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Arq Bras Cardiol ; 113(4): 787-891, 2019 11 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31691761
Eur Heart J Acute Cardiovasc Care ; 8(7): 643-651, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29359586


OBJECTIVE: In ST-elevation myocardial infarction, 7-15% of patients admitted as Killip I will develop symptomatic heart failure or decreased ejection fraction. However, available clinical scores do not predict the risk of severe outcomes well, such as heart failure, recurrent myocardial infarction, and sudden death in these Killip I individuals. Therefore, we evaluated whether one vs two measurements of BNP would improve prediction of adverse outcomes in addition to the GRACE score in ST-elevation myocardial infarction/Killip I individuals. METHODS: Consecutive patients with ST-elevation myocardial infarction/Killip I (n=167) were admitted and followed for 12 months. The GRACE score was calculated and plasma BNP levels were obtained in the first 12 h after symptom onset (D1) and at the fifth day (D5). RESULTS: Fifteen percent of patients admitted as Killip I developed symptomatic heart failure and/or decreased ejection fraction in 12 months. The risk of developing symptomatic heart failure or ejection fraction <40% at 30 days was increased by 8.7-fold (95% confidence interval: 1.10-662, p=0.046) per each 100 pg/dl increase in BNP-change. Both in unadjusted and adjusted Cox-regressions, BNP-change as a continuous variable was associated with incident sudden death/myocardial infarction at 30 days (odds ratio 1.032 per each increase of 10 pg/dl, 95% confidence interval: 1.013-1.052, p<0.001), but BNP-D1 was not. The GRACE score alone showed a moderate C-statistic=0.709 (p=0.029), but adding BNP-change improved risk discrimination (C-statistic=0.831, p=0.001). Net reclassification confirmed a significant improvement in individual risk prediction by 33.4% (95% confidence interval: 8-61%, p=0.034). However, GRACE +BNP-D1 did not improve risk reclassification at 30 days compared to GRACE (p=0.8). At 12 months, BNP-change was strongly associated with incident sudden death/myocardial infarction, but not BNP-D1. CONCLUSIONS: Only BNP-change following myocardial infarction was associated with poorer short- and long-term outcomes. BNP-change also improves risk reclassification in addition to the GRACE score.

Eletrocardiografia , Insuficiência Cardíaca/epidemiologia , Peptídeo Natriurético Encefálico/sangue , Alta do Paciente/tendências , Medição de Risco/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/sangue , Volume Sistólico/fisiologia , Biomarcadores/sangue , Brasil/epidemiologia , Seguimentos , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Incidência , Prognóstico , Estudos Prospectivos , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Taxa de Sobrevida/tendências , Fatores de Tempo
JACC Cardiovasc Imaging ; 11(8): 1045-1055, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30092965


OBJECTIVES: The goal of this study was to demonstrate that cardiac magnetic resonance could reveal anthracycline-induced early tissue remodeling and its relation to cardiac dysfunction and left ventricular (LV) atrophy. BACKGROUND: Serum biomarkers of cardiac dysfunction, although elevated after chemotherapy, lack specificity for the mechanism of myocardial tissue alterations. METHODS: A total of 27 women with breast cancer (mean age 51.8 ± 8.9 years, mean body mass index 26.9 ± 3.6 kg/m2), underwent cardiac magnetic resonance before and up to 3 times after anthracycline therapy. Cardiac magnetic resonance variables were LV ejection fraction, normalized T2-weighted signal intensity for myocardial edema, extracellular volume (ECV), LV cardiomyocyte mass, intracellular water lifetime (τic; a marker of cardiomyocyte size), and late gadolinium enhancement. RESULTS: At baseline, patients had a relatively low (10-year) Framingham cardiovascular event risk (median 5%), normal LV ejection fractions (mean 69.4 ± 3.6%), and normal LV mass index (51.4 ± 8.0 g/m2), a mean ECV of 0.32 ± 0.038, mean τic of 169 ± 69 ms, and no late gadolinium enhancement. At 351 to 700 days after anthracycline therapy (240 mg/m2), mean LV ejection fraction had declined by 12% to 58 ± 6% (p < 0.001) and mean LV mass index by 19 g/m2 to 36 ± 6 g/m2 (p < 0.001), and mean ECV had increased by 0.037 to 0.36 ± 0.04 (p = 0.004), while mean τic had decreased by 62 ms to 119 ± 54 ms (p = 0.004). Myocardial edema peaked at about 146 to 231 days (p < 0.001). LV mass index was associated with τic (ß = 4.1 ± 1.5 g/m2 per 100-ms increase in τic, p = 0.007) but not with ECV. Cardiac troponin T (mean 4.6 ± 1.4 pg/ml at baseline) increased significantly after anthracycline treatment (p < 0.001). Total LV cardiomyocyte mass, estimated as: (1 - ECV) × LV mass, declined more rapidly after anthracycline therapy, with peak cardiac troponin T >10 pg/ml. There was no evidence for any significant interaction between 10-year cardiovascular event risk and the effect of anthracycline therapy. CONCLUSIONS: A decrease in LV mass after anthracycline therapy may result from cardiomyocyte atrophy, demonstrating that mechanisms other than interstitial fibrosis and edema can raise ECV. The loss of LV cardiomyocyte mass increased with the degree of cardiomyocyte injury, assessed by peak cardiac troponin T after anthracycline treatment. (Doxorubicin-Associated Cardiac Remodeling Followed by CMR in Breast Cancer Patients; NCT03000036).

Antibióticos Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/efeitos adversos , Imagem Cinética por Ressonância Magnética , Miócitos Cardíacos/patologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Atrofia , Biomarcadores/sangue , Cardiotoxicidade , Meios de Contraste/administração & dosagem , Feminino , Humanos , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/metabolismo , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes , Fatores de Risco , Fatores de Tempo , Troponina T/sangue , Disfunção Ventricular Esquerda/induzido quimicamente , Disfunção Ventricular Esquerda/patologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/efeitos dos fármacos , Remodelação Ventricular/efeitos dos fármacos
PLoS One ; 13(7): e0199718, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29995922


Risk stratification in secondary prevention has emerged as an unmet clinical need in order to mitigate the Number-Needed-to-Treat and make expensive therapies both clinically relevant and cost-effective. P wave indices reflect atrial conduction, which is a sensitive marker for inflammatory, metabolic, and pressure overload myocardial cell remodeling; the three stimuli are traditional mechanisms for adverse clinical evolution. Accordingly, we sought to investigate the predictive role of P-wave indices to estimate residual risk in patients with chronic coronary artery disease (CAD). The cohort included 520 post-Coronary Artery Bypass Grafting patients with a median age of 60 years who were followed for a median period of 1025 days. The primary endpoint was long-term all-cause death. Cubic spline model demonstrated a linear association between P-wave duration and incidence rate of long-term all-cause death (p = 0.023). P-wave >110ms was a marker for an average of 425 days shorter survival as compared with P-wave under 80ms (Logrank p = 0.020). The Cox stepwise regression models retained P-wave duration as independent marker (HR:1.37; 95%CI:1.05-1.79,p = 0.023). In conclusion, the present study suggests that P-wave measurement may constitute a simple, inexpensive and accessible prognostic tool to be added in the bedside risk estimation in CAD patients.

Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/epidemiologia , Frequência Cardíaca , Complicações Pós-Operatórias/epidemiologia , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/cirurgia , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade
Int J Cardiovasc Imaging ; 34(1): 15-24, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27437924


After orthotopic heart transplantation (OHT), the allograft undergoes characteristic alterations in myocardial structure, including hypertrophy, increased ventricular stiffness, ischemia, and inflammation, all of which may decrease overall graft survival. Methods to quantify these phenotypes may clarify the pathophysiology of progressive graft dysfunction post-OHT. We performed cardiac magnetic resonance (CMR) with T1 mapping in 26 OHT recipients (mean age 47 ± 7 years, 30 % female, median follow-up post-OHT 6 months) and 30 age-matched healthy volunteers (mean age 50.5 ± 15 years; LVEF 63.5 ± 7 %). OHT recipients had a normal left ventricular ejection fraction (LVEF 65.3 ± 11 %) with higher LV mass relative to age-matched healthy volunteers (114 ± 27 vs. 85.8 ± 18 g; p < 0.001). There was no late gadolinium enhancement in either group. Both myocardial extracellular volume fraction (ECV) and intracellular lifetime of water (τic), a measure of cardiomyocyte hypertrophy, were higher in patients post-OHT (ECV: 0.39 ± 0.06 vs. 0.28 ± 0.03, p < 0.0001; τic: 0.12 ± 0.08 vs. 0.08 ± 0.03, p < 0.001). ECV was associated with LV mass (r = 0.74, p < 0.001). In follow-up, OHT recipients with normal biopsies by pathology (ISHLT grade 0R) in the first year post-OHT exhibited a lower ECV relative to patients with any rejection ≥2R (0.35 ± 0.02 for 0R vs. 0.45 ± 0, p < 0.001). Higher ECV but not LVEF was significantly associated with a reduced rejection-free survival. After OHT, markers of tissue remodeling by CMR (ECV and τic) are elevated and associated with myocardial hypertrophy. Interstitial myocardial remodeling (by ECV) is associated with cellular rejection. Further research on the impact of graft preservation and early immunosuppression on tissue-level remodeling of the allograft is necessary to delineate the clinical implications of these findings.

Cardiomegalia/diagnóstico por imagem , Transplante de Coração , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Idoso , Aloenxertos , Biópsia , Cardiomegalia/etiologia , Cardiomegalia/patologia , Cardiomegalia/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Fibrose , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Valor Preditivo dos Testes , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento
Artigo em Português | LILACS | ID: biblio-909214


O diabete mellitus (DM) é uma comorbidade muito frequente entre os pacientes com síndrome coronariana aguda (SCA), acometendo, aproximadamente, 20 a 37% desses. Além de ser um preditor de risco independente, também está relacionado a uma maior prevalência de quadros atípicos de SCA. Apesar disso, é importante ressaltar que no caso da SCA, a maioria dos pacientes com DM apresenta o mesmo quadro clínico que os pacientes sem a doença. Assim como para os pacientes não diabéticos, os scores de risco devem ser aplicados. Entretanto, essa comorbidade por si própria já prediz uma maior gravidade. Inclusive é mais aconselhável utilizar para esses pacientes uma estratégia invasiva precoce. Em relação ao tratamento medicamentoso da SCA, não há alterações significativas no tratamento dos pacientes com DM para os pacientes sem DM. Já no que diz respeito à terapia de reperfusão, muito se extrapola dos conhecimentos em angina estável, em que há uma superioridade do tratamento cirúrgico sobre o percutâneo para os pacientes com DM, ainda que haja falta de evidências no contexto agudo. Finalmente, o conjunto de evidências não é definitivo para indicar a melhor estratégia para o controle da hiperglicemia, entretanto, sabe-se que tanto a hiperglicemia quanto à hipoglicemia durante a internação está relacionada aos piores desfechos. Portanto, é importante evitar valores de glicemia superiores a 180 mg/dL e inferiores a 90 mg/dL, ficando a estratégia de controle rigoroso de glicemia com insulina intravenosa restrita aos pacientes selecionados.

Diabetes mellitus (DM) is a frequent comorbidity among patients with acute coronary syndrome (ACS), affecting about 20% to 37% of these patients. Besides being an independent risk predictor, it is also related to a higher prevalence of atypical presentations of ACS. Despite this, it is important to emphasize that in the case of ACS the majority of patients with DM have the same clinical presentation as patients without the disease. Just as for non-diabetic patients, risk scores should be applied. However, this comorbidity per se predicts a greater severity. Also, it is preferable to use an early invasive strategy for these patients. Regarding the medicinal treatment of ACS, there are no significant differences between the treatment of patients with DM and those without DM. In relation to reperfusion therapy, much of it is extrapolated from knowledge of stable angina, in which surgical treatment takes precedence over percutaneous treatment for patients with DM, despite the lack of evidence in the acute context. Finally, there is no definitive body of evidence to indicate the best strategy to control hyperglycemia, but it is known that both hyperglycemia and hypoglycemia during hospitalization are associated with worse outcomes. Thus, it is important to avoid glycemia values above 180 mg/dL and below 90 mg/dL, restricting the strategy of strict glycemic control with intravenous insulin to selected patients.

Humanos , Feminino , Idoso , Síndrome Coronariana Aguda/diagnóstico por imagem , Diabetes Mellitus/tratamento farmacológico , Revascularização Miocárdica , Aspirina/administração & dosagem , Glicemia , Metanálise em Rede , Cloridrato de Prasugrel/administração & dosagem , Reperfusão
Faludi, André Arpad; Izar, Maria Cristina de Oliveira; Saraiva, José Francisco Kerr; Chacra, Ana Paula Marte; Bianco, Henrique Tria; Afiune Neto, Abrahão; Bertolami, Adriana; Pereira, Alexandre C.; Lottenberg, Ana Maria; Sposito, Andrei C.; Chagas, Antonio Carlos Palandri; Casella Filho, Antonio; Simão, Antônio Felipe; Alencar Filho, Aristóteles Comte de; Caramelli, Bruno; Magalhães, Carlos Costa; Negrão, Carlos Eduardo; Ferreira, Carlos Eduardo dos Santos; Scherr, Carlos; Feio, Claudine Maria Alves; Kovacs, Cristiane; Araújo, Daniel Branco de; Magnoni, Daniel; Calderaro, Daniela; Gualandro, Danielle Menosi; Mello Junior, Edgard Pessoa de; Alexandre, Elizabeth Regina Giunco; Sato, Emília Inoue; Moriguchi, Emilio Hideyuki; Rached, Fabiana Hanna; Santos, Fábio César dos; Cesena, Fernando Henpin Yue; Fonseca, Francisco Antonio Helfenstein; Fonseca, Henrique Andrade Rodrigues da; Xavier, Hermes Toros; Mota, Isabela Cardoso Pimentel; Giuliano, Isabela de Carlos Back; Issa, Jaqueline Scholz; Diament, Jayme; Pesquero, João Bosco; Santos, José Ernesto dos; Faria Neto, José Rocha; Melo Filho, José Xavier de; Kato, Juliana Tieko; Torres, Kerginaldo Paulo; Bertolami, Marcelo Chiara; Assad, Marcelo Heitor Vieira; Miname, Márcio Hiroshi; Scartezini, Marileia; Forti, Neusa Assumpta; Coelho, Otávio Rizzi; Maranhão, Raul Cavalcante; Santos Filho, Raul Dias dos; Alves, Renato Jorge; Cassani, Roberta Lara; Betti, Roberto Tadeu Barcellos; Carvalho, Tales de; Martinez, Tânia Leme da Rocha; Giraldez, Viviane Zorzanelli Rocha; Salgado Filho, Wilson.
Arq. bras. cardiol ; 109(2,supl.1): 1-76, ago. 2017. tab, graf
Artigo em Português | LILACS-Express | LILACS | ID: biblio-887919
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(3): f:201-l:204, jul.-set. 2017. tab, graf
Artigo em Português | LILACS | ID: biblio-875318


A necessidade de anticoagulação tem sido crescente em pacientes com síndromes coronarianas agudas, devido à fibrilação atrial com risco de tromboembolismo, presença de tromboembolismo venoso, doenças valvares ou próteses e à maior prevalência em idosos. Nesse cenário, a escolha da terapia antitrombótica mais adequada, notadamente para os pacientes que recebem tratamento percutâneo com inserção de stents, tem sido revista em diretrizes baseadas em estudos recentes, que incluíram novos anticoagulantes e antiplaquetários, em comparação com a estratégia padrão com anti-vitamina K e uso de terapia antiplaquetária dupla, com aspirina e tienopiridínico. Nesta revisão, incluímos estudos que fundamentam as estratégias atuais para o uso combinado de anticoagulantes orais e antiplaquetários em síndromes coronarianas agudas e as diferenças para o uso de anticoagulante em intervenções percutâneas eletivas

The need for anticoagulation is increasing in subjects with acute coronary syndromes, due to atrial fibrillation with risk of thromboembolism, the presence of venous thromboembolism, valve diseases or prostheses, and higher prevalence in the elderly. In this scenario, the choice of most appropriate antithrombotic therapy, particularly for patients who receive percutaneous treatment with the insertion of stents, has been reviewed in guidelines based on recent studies, which included new anticoagulants and antiplatelet agents in comparison with the standard strategy with anti-vitamin K and the use of dual antiplatelet therapy, with aspirin and thienopyridine. This review includes studies that form the basis of the current strategies for the combined use of oral anticoagulant and antiplatelets in acute coronary syndromes and the differences for the use of an anticoagulant in elective percutaneous interventions

Humanos , Masculino , Feminino , Síndrome Coronariana Aguda , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Hemorragia/terapia , Prevalência , Rivaroxabana/administração & dosagem , Rivaroxabana/uso terapêutico , Fatores Sexuais , Stents
Curr Med Res Opin ; 33(2): 239-251, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27776432


In the last two decades, statin therapy has proved to be the most potent isolated therapy for attenuation of cardiovascular risk. Its frequent use has been seen as one of the most important elements for the reduction of cardiovascular mortality in developed countries. However, the recurrent incidence of muscle symptoms in statin users raised the possibility of causal association, leading to a disease entity known as statin associated muscle symptoms (SAMS). Mechanistic studies and clinical trials, specifically designed for the study of SAMS have allowed a deeper understanding of the natural history and accurate incidence. This set of information becomes essential to avoid an unnecessary risk of severe forms of SAMS. At the same time, this concrete understanding of SAMS prevents overdiagnosis and an inadequate suspension of one of the most powerful prevention strategies of our times. In this context, the Luso-Latin American Consortium gathered all available information on the subject and presents them in detail in this document as the basis for the identification and management of SAMS.

Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doenças Musculares/induzido quimicamente , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Fatores de Risco
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(2): 105-111, abr.-jun.2016. tab, ilus
Artigo em Português | LILACS | ID: lil-796514


A morbidade e a mortalidade nas síndromes coronarianas agudas – causadas principalmente pela instabilidade da placa aterosclerótica, levando à formação de trombos – foi bastante reduzida com o advento de antiplaquetários, antitrombóticos e revascularização precoce. Hoje, dispomos de quatro antitrombóticos para uso nestas condições: a heparina não fracionada, a de baixo peso molecular, o fondaparinux e a bivalirudina – sendo apenas as três primeiras disponíveis no Brasil. Como são agentes antiocoagulantes, o risco de sangramento não é desprezível e deve ser apropriadamente dosado com o fim de trazer o máximo benefício antitrombótico, sem grande risco hemorrágico. Nesta revisão sumarizamos o atual estado da arteno uso de antitrombóticos no Brasil...

Morbidity and mortality in the acute coronary syndromes – caused in the majorly by atherosclerotic plaque instability, with consequent thrombus formation – was drastically reduced by the advent of antiplatelet and antithrombotic agents, and by early revascularization. Nowadays, we have 4 antithrombotic agents: unfractionated heparin, low molecular weight heparin, fondaparinux and bivalirudin – with only the first 3 available in Brazil. As they comprise anticoagulant effects, the risk of bleedingis high and must be taken into account when prescribed, in order to bring the greater benefits without higher bleeding risk. In this review we summarized the current state of the art about the use of these agents in our country...

Humanos , Fibrinolíticos/administração & dosagem , Placa Aterosclerótica/complicações , Placa Aterosclerótica/terapia , Síndrome Coronariana Aguda/terapia , Trombose/terapia , Angioplastia/métodos , Enoxaparina/administração & dosagem , Heparina/administração & dosagem , Inibidores da Agregação de Plaquetas/administração & dosagem , Protaminas/administração & dosagem , Fatores de Risco
Arq Bras Cardiol ; 105(2 Suppl 1): 1-105, 2015 Aug.
Artigo em Português | MEDLINE | ID: mdl-26375058
Postgrad Med ; 127(1): 66-72, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25526235


INTRODUCTION: Hypertension (HTN) is a preventable cause of cardiovascular morbidity and mortality. OBJECTIVES: To compare the prevalence, awareness, treatment, and control of HTN among urban and riverside populations in Porto Velho, Amazon region. METHODS: We conducted a cross-sectional study between July and December 2013 based on a household survey of individuals aged 35-80 years. Interviews by using a standardized questionnaire, and blood pressure (BP), weight, height, and waist circumference measurements were performed. HTN was defined when individuals reported having the disease, received antihypertensive medications, or had a systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Awareness was based on self-reports and the use of antihypertensive medications. Control was defined as a BP ≤ 140/90 mm Hg. RESULTS: Among the 1410 participants, 750 (53.19%) had HTN and 473 (63.06%) had diagnosis awareness, of whom 404 (85.41%) received pharmacological treatment but with low control rate. The prevalence and treatment rates were higher in the urban areas (55.48% vs. 48.87% [p = 0.02] and 61.25% vs. 52.30% [p < 0.01], respectively). HTN awareness was higher in the riverside area (61.05% vs. 67.36% ; p < 0.01), but the control rates showed no statistically significant difference (22.11% vs. 23.43% ; p = 0.69). CONCLUSION: HTN prevalence was higher in the urban population than in the riverside population. Of the hypertensive individuals in both areas, <25% had controlled HTN. Comprehensive public health measures are needed to improve the prevention and treatment of systemic arterial HTN and prevent other cardiovascular diseases.

Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , População Urbana
Rev. Soc. Cardiol. Estado de Säo Paulo ; 24(1): 10-16, jan.-mar. 2014.
Artigo em Português | LILACS | ID: lil-729288


A doenças aterosclerótica coronariana (DAC) continua sendo a principal causa de morte. Consequentemente, há interesse crescente no diagnóstico de DAC em assintomáticos. Entretanto, existem alguns questionamentos acerca da indicação e custo-benefício de tal rastreamento, bem como qual ferramenta diagnóstica seria a mais adequada. A DAC obstrutiva pode ocorrer em pacientes pouco sintomáticos ou mesmo assintomáticos, o pode ocorrer progredir rapidamente. A primeira manifestação clínica pode ser angina instável, infarto do miocárdio, ou mesmo morte súbita. A justificativa para a detecção precoce da DAC é que seu diagnóstico nos estágios subclínicos pode permitir a identificação dos indivíduos com risco aumentado de eventos cardíacos adversos e a instituição de tratamento adequado nos indivíduos de alto risco pode melhorar o prognóstico. De acordo com as diretrizes atuais, em pacientes assintomáticos, o teste ergométrico é recomendado apenas em pacientes de alto risco cardiovascular com ECG interpretável e paciente capas de se exercitar. Outros testes diagnósticos não invasivos como ecocardiografia de estresse, ressonância cardíaca de estresse, cintilografia miocárdica, escore de cálcio, angiotomografia coronária só são recomendados em casos selecionados após julgamento clínico. Esses exames são mais adequados em pacientes com ECG não passível de interpretação adequada no teste ergométrico convencional e em pacientes não capazes de se exercitar, com alto risco cardiovascular. Não é recomendado o rastreamento de rotina de DAC em assintomáticos com baixo risco cardiovascular. Naqueles com risco intermediário, os exames mais adequados, levando em consideração o julgamento clínico e o riso-benefício do exame, são o teste ergométrico convencional e o escore de risco.

Coronary heart disease (CHD) remains the leading cause of mortality. There is na increasing interest in the diagnosis of CHD when patients are still asymptomatic. However, questions remaing regarding the appropriateness and cost effectiveness of screening and the best test. Obstructive CHD can exist with few or no symptoms, and can progress rapidly. The The first clinical manifestations can be: acute myocardial infarction (MI), unstable angina, or sudden cardiac death. The explanation for early detection of CHD is that detection during the subclinical stages of disease might permit the identification of patients at increased risk of na acute cardiac event and that appropriate therapy might improve the prognosis of those at high risk. Based on last guidelines, exercise testing in recommended in asymptomatic adults with high cardiovascular risk, able to exercise, and with interpretable ECG. Other non-invasive tests such as stress echocardiography, cardiac resonance, nuclear imaging, coronary tomography, calcium quantification, are only recommended in selected cases after clinical assessment. These tests are more adequate in patients with no interpretable ECG or not able recommended routine screening of CHD in asymptomatic adults with low cardiovascular risk. In those with moderate risk, exercise testing and calcium coronary quatification may be recommended, after clinical assessment.

Humanos , Masculino , Feminino , Aterosclerose/diagnóstico , Doença da Artéria Coronariana/diagnóstico , Valor Preditivo dos Testes , Fatores de Risco , Teste de Esforço/efeitos adversos , Doenças Assintomáticas , Cálcio , Análise Custo-Benefício , Cintilografia/métodos , Diabetes Mellitus , Eletrocardiografia/métodos , Guias como Assunto/normas , Prognóstico
Inflammation ; 37(3): 678-85, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24282109


Enhanced systemic inflammatory activity (SIA) during myocardial infarction (MI) and the extent of the peri-infarct zone characterized by cardiac magnetic resonance imaging (CMRi) are both associated with increased risk of life-threatening arrhythmias and sudden cardiac death. The present study investigated the existence of association between these two phenomena in 98 patients (55 ± 10 years) with ST segment elevation MI. Plasma levels of C-reactive protein (CRP), interleukin-2 (IL-2), and tumor necrosis factor (TNF) were measured on admission (D1) and on the fifth day post-MI (D5). CMRi was performed 2 weeks after MI to quantify peri-infarct zone (PIZ). Between D1 and D5, the increase in CRP (6.0 vs. 5.6 times; p = 0.02), IL-2 (3.6 vs. 3.4 times; p = 0.04) and tumor necrosis factor type α (TNF-α; 4.6 vs. 3.9 times; p = 0.001) were higher in patients with PIZ above the median than in the counterparts. PIZ was correlated with CRP-D5 (r = 0.69), delta-CRP (r = 0.7), IL-2-D5 (r = 0.5), delta-IL-2 (r = 0.6), TNF-α (r = 0.5), delta-TNF-α (r = 0.4; p = 0.0001). Enhanced activation of SIA during the acute phase of MI is directly related with generation of PIZ.

Arritmias Cardíacas/patologia , Morte Súbita Cardíaca/patologia , Inflamação/imunologia , Infarto do Miocárdio/imunologia , Infarto do Miocárdio/patologia , Proteína C-Reativa/metabolismo , Angiografia Coronária , Feminino , Coração/fisiopatologia , Humanos , Interleucina-2/sangue , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fator de Necrose Tumoral alfa/sangue
Am J Med ; 126(9): 834-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23830536


BACKGROUND: Iron chelation therapy in patients with thalassemia major may not prevent iron overload in all organs, especially those in which iron enters cells through specific calcium channels. We designed a controlled pilot study to assess the potential of the calcium channel blocker amlodipine in strengthening the efficacy of iron chelation. METHODS: Fifteen patients with thalassemia major undergoing chelation therapy were randomized to receive amlodipine added to standard treatment in a 1:2 allocation for 12 months. T2* values for assessment of iron overload in the liver and heart using magnetic resonance imaging were obtained at baseline and at 6 and 12 months. RESULTS: In the amlodipine-treated group, heart T2* increased significantly in comparison to baseline at 6 and 12 months (21.7 ± 7.2 ms to 28.2 ± 7.9 ms and 28.3 ± 8.0 ms, with P = .007 and .03, respectively), while no differences were observed in the control group (25.1 ± 8.8 ms to 24.7 ± 7.8 ms and 26.2 ± 11.4 ms; P = .99 and 0.95, respectively); significant differences between groups were observed at 6 months (28.2 ± 7.9 ms vs 24.7 ± 7.8 ms in the control group, P = .03). A significant reduction in ferritin levels also was observed in the treated group at 12 months. CONCLUSIONS: The use of amlodipine in conjunction with standard chelation therapy may suggest a new strategy in preventing and treating iron overload in patients with thalassemia major, especially in organs where iron absorption depends on active uptake by calcium channels like the heart.

Anlodipino/uso terapêutico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Sobrecarga de Ferro/tratamento farmacológico , Sobrecarga de Ferro/etiologia , Miocárdio/metabolismo , Talassemia beta/complicações , Adolescente , Adulto , Análise de Variância , Terapia por Quelação , Distribuição de Qui-Quadrado , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Projetos Piloto , Resultado do Tratamento
Arq. bras. cardiol ; 101(1): 68-77, jul. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-681830


FUNDAMENTO: Medidas ainda hoje utilizadas como referência na ressonância magnética cardíaca foram obtidas principalmente de estudos realizados em populações norte-americanas e europeias. OBJETIVO: Obter medidas do diâmetro diastólico, diâmetro sistólico, volume diastólico final, volume sistólico final, fração de ejeção e massa miocárdica dos ventrículos esquerdo e direito em brasileiros. MÉTODOS: Foram submetidos à ressonância magnética cardíaca, utilizando técnica de precessão livre em estado de equilíbrio, 54 homens e 53 mulheres, com idade média de 43,4 ± 13,1 anos, assintomáticos, sem cardiopatias. RESULTADOS: As médias e os desvios padrão dos parâmetros do ventrículo esquerdo foram: diâmetro diastólico = 4,8 ± 0,5 cm; diâmetro sistólico = 3,0 ± 0,6 cm; volume diastólico final = 128,4 ± 29,6 mL; volume sistólico final = 45,2 ± 16,6 mL; fração de ejeção = 65,5 ± 6,3%; massa = 95,2 ± 30,8 g. Para o ventrículo direito, foram: diâmetro diastólico = 3,9 ± 1,3 cm; diâmetro sistólico = 2,5 ± 0,5 cm; volume diastólico final = 126,5 ± 30,7 mL; volume sistólico final = 53,6 ± 18,4 mL; fração de ejeção = 58,3 ± 8,0% e massa = 26,1 ± 6,1 g. As massas e os volumes foram significativamente maiores nos homens, exceto para o volume sistólico final do ventrículo esquerdo. A fração de ejeção do ventrículo direito foi significativamente maior nas mulheres. Houve correlação significativa e inversa do volume sistólico do volume direito com o aumento da idade. CONCLUSÃO: Este estudo descreveu, pela primeira vez, medidas cardíacas obtidas pela ressonância magnética cardíaca em brasileiros assintomáticos, sem cardiopatias, mostrando diferenças de acordo com o gênero e a idade.

BACKGROUND: Still today, measurements used as a reference in the cardiac magnetic resonance imaging have been obtained mainly from studies carried out in North-American and European populations. OBJECTIVE: To obtain measurements of the diastolic diameter, systolic diameter, end diastolic volume, end systolic volume, ejection fraction, and myocardial mass of the left and right ventricles in Brazilians. METHODS: 54 men and 53 women, with mean age of 43.4 ± 13.1 years, asymptomatic, with no cardiomyopathies, have been subjected to the cardiac magnetic resonance imaging, using a balanced steady state free precession technique. RESULTS: The averages and the standard deviations of the parameters for the left ventricle have been: diastolic diameter = 4.8 ± 0.5 cm; systolic diameter = 3.0 ± 0.6 cm; end diastolic volume = 128.4 ± 29.6 mL; end systolic volume = 45.2 ± 16.6 mL; ejection fraction = 65.5 ± 6.3%; mass = 95.2 ± 30.8 g. For the right ventricle, they have been: diastolic diameter = 3.9 ± 1.3 cm; systolic diameter = 2.5 ± 0.5 cm; end diastolic volume = 126.5 ± 30.7 mL; end systolic volume = 53.6 ± 18.4 mL; ejection fraction = 58.3 ± 8.0%, and mass = 26.1 ± 6.1 g. The masses and the volumes were significantly greater in the men, except for the end systolic volume of the left ventricle. The ejection fraction of the right ventricle has been significantly greater in the women. There has been a significant and inverted correlation of the systolic volume of the right volume with the progression of the age. CONCLUSION: This study has described, for the first time, cardiac measurements obtained through the cardiac magnetic resonance imaging in Brazilians, asymptomatic, with no cardiomyopathies, showing differences in accordance with gender and age.

Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ventrículos do Coração/anatomia & histologia , Imagem por Ressonância Magnética/métodos , Volume Sistólico/fisiologia , Função Ventricular/fisiologia , Brasil , Diástole/fisiologia , Variações Dependentes do Observador , Valores de Referência , Estatísticas não Paramétricas , Sístole/fisiologia