Advanced echocardiography techniques (AETs) to assess left atrial structure and function in individuals with resistant hypertension.

AIMS: Resistant hypertension (RH) is a challenging phenotype within the hypertension (HTN) spectrum, requiring careful assessment and follow-up. Evaluation of left atrial function may be clinically informative, but is usually neglected. Advanced Echocardiography Techniques (AETs), such as Strain Analysis and three-dimensional echocardiography (3D ECHO) may be useful complementary tools to assess atrial function in patients with RH. METHODS AND RESULTS: Ninety-six eligible adult patients were categorized into three groups: resistant hypertensive (RH), controlled hypertensive (CH), and normotensive (N), and underwent AETs to identify morphofunctional changes in the left atrium (LA) across different HTN phenotypes. The LA reservoir strain was significantly lower among RH than in N and CH patients (p < .001). Accordingly, LA conduit strain showed a gradient through the groups: higher among N, followed by CH and RH patients (p = .015). LA contraction strain was higher among CH than in N and RH patients (p = .02). Maximum indexed, pre-A, and minimum atrial volumes obtained by 3D ECHO showed differences between N and the others (p < .001), but not between CH and RH. N patients showed a higher fraction of passive emptying of the LA than the others (p = .02), with no difference between CH and RH. Total emptying of the LA only differed between N and RH patients, while active emptying of the LA showed no difference between the groups (p = .82). CONCLUSION: The left atrium may present early functional changes in response to HTN, which are detectable by AETs. AETs, especially S-LA, allowed to identify markers of atrial myocardial damage in both RH and CH patients.

Advanced echocardiography techniques (AETs) to assess left atrial structure and function in individuals with resistant hypertension

AIMS: Resistant hypertension (RH) is a challenging phenotype within the hypertension (HTN) spectrum, requiring careful assessment and follow-up. Evaluation of left atrial function may be clinically informative, but is usually neglected. Advanced Echocardiography Techniques (AETs), such as Strain Analysis and three-dimensional echocardiography (3D ECHO) may be useful complementary tools to assess atrial function in patients with RH. METHODS AND RESULTS: Ninety-six eligible adult patients were categorized into three groups: resistant hypertensive (RH), controlled hypertensive (CH), and normotensive (N), and underwent AETs to identify morphofunctional changes in the left atrium (LA) across different HTN phenotypes. The LA reservoir strain was significantly lower among RH than in N and CH patients (p < .001). Accordingly, LA conduit strain showed a gradient through the groups: higher among N, followed by CH and RH patients (p = .015). LA contraction strain was higher among CH than in N and RH patients (p = .02). Maximum indexed, pre-A, and minimum atrial volumes obtained by 3D ECHO showed differences between N and the others (p < .001), but not between CH and RH. N patients showed a higher fraction of passive emptying of the LA than the others (p = .02), with no difference between CH and RH. Total emptying of the LA only differed between N and RH patients, while active emptying of the LA showed no difference between the groups (p = .82). CONCLUSION: The left atrium may present early functional changes in response to HTN, which are detectable by AETs. AETs, especially S-LA, allowed to identify markers of atrial myocardial damage in both RH and CH patients.

Análise funcional do átrio esquerdo na identificação da injuria hipertensiva incipiente / Functional analysis of the left atrium in the identification of incipient hypertensive injury

INTRODUÇÃO: Alterações estruturais e funcionais do ventrículo esquerdo decorrentes da hipertensão arterial são bem caracterizadas e constituem valiosos marcadores prognósticos. Embora a análise estrutural do átrio esquerdo (AE) pelo cálculo do volume atrial seja parte da avaliação ecocardiográfica de rotina, sua avaliação funcional é menos usual. O estudo da deformação do AE por meio do strain longitudinal e o cálculo da rigidez atrial esquerda podem permitir caracterizar suas alterações funcionais adaptativas ao longo do espectro pressórico. OBJETIVO: Avaliar a função atrial esquerda em diferentes fenótipos de hipertensos. METODOLOGIA: Hipertensos Resistentes (HR); Hipertensos Controlados (HC) e Normotensos (N), assim categorizados a partir da monitorização ambulatorial da pressão arterial de 24 horas, foram submetidos a avaliação ecocardiográfica transtorácica avançada, incluindo a análise de deformação miocárdica pelo strain e o cálculo da rigidez atrial esquerda. Os grupos foram comparados entre si quanto a parâmetros estruturais e funcionais do AE. RESULTADOS: 96 pacientes foram considerados elegíveis para o estudo, sendo 32 indivíduos alocados em cada grupo. O volume indexado do AE foi semelhante entre HC (30 ± 7 mL/m2 ) e HR (33 ± 10 mL/m2 ) e menor nos N (25 ± 4 mL/m2 ) ­ p < 0,05. O índice de massa ventricular esquerda foi maior nos HR (102,0 ± 24,2 g/m2 ), seguido dos HC (83,2 ± 16,8 g/m2 ) e N (67,1 ± 10,9 g/m2 ) ­ p < 0,05. Nenhum paciente do grupo N apresentou disfunção diastólica, enquanto a disfunção diastólica grau I foi observada em 32% dos HC e 52% dos HR. O strain longitudinal global do VE foi semelhante entre N (20 ± 2%) e HC (20 ± 3%), mas reduzido nos HR (17 ± 3%). A avaliação funcional do AE incluiu o strain atrial em suas 3 fases: reservatório, conduto e contração. O strain de reservatório foi semelhante entre N (34% ± 6) e HC (33% ± 6), mas reduzido nos HR (27% ± 7; p < 0,001). O strain de conduto foi maior no grupo N (19% ± 6), seguido em ordem decrescente pelo HC (16% ± 5) e HR (12% ± 5; p = 0,015). O strain de contração foi maior no grupo HC (17% ± 4), diferindo dos grupos N (15% ± 3) e HR (12% ± 5; p < 0,02). O grupo HR apresentou os maiores índices de rigidez do átrio esquerdo, seguido em ordem decrescente pelos grupos HC e N (p < 0,001). CONCLUSÃO: A função do AE apresentou diferenças significativas de acordo com o fenótipo dos hipertensos. Enquanto nos HR o AE se apresenta mais rígido e com menores índices de deformação que os HC, estes apresentam função contrátil mais intensa, mesmo quando comparados aos normotensos.

Evaluation of myocardial work in patients with resistant arterial hypertension

AIMS: Individuals with resistant arterial hypertension are particularly at risk of developing target organ damage and cardiovascular events. The advanced echocardiography technique called myocardial work (MW), through the analysis of the left ventricular pressure-strain loop, is among the possibilities for evaluating these individuals. Our study was designed to describe the behavior of MW indices in individuals with resistant arterial hypertension (RH), controlled hypertension (CH), and normal arterial pressure (N). METHODS AND RESULTS: Seventy-one patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and were characterized into three groups after a medical consult: RH (subjects with hypertension on four or more antihypertensive medications despite having controlled blood pressure); CH (subjects with hypertension on up to two antihypertensive medications); and N (individuals with normal ABPM; not using any medications). Echocardiographic analysis was performed using the Vivid E95 ultrasound system and blood pressure was measured at the time of the examination and subsequently used to determine myocardial work indices. RH demonstrated lower global work efficiency (GWE, mean = .95%; p = .005) and higher global wasted work (GWW, mean = 114 mm Hg%; p = .011) compared to other groups. Left ventricular mass measured by three-dimensional echocardiography, systolic wall stress, relative wall thickness and peak systolic dispersion were inversely correlated to GWE. No difference was observed between CH and N groups regarding MW indices. On multivariate analysis, only systolic wall stress remained as an independent predictor of GWE, when controlled by 3D mass index, relative wall thickness, peak systolic dispersion, and the hypertension group. CONCLUSION: Individuals with resistant hypertension have lower global work efficiency and higher global wasted work, compared to individuals with controlled hypertension and without arterial hypertension.

Terapia farmacológica para redução do risco cardiovascular no portador de diabetes / Pharmacological therapy to reduce cardiovascular risk in patients with diabetes

O Diabetes Mellitus é uma condição de elevada prevalência e grande morbidade, principalmente devido à doença cardiovascular. O avanço no tratamento da diabetes tem aumentado a sobrevida dos pacientes e com isso, aumentado a incidência de complicações crônicas. Atualmente, diversas estratégias terapêuticas são propostas para tentar reduzir o risco de complicações cardiovasculares nesse grupo de pacientes...

Nutritional repercussions in patients submitted to bariatric surgery.

BACKGROUND: Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. AIM: To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. METHOD: A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. RESULTS: The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m(²). In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. CONCLUSION: Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight.

Nutritional repercussions in patients submitted to bariatric surgery / Repercussões nutricionais em pacientes submetidos à cirurgia bariátrica

BACKGROUND: Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. AIM: To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. METHOD: A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. RESULTS: The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m². In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. CONCLUSION: Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight. .

RACIONAL: Poucos estudos avaliam a associação entre distúrbios nutricionais, qualidade de vida e perda de peso em pacientes submetidos à cirurgia bariátrica. OBJETIVO: Identificar alterações nutricionais em pacientes submetidos à cirurgia bariátrica e correlacioná-las com perda de peso, controle de comorbidades e qualidade de vida. MÉTODO: Estudo de coorte, prospectivo, analítico e descritivo envolvendo 59 pacientes submetidos à cirurgia bariátrica. Os dados foram coletados no pré-operatório e aos três e seis meses pós- operatórios, quantificando aspectos nutricionais e utilizando o Bariatric Analysis and Reporting Outcomes System (BAROS) como ferramenta de sucesso. Os dados usaram intervalo de confiança de 95%. RESULTADOS: O total de mulheres foi 47 (79,7%), sendo 55,9% com IMC entre 40-49,9 kg/m². No sexto mês depois da operação os escores de qualidade de vida foram significativamente maiores do que no pré-operatório (p<0,05) e 27 (67,5%) pacientes tinham todas comorbidades resolvidas, 48 (81,3%) apresentaram conceito BAROS muito bom ou excelente. Após três e seis meses 16 e 23 pacientes apresentaram algum distúrbio nutricional, respectivamente. Não houve relação entre a perda do excesso de peso e qualidade de vida entre pacientes com ou sem distúrbio nutricional. CONCLUSÃO: os distúrbios nutricionais são pouco frequentes no pós-operatório precoce e, quando presentes, têm pouca ou nenhuma influência na qualidade de vida e na perda do excesso de peso. .

Avaliação do controle da asma em pacientes acompanhados em dois ambulatórios de pneumologia vinculados à Estratégia Saúde da Família em Tubarão, Santa Catarina, Brasil / Assessment of asthma control in patients monitored at two pulmonology outpatient clinics linked to the Family Health Strategy in Tubarão, Santa Catarina state, Brazil / Evaluación del control del asma en pacientes asistidos en dos ambulatorios de neumología vinculados a la Estrategia de Salud Familiar en Tubarão, Santa Catarina, Brasil

Introdução: A asma é uma doença crônica debilitante, que pode gerar restrições diretamente ligadas a um mau controle da doença. O controle da asma pode ser avaliado por instrumentos padronizados. Objetivo: Determinar o controle da asma por meio do Questionário de Controle da Asma (QCA) e do Teste de Controle da Asma (TCA) e a classificação de acordo com as Diretrizes para o Manejo da Asma, de 2012. Métodos: Estudo observacional transversal com pacientes atendidos em ambulatórios de referência vinculados à Estratégia Saúde da Família em Tubarão-SC. A população foi composta por todos os pacientes asmáticos adultos que recorreram a consultas médicas durante o período de janeiro a novembro de 2010. Os dados foram compilados em uma planilha Excel e analisados pelo programa INSTAT 3. Foi realizada análise descritiva e aplicado teste quiquadrado para verificar associação entre respostas do TCA e QCA. Resultados: Foram avaliados 49 pacientes, tendo, a maioria deles, asma intermitente ou persistente leve (51%). Na avaliação do controle da asma o TCA mostrou que 69,3% dos pacientes não estavam controlados. Em relação ao QCA, foram considerados fora do alvo 75,5% dos pacientes. Houve associação significativa entre o TCA e QCA (p<0,05). Quanto às Diretrizes para o Manejo da Asma, 2012, 57,14% dos pacientes foram considerados não controlados; 30,6% estavam parcialmente controlados; e 12,2%, controlados. Conclusão: Os asmáticos estavam, em sua maioria, não controlados. Torna-se necessário identificar os fatores ligados ao descontrole e buscar estratégias, visando melhorar os escores para redução da morbimortalidade associada à asma.

Introduction: Asthma is a chronic debilitating disease which can generate constraints directly associated with poor disease control. Asthma control can be evaluated using standardized instruments. Objective: To determine asthma control through the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT), and to classify it according to the Guidelines for the Management of Asthma, 2012. Methods: This is a cross-sectional observational study with patients of two pulmonology outpatient clinics linked to the Family Health Strategy in the municipality of Tubarão, Santa Catarina state. The population consisted of all adult asthmatic patients who resorted to medical appointments from January to November 2010. The data were compiled in Excel and analyzed by INSTAT 3 software. We performed descriptive analysis and applied the chi-square test to assess the association between ACT and ACQ answers. Results: We evaluated 49 patients, most of them presenting intermittent or mild persistent asthma (51%). In the assessment of asthma control, ACT showed that 69.3% of patients were considered uncontrolled, while ACQ showed that 75.5% of patients were considered off-target. Significant association was found between ACT and ACQ (p<0.05). Regarding the 2012 Guidelines for the Management of Asthma, 57.14% of patients were considered uncontrolled; 30.6% were partially controlled; and 12.2% were controlled. Conclusion: Most asthmatics were uncontrolled. It is necessary to identify the factors related to uncontrolled patients and search strategies to improve health scores for reduction of morbimortality caused by asthma.

Introducción: El asma es una enfermedad crónica debilitante, que puede generar restricciones directamente relacionadas con el mal control de la enfermedad. El control del asma puede ser evaluado utilizando instrumentos estandarizados. Objetivo: Determinar el control del asma a través del Cuestionario de Control del Asma (CCA) y la Prueba de Control del Asma (PCA) y la clasificación de acuerdo con la Guía para el Manejo del Asma, de 2012. Métodos: Estudio observacional transversal con pacientes atendidos en ambulatorios de referencia vinculados a la Estrategia de Salud Familiar en Tubarão-SC. La población estaba compuesta por todos los pacientes asmáticos adultos que recurrieron a citas médicas durante el período de enero a noviembre de 2010. Los datos se recopilaron en una hoja de cálculo Excel y se analizaron con el software INSTAT 3. Se realizó un análisis descriptivo y se aplicó el test chi-cuadrado para evaluar la asociación entre respuestas del PCA y CCA. Resultados: Se evaluaron 49 pacientes, la mayoría de ellos con asma intermitente o persistente leve (51%). En la evaluación del control del asma, el PCA mostró que el 69,3% de los pacientes no estaban bajo control. En el CCA se consideró fuera de objetivo al 75,5% de los pacientes. Se encontró una asociación significativa entre PCA y CCA (p <0,05). En cuanto a la Guía para el Manejo del Asma, de 2012, se consideró al 57,14% de los pacientes fuera de control; el 30,6% estaban parcialmente bajo control; y el 12,2% bajo control total. Conclusión: La mayoría de los asmáticos no estaban bajo control. Es necesario identificar los factores relacionados con el descontrol y buscar estrategias con el objetivo de mejorar los puntajes para reducir la morbimortalidad asociada al asma.