Ultrasound study of forearm arteries in patients undergoing cardiac catheterization, and assessment of predictors of arterial vessel caliber

BACKGROUND: The radial approach has been increasingly used worldwide for diagnostic and therapeutic cardiac catheterization. The radial artery caliber is one of the limitations of its use. The objective of this study was to describe the anatomy of the radial and ulnar arteries, as well as to develop a radial artery diameter prediction score using clinical and anthropometric criteria. METHODS: Using vascular ultrasound with bilateral radial and ulnar artery measurements, 1,180 patients who underwent cardiac catheterization or angioplasty procedures were prospectively evaluated. Using the patients' variables, a radial artery diameter prediction score was developed in a cross-sectional fashion, using half of the sample. The score was validated with the half not used for deriving the model. RESULTS: A total of 1,180 patients were evaluated. The mean internal diameter of the right and left radial arteries was 2.69±0.69mm and 2.53±0.64mm (p<0.01), and the mean internal diameter of the right and left ulnar arteries was 2.09±0.59mm and 2.10±0.60mm (p=0.76), respectively. The factors that positively correlated with arterial size were male sex, previous catheterization, height, weight, and body surface area. The risk score developed using clinical and anthropometric variables had unsatisfactory discriminatory capacity (c-statistics 0.64). CONCLUSION: The right radial artery is the largest forearm artery in most cases. Men and patients who had previously undergone catheterization have a larger mean radial artery diameter. The artery diameter prediction score has modest accuracy for clinical use. (AU)

Analysis of the Appropriate Use Criteria for Coronary Angiography in Two Cardiology Services of Southern Brazil / Análise do Uso dos Critérios de Indicação de Coronariografia em Dois Serviços de Cardiologia do Sul do Brasil

Abstract Background: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. Objective: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. Methods: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). Results: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. Conclusion: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

Resumo Fundamento: Apesar de sua grande relevância, não existem trabalhos em nosso país que avaliem a aplicação das diretrizes de 2012 para uso apropriado do cateterismo cardíaco diagnóstico. Objetivo: Analisar a apropriação das coronariografias realizadas em dois hospitais da região sul do Brasil. Métodos: Estudo transversal multicêntrico, que analisou as indicações, resultados e propostas de tratamento de 737 coronariografias realizadas em um hospital terciário com múltiplas especialidades (Hospital A) e um hospital cardiológico terciário (Hospital B). Foram incluídas coronariografias eletivas ou de urgência, com exceção dos casos de infarto agudo do miocárdio com elevação do segmento ST. O nível de significância estatística adotado foi de 5% (p < 0,05). Resultados: Do total de 737 coronariografias, 63,9% foram realizadas em pacientes do sexo masculino. A média de idade foi 61,6 anos. A indicação foi síndrome coronariana aguda em 57,1% e investigação de doença arterial coronariana em 42,9% dos casos. Em relação à apropriação, 80,6% foram classificadas como apropriadas, 15,1% ocasionalmente apropriadas e 4,3% raramente apropriadas. O tratamento proposto foi clínico para 62,7%, intervenção coronária percutânea para 24,6% e cirurgia de revascularização miocárdica para 12,7% dos casos. Das coronariografias classificadas como raramente apropriadas, 56,2% foram relacionadas à não realização de provas funcionais prévias e 21,9% apresentaram lesões coronarianas graves. Porém, independentemente do resultado da coronariografia, todos os pacientes nesse grupo foram indicados para tratamento clínico. Conclusão: Observamos baixo número de coronariografias raramente apropriadas em nossa amostra. A recomendação da diretriz nesses casos foi adequada, sendo que nenhum paciente necessitou de tratamento de revascularização. A maior parte desses casos se deve à não realização de provas funcionais.

Analysis of the Appropriate Use Criteria for Coronary Angiography in Two Cardiology Services of Southern Brazil.

BACKGROUND: Despite its great relevance, there are no studies in our country evaluating the application of the 2012 guidelines for the appropriate use of cardiac diagnostic catheterization. OBJECTIVE: To analyze the adequacy of coronary angiography performed in two hospitals in the southern region of Brazil. METHODS: This is a multicenter cross-sectional study, which analyzed indications, results and proposals for the treatment of 737 coronary angiograms performed in a tertiary hospital with multiple specialties (Hospital A) and a tertiary cardiology hospital (Hospital B). Elective or emergency coronary angiographies were included, except for cases of acute myocardial infarction with ST segment elevation. The level of statistical significance adopted was 5% (p < 0.05). RESULTS: Of the 737 coronary angiograms, 63.9% were performed in male patients. The mean age was 61.6 years. The indication was acute coronary syndrome in 57.1%, and investigation of coronary artery disease in 42.9% of the cases. Regarding appropriation, 80.6% were classified as appropriate, 15.1% occasionally appropriate, and 4.3% rarely appropriate. The proposed treatment was clinical for 62.7%, percutaneous coronary intervention for 24.6%, and myocardial revascularization surgery for 12.7% of the cases. Of the coronary angiographies classified as rarely appropriate, 56.2% were related to non-performance of previous functional tests, and 21.9% showed severe coronary lesions. However, regardless of the outcome of coronary angiography, all patients in this group were indicated for clinical treatment. CONCLUSION: We observed a low number of rarely appropriate coronary angiograms in our sample. The guideline recommendation in these cases was adequate, and no patient required revascularization treatment. Most of these cases are due to non-performance of functional tests.

Perfil dos Pacientes Internados por Insuficiência Cardíaca em Hospital Terciário / Profile of Patients Hospitalized for Heart Failure in Tertiary Care Hospital

Fundamentos: A insuficiência cardíaca é uma doença de alta prevalência, responsável por grande número de hospitalizações e altas taxas de mortalidade em nosso país. O tratamento instituído tem influência nos índices de mortalidade e na qualidade de vida dos pacientes. Objetivo: Identificar e comparar o perfil clínico-epidemiológico e o tratamento instituído entre os pacientes sobreviventes e não sobreviventes internados com insuficiência cardíaca aos dados da literatura internacional. Métodos: Estudo transversal, retrospectivo, de 816 pacientes com insuficiência cardíaca que sobreviveram ou não à internação. Foram registradas características clínicas, epidemiológicas, dados laboratoriais, ecocardiográficos e o tratamento instituído. Resultados: A maioria dos pacientes encontrava-se em classe funcional III/IV. A idade média foi de 66,5 ± 13,8 anos. Metade era do sexo masculino e 88,3%, brancos. A mortalidade intra-hospitalar foi de 11,2%. Idade avançada, etnia branca, classe funcional elevada, reinternações, internações prolongadas, presença de doença arterial coronariana, fibrilação atrial crônica, insuficiência mitral grave, disfunção diastólica do tipo restritivo, disfunção renal e peptídeo natriurético elevado tiveram associação com maior mortalidade, assim como pacientes que, durante a internação, apresentaram tromboembolismo pulmonar, síndrome isquêmica aguda, infecção pulmonar ou necessidade de diálise. O uso de inibidores da enzima conversora de angiotensina ou de bloqueadores dos receptores da angiotensina na admissão hospitalar foi significativamente maior entre os sobreviventes. Conclusão: A mortalidade intra-hospitalar foi elevada quando comparada à média internacional, mas foi semelhante a de outros serviços de referência brasileiros. Vários indicadores de maior gravidade foram observados no grupo não sobrevivente

Background: Heart failure is a highly prevalent disease, responsible for many admissions and high mortality rates in our country. The treatment influences patient's mortality and quality of life. Objective: To identify and compare the clinical and epidemiological survivor's and non-survivor's profiles and treatment of patients hospitalized with heart failure with the international literature. Methods: Cross-sectional, retrospective study of 816 survivors and non-survivors with heart failure. All patients had their clinical and epidemiological, laboratory and echocardiographic data and treatment recorded. Results: Most patients were in functional class III/IV. Mean age was 66.5 ± 13.8 years. Half of the patients were men and 88.3% were Caucasians. In-hospital mortality was 11,2%. Highly mortality was associated with old age, Caucasian ethnicity, high functional class, readmissions, prolonged hospitalization, presence of coronary artery disease, chronic atrial fibrillation, severe mitral regurgitation, restrictive diastolic dysfunction, renal dysfunction, and elevated natriuretic peptide levels, as well as with patients who had pulmonary embolism, acute coronary syndrome, pulmonary infection or required dialysis during hospitalization. The use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers at admission was significantly higher among survivors. Conclusion: In-hospital mortality was high when compared to international averages, but it was similar to other Brazilian referral services. Numerous higher severity indicators were observed in the non-survivor group

Avaliação do impacto das novas diretrizes no uso de estatinas / Assessing the impact of new guidelines on the use of statins

Fundamentos: A doença arterial coronariana é a principal causa de morte no Brasil e possui relação direta com a dislipidemia. Objetivo: Analisar o padrão do uso de estatinas antes e após a publicação das novas diretrizes de dislipidemia em pacientes com doença cardiovascular aterosclerótica prévia. Métodos: Estudo transversal, retrospectivo. Foram avaliados, aleatoriamente, 515 pacientes consecutivos com doença aterosclerótica, atendidos no ambulatório do Instituto de Cardiologia de Santa Catarina, SC, Brasil , entre2011 e 2015. Destes, apenas 76,9% faziam uso de alguma estatina. Foram coletados dados de história clínica, fatores de risco para doença cardiovascular, dados laboratoriais referentes aos valores de colesterol (HDL-c e LDL-c) e triglicerídeos (TG), tratamento referente à escolha das estatinas e suas doses, antes e depois de outubro de 2013,data de publicação das novas diretrizes. Resultados: Após a publicação das novas diretrizes, 477 pacientes utilizavam estatinas, representando 92,6% da amostra avaliada (p=0,0001). Quanto à escolha da estatina, o uso de sinvastatina diminuiu para 69,2% (p=0,02),o de atorvastatina aumentou para 25,2% (p=0,003) e o de rosuvastatina foi 5,7% (p=ns). Antes da divulgação das novas diretrizes, as doses médias de sinvastatina, atorvastatina e rosuvastatina eram 33,6±9,4mg, 32,1±18,9mg,13,1±7,9mg, respectivamente. Após a publicação, essas doses médias aumentaram para: sinvastatina 36,7±7,9mg(p=0,0001) e atorvastatina 36,8±16,2mg (p=0,0001). Conclusões: As taxas de uso de estatinas na amostra estudada aumentaram após a publicação da nova Diretriz ACC/AHA e da V Diretriz brasileira de dislipidemia, no entanto atingiu um número limitado de pacientes, associado a doses abaixo do preconizado e metas numéricas inadequadas de colesterol, o que pode gerar implicações prognósticas desfavoráveis.

Background: Coronary artery disease (CAD) is the leading cause of death in Brazil and has a direct connection with dyslipidemia. Objective: To analyze the pattern of use of statins before and after the publication of the new guidelines on dyslipidemia in patients with a history of atherosclerotic cardiovascular disease. Methods: Cross-sectional retrospective study. In this study, 515 consecutive patients with atherosclerotic were randomly evaluatedat the outpatient facility of Instituto de Cardiologia de Santa Catarina, SC, Brazil, between 2011 and 2015. Of these, only 76.9%were using statins. Data relating to clinical history, risk factors for cardiovascular disease, laboratory data for cholesterol levels (HDL-c and LDL-c) and triglycerides (TG) were collected, as well as treatment concerning the choice of statins and their doses before and after October 2013, when the new guidelines were published. Results: After the publication of the new guidelines, 477 patients used statins, representing 92.6% of the study sample (p=0.0001). As to the choice of statin, the use of simvastatin declined to 69.2% (p=0.02), atorvastatin increased to 25.2% (p=0.003) and rosuvastatin was 5.7% (p=ns). Before the release of the new guidelines, the average doses of simvastatin, atorvastatin and rosuvastatin were 33.6±9.4mg, 32.1±18.9mg, 13.1±7.9mg, respectively. After publication, these average doses increased to: simvastatin 36.7±7.9mg (p=0.0001) and atorvastatin 36.8±16.2mg (p=0.0001). Conclusions: The statin use rates in the study sample increased after the publication of the new ACC/AHA Guidelines and theV Brazilian Guidelines on Dyslipidemia. However, they reached a limited number of patients, associated with doses below there commended and improper numerical targets of cholesterol, which can generate unfavorable prognostic implications.

Avaliação do conhecimento dos pais sobre segurança no transporte de crianças em veículos automotores e motocicletas / Evaluation of knowledge of parents about safety in transportation of children in vehicles and motorcycles

OBJETIVO:Avaliar o nível de conhecimento dos pais sobre segurança no transporte de crianças em veículos automotores e motocicletas. MÉTODOS: Estudo transversal, realizado por meio de questionário autoaplicável em pais e responsáveis que acompanhavam crianças na sala de espera de ambulatórios público e privado. Para avaliar os conhecimentos sobre segurança no transporte de crianças, foram utilizadas as recomendações da Associação Brasileira de Medicina do Tráfego. A análise dos dados foi realizada por meio do teste do qui-quadrado e as variáveis quantitativas testadas por Mann-Whitney, sendo significante p<0,05. RESULTADOS: A amostra foi composta por 248 pais, sendo 119 da rede privada e 129 da rede pública. Dentre as questões relacionadas com motocicletas, 76 por cento daqueles que costumam transportar crianças nesse veículo acertaram a idade mínima permitida, todavia mais de 30 por cento não acertaram a posição segura para tal. Quanto ao transporte em automóveis, a questão com maior percentual de respostas corretas foi referente à idade mínima para utilizar o banco da frente, com 64 por cento de acertos. Nas demais questões, estes variaram de 24 a 46 por cento. CONCLUSÕES: O conhecimento da população estudada sobre a segurança no transporte de crianças em veículos automotores é deficiente, tanto no emprego de dispositivos de retenção, pré-requisitos para o uso do banco da frente, bem como idade e forma de transporte de crianças em motocicletas.

OBJECTIVE:To evaluate parents' knowledge on safe transport of children in motor vehicles and motorcycles. METHODS: Cross-sectional study that applied a questionnaire to parents and guardians who were accompanying children in the waiting room for outpatient public and private services. To evaluate knowledge on safe transport of children, the recommendations of the Brazilian Association on Traffic Medicine were used. Data analysis was performed using the chi-square and Mann-Whitney tests for categorical and numerical variables respectively, being significant p<0.05. RESULTS: The sample consisted of 248 parents, 119 from private and 129 public medical services. Among the issues related to motorcycles, 76 percent of those who usually carry children in this vehicle answered correctly the minimum age allowed for that, however more than 30 percent of them did not know the safest position to carry children on motorcycles. Considering the automobile transport, the question with the highest percentage of correct answers was about the minimum age to use the front seat, with 64 percent of correct answers. In other issues, the percentage of correct answers ranged from 24 to 46 percent. CONCLUSIONS: Knowledge of the studied population about safe transport of children in motor vehicles is poor, especially regarding the use of the restraint system, the prerequisites for front seat use, as well the age and the correct form of transporting children on motorcycles.