUC = 0.77), while all precision and sensitivity obtained were >96 and 92%, respectively. Random Forest had the best performance (AUC: 0.853; accuracy: 0,938; precision: 0.968; sensitivity: 0.963). ML algorithms performed very well in image classification. These models were capable of distinguishing polar maps remarkably into normal and abnormal.

Machine Learning Algorithms to Detect Sex in Myocardial Perfusion Imaging.

Myocardial perfusion imaging (MPI) is an essential tool used to diagnose and manage patients with suspected or known coronary artery disease. Additionally, the General Data Protection Regulation (GDPR) represents a milestone about individuals' data security concerns. On the other hand, Machine Learning (ML) has had several applications in the most diverse knowledge areas. It is conceived as a technology with huge potential to revolutionize health care. In this context, we developed ML models to evaluate their ability to distinguish an individual's sex from MPI assessment. We used 260 polar maps (140 men/120 women) to train ML algorithms from a database of patients referred to a university hospital for clinically indicated MPI from January 2016 to December 2018. We tested 07 different ML models, namely, Classification and Regression Tree (CART), Naive Bayes (NB), K-Nearest Neighbors (KNN), Support Vector Machine (SVM), Adaptive Boosting (AB), Random Forests (RF) and, Gradient Boosting (GB). We used a cross-validation strategy. Our work demonstrated that ML algorithms could perform well in assessing the sex of patients undergoing myocardial scintigraphy exams. All the models had accuracy greater than 82%. However, only SVM achieved 90%. KNN, RF, AB, GB had, respectively, 88, 86, 85, 83%. Accuracy standard deviation was lower in KNN, AB, and RF (0.06). SVM and RF had had the best area under the receiver operating characteristic curve (0.93), followed by GB (0.92), KNN (0.91), AB, and NB (0.9). SVM and AB achieved the best precision. Our results bring some challenges regarding the autonomy of patients who wish to keep sex information confidential and certainly add greater complexity to the debate about what data should be considered sensitive to the light of the GDPR.

Comparison of clinical and histologic findings in daylight photodynamic therapy for skin field cancerization: A randomized controlled four-arm study on physical methods-assisted delivery of methyl aminolevulinate.

BACKGROUND: Daylight photodynamic therapy (DL-PDT) has similar efficacy to conventional photodynamic therapy in treating actinic keratosis (AKs). Good clinical outcomes have been reported when associated with physical methods such as microneedles, but a comparison of different methods and histologic studies is lacking. OBJECTIVES: To evaluate clinical and histologic modifications induced by standard DL-PDT and compare with DL-PDT associated with physical methods in treating skin field cancerization of the face. METHODS: Forty patients with photodamaged skin and at least one AK lesion on the face were randomly distributed into four groups, ten patients in each (I: Standard DL-PDT; II: DL-PDT + microneedles; III: DL-PDT + CO2 laser; IV: DL-PDT + microdermabrasion) and underwent two DL-PDT sessions with methyl aminolevulinate cream and 2-hour daylight exposure. Skin biopsies were performed on all patients before and 3 months after. All fragments were stained using the hematoxylin-eosin, orcein, and picrosirius. RESULTS: All 40 patients completed the study. Group III had a higher AK-clearance after 1 (p = 0,002) and 3 (p = 0,034) months, but it was similar in every group at 6 months (p = 0,441). Group III and IV had better clinical global improvement on texture, pigmentation and fine lines. In the groups associated with physical methods, the improvement of the keratinocytes' atypia and solar elastosis were remarkable. Only group III showed a significant reduction in solar elastosis (p = 0.034) and increased collagen type I (p = 0.028) after treatment. CONCLUSION: DL-PDT-associated with physical methods had better clinical and histologic results. AK-clearance were significantly higher after 1 and 3 months with pretreatment-CO2 laser. Photorejuvenation were more evident with pretreatment-CO2 laser and microdermabrasion. Pretreatment-CO2 laser showed a significant reduction in solar elastosis and increase of collagen type 1. These results pointed to the pretreatment with laser as a potentially better option for skin field cancerization of the face.

Liver stiffness as measured by transient elastography is a predictor of outcomes in patients with chronic heart failure with reduced, mid-range, and recovered left-ventricular ejection fraction.

Background: Transient elastography is a noninvasive method for assessing liver stiffness (LS), which can reflect right-sided filling pressure associated with passive liver congestion in patients with HF. Methods: A prospective, single-center observational study in which LS was measured in consecutive ambulatory patients with heart failure with reduced, mid-range, and recovered left ventricular ejection fraction, between March 2018 and June 2019. Mean follow up was 219 ± 86 days. The primary endpoint was time to first event, which was defined as a composite of cardiovascular death or HF hospitalization. Results: Eighty-five patients were included in the final analysis. Mean age was 62 ± 10 and 68% were male. Mean ejection fraction and median NT-proBNP were, respectively, 38.7 ± 14.3% and 1140 pg/mL (interquartile range 224.3-2810.3). The median LS for the entire population was 6.3 (2.5-41.2) kPa. LS correlated with NT-proBNP (r = 0.46; p < 0.0001), total bilirubin (r = 0.47; p < 0.001), direct bilirubin (r = 0.43; p = 0.0001), gama-glutamyl-transpeptidase (r = 0.54; p < 0.0001), and alkaline phosphatase (r = 0.39; p = 0.0004). A Receiver Operating Characteristic (ROC) curve was performed and a cut point of 5.9 kPa showed sensitivity of 80% and specificity of 64.1% with area under the curve of 0.73. Using Cox proportional hazard model (independent variables: LS as a continuous variable, age, gender, NT-proBNP, LVEF, and creatinine), only LS was independently associated with the primary endpoint (hazard ratio 1.05, 95% confidence interval 1.01-1.09; for each increment of one unit of LS). Conclusion: LS correlates with biomarkers of myocardial stretch and several liver function tests and is an independent predictor of outcomes in ambulatory patients with HF.

Prognosis of Heart Failure with Preserved Ejection Fraction in Primary Care by the H2FPEF Score

Abstract Background: Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care. Objective: The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease. Methods: This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e' ratio ranged from 0 to 9 points. The level of statistical significance was p<0.05. Results: HFpEF was diagnosed in 58(14.4%). Among patients with H2FPEF≥4, 30% had HFpEF and in those with a score≤4, HFpEF was present in 12%. Patients with HFpEF and H2FPEF≥4 had 53% of outcomes, whereas patients with HFpEF and a score ≤4 had a 21% of outcomes. BNP values were higher in patients with HFpEF compared to those without HFpEF(p<0.0001). Conclusion: H2FPEF≥4 indicated a worse prognosis in patients with HFpEF assisted in primary care. H2FPEF may be a simple and useful tool for risk stratification in patients with HFpEF at the primary care.

Artificial Intelligence in Cardiology: Concepts, Tools and Challenges - "The Horse is the One Who Runs, You Must Be the Jockey". / Inteligência Artificial em Cardiologia: Conceitos, Ferramentas e Desafios ­ "Quem Corre é o Cavalo, Você Precisa ser o Jóquei".

The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Complete Atrioventricular Block and Cardiopulmonary Involvement in Rapidly Progressive Systemic Sclerosis

Abstract The heart and lung are target organs in systemic sclerosis (SSc) and similar symptoms (dyspnea and cough) may make the differential diagnosis between the two lesions difficult. In addition, complete atrioventricular block (CAVB) is a rare complication of this disease. This case report is about a patient with SSc and pulmonary fibrosis who was admitted to the emergency room with CAVB, heart failure (HF) and progressive worsening of the underlying disease.

Inteligência Artificial em Cardiologia: Conceitos, Ferramentas e Desafios - Quem Corre é o Cavalo, Você Precisa ser o Jóquei / Artificial Intelligence in Cardiology: Concepts, Tools and Challenges - The Horse is the One Who Runs, You Must Be the Jockey

Resumo Os recentes avanços ao nível de hardware e a crescente exigência de personalização dos cuidados associados às necessidades urgentes de criação de valor para os pacientes contribuíram para que a Inteligência Artificial (IA) promovesse uma mudança significativa de paradigma nas mais diversas áreas do conhecimento médico, em particular em Cardiologia, por sua capacidade de apoiar a tomada de decisões e melhorar o desempenho diagnóstico e prognóstico. Nesse contexto, o presente trabalho faz uma revisão não-sistemática dos principais trabalhos publicados sobre IA em Cardiologia, com foco em suas principais aplicações, possíveis impactos e desafios.

Abstract The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Distinct mortality profile in systemic sclerosis: a death certificate study in Rio de Janeiro, Brazil (2006-2015) using a multiple causes of death analysis.

The objective of this study was to assess the mortality profile related to SSc in the state of Rio de Janeiro, Brazil. We retrospectively examined all registered deaths in the region (2006-2015 period) in which the diagnosis of SSc was mentioned on any line of the death certificates (underlying cause of death [UCD], n = 223; non-UCD, n = 151). Besides the analysis of gender, age, and the causes of death, we also compared the mortality from UCDs between individuals whose death causes included SSc (cases) and those whose death causes did not include SSc (deceased controls). For the latter comparison, we used the mortality odds ratio to approximate the cause-specific standardized mortality ratio. We identified 1495 death causes among the 374 SSc cases. The mean age at death of the SSc cases (85% women) was significantly lower than that of the controls (n = 1,294,117) (58.7 vs. 65.5 years, respectively). The main death causes were circulatory system diseases, infections, and respiratory diseases (36%, 34%, and 21% of SSc cases, respectively). Compared to the deceased controls, there were proportionally more deaths among the SSc cases from pulmonary arterial hypertension, lung fibrosis, septicemia, gastrointestinal hemorrhage, other systemic connective tissue diseases, and heart failure (for death age < 50 years). We confirmed the high burden of cardiovascular, respiratory, and infectious causes in this predominantly non-Caucasian sample of SSc patients. Of interest, the percentage of infection-related deaths in our report was about three times higher than that in SSc studies with predominantly Caucasian populations.

Association between B-type natriuretic peptide and within-visit blood pressure variability.

BACKGROUND: Blood pressure variability (BPV) has been shown to predict cardiovascular events. Within-visit BPV is the simplest and easiest measure of BPV, but previous studies have shown conflicts as to whether within-visit BPV correlates with target organ damage. We aimed to evaluate whether within-visit BPV correlates with B-type natriuretic peptide (BNP) in a general population. HYPOTHESIS: Within-visit BPV correlates with BNP in a general population. METHODS: This was a cross-sectional study that included 633 individuals, randomly selected, age 45 to 99 years, registered in the primary care program from an urban medium-sized town. Patients were scheduled for a single-day visit that consisted of clinical evaluation and laboratory tests. Three blood pressure (BP) readings, 1 minute apart, were done, and within-visit BPV was determined as the coefficient of variation (CV) of the 3 BP measures. Our main outcome was to correlate BNP and within-visit BPV. A multivariable model was estimated using a generalized linear model to evaluate the independent effects of different variables on BNP levels. RESULTS: The median age was 57 years. Median BNP was 16 pg/mL, and the median systolic and diastolic BP-CV were, respectively, 3.9% and 3.5%. There was a weak but positive correlation between BNP and both systolic BP-CV and diastolic BP-CV (r = 0.107 and P = 0.007 and r = 0.092 and P = 0.019, respectively). In multiple regression equation, systolic BP, diastolic BP-CV, body mass index, and estimated glomerular filtration rate were associated with BNP. CONCLUSIONS: In the present study, there was a positive, albeit weak, correlation between within-visit BPV and BNP. In addition, diastolic BPV was associated with BNP even after adjustment for multiple confounders.

The Role of Renin-Angiotensin-Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging.

Many cardiovascular diseases present renin-angiotensin-aldosterone system (RAAS) hyperactivity as an important pathophysiological mechanism to be target in the therapeutic approaches. Moreover, arterial stiffness is currently considered as a new independent risk factor for cardiovascular disease in different clinical conditions, including hypertension and chronic kidney disease. In fact, excessive stimulation of angiotensin type 1 (AT1) receptors, as well as mineralocorticoid receptors, results in cellular growth, oxidative stress and vascular inflammation, which may lead to arterial stiffness and accelerate the process of vascular aging. In the last decades, a vasoprotective axis of the RAAS has been discovered, and now it is well established that new components with antioxidant and anti-inflammatory properties play important roles promoting vasodilation, natriuresis and reducing collagen deposition, thus attenuating arterial stiffness and improving endothelial function. In this review, we will focus on these pathophysiological mechanisms and the relevance of RAAS inhibition by different strategies to increase arterial compliance and to decelerate vascular aging.

Pacientes cirróticos com escore Child-Pugh C apresentam intervalos QT mais longo / Cirrhotic patients with Child-Pugh C have longer QT intervals

Fundamento e objetivos: A cardiomiopatia cirrótica tem sido usada para descrever a disfunção cardíaca crônica em pacientes cirróticos sem doença cardíaca estrutural prévia. Além disso, o prolongamento do intervalo QT é uma das alterações cardíacas mais importantes relacionadas à cirrose. Estudos prévios sugerem que o prolongamento QT está associado com uma taxa de mortalidade mais alta em pacientes cirróticos. O objetivo deste estudo foi analisar intervalos QTs segundo a gravidade da cirrose, medida pela classificação Child-Plugh. Materiais e métodos: Em um estudo transversal, um total de 67 pacientes com cirrose não alcoólica submeteu-se à avaliação clínica e eletrocardiográfica. A gravidade da cirrose foi classificada de acordo com o escore Child-Pugh. O intervalo QT foi medido por um eletrocardiograma de 12 derivações. Resultados: Os intervalos QTs foram mais longos em pacientes no grupo Child-Plugh C que nos grupos Child-Pugh A e B (459 ± 33 vs 436 ± 25 e 428 ± 34 ms, respectivamente, p = 0,004). Houve uma correlação positiva entre o intervalo QT e o escore Child-Pugh em indivíduos com escore Child-Pugh ≥ 7 (r = 0,50; p < 0,05) e intervalos QT ≥ 440 ms (r = 0,46, p < 0,05). Conclusão: O presente estudo mostrou que pacientes com cirrose Child-Plugh C apresentam intervalos QTs mais longos, o que reforçou a relação entre a gravidade da cirrose e achados eletrocardiográficos da cardiomiopatia cirrótica. Além disso, esse resultado foi encontrado em pacientes sem sintomas cardíacos, o que destacou a importância de um método simples e não invasivo, como o eletrocardiograma, para identificar pacientes cirróticos com cardiomiopatia

Background and aims: Cirrhotic cardiomyopathy has been used to describe chronic cardiac dysfunction in cirrhotic patients with no previous structural heart disease. Additionally, QT prolongation is one of the most important cardiac alterations related to cirrhosis. Previous studies suggest that QT prolongation is associated with a higher mortality rate among cirrhotic patients. The aim of this study was to analyze QT intervals according to cirrhosis severity as measured by the Child-Pugh classification. Materials and methods: In a cross-sectional study, a total of 67 patients with nonalcoholic cirrhosis underwent clinical and electrocardiographic evaluation. Cirrhosis severity was classified according to the Child-Pugh score. The QT interval was measured by a 12-lead electrocardiogram. Results: The QT intervals were longer in patients in the Child-Pugh C group than those in the Child-Pugh A and B groups (459 ± 33 vs 436 ± 25 and 428 ± 34 ms, respectively, p=0.004). There was a positive correlation between the QT interval and the Child-Pugh score in individuals with Child-Pugh scores ≥ 7 (r=0.50, p<0.05) and QT intervals ≥ 440 ms (r=0.46, p<0.05). Conclusion: The present study showed longer QT intervals in patients with Child-Pugh C cirrhosis, which reinforced the relationship between the severity of cirrhosis and electrocardiographic findings of cirrhotic cardiomyopathy. Moreover, this finding emerged in patients with no cardiac symptoms, which highlighted the importance of a simple and noninvasive method (ECG) to identify cirrhotic patients with cardiomyopathy

Cardiodesfibrilador implantável na prevenção de morte súbita em paciente com distrofia muscular tipo 1 (doença de Steinert) / Implantable cardiac defibrillator for sudden death prevention in myotonic dystrophy type 1 (Steinert disease)

A distrofia muscular tipo 1 é uma miopatia hereditária genética com alto risco de morte súbita. Como a morte súbita é um evento comum, existe o desafio de identificar o paciente de maior risco para considerar a colocação de um cardiodesfibrilador implantável. O presente estudo relata o caso de um paciente com distrofia muscular tipo 1 com marcadores de alto risco para morte súbita, no qual foi implantado um cardiodesfibrilador implantável com sucesso. A correta estratificação para morte súbita é um importante passo na indicação do cardiodesfibrilador implantável

Myotonic dystrophy type 1 is a genetic and hereditary myopathy associated to a high risk of sudden death. As sudden death is a relatively common event, it is a challenge to identify those patients with highest risk to consider the use of an implantable cardiac defibrillator. The present case report describes a myotonic dystrophy type 1 patient with risk factors for sudden death in whom an implantable cardiac defibrillator was successfully implanted. The correct risk stratification for sudden death is an important step for the indication of an implantable cardiac defibrillator