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1.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
2.
Am Heart J ; 184: 88-96, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27892891

RESUMO

Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30days. RESULTS: The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P=.46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P=.74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P=.50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P=.26), and stroke (0.9% vs 0%, P=.25). CONCLUSION: In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naïve patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naïve patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population.


Assuntos
Atorvastatina/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Infarto do Miocárdio/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Acidente Vascular Cerebral/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Infarto do Miocárdio/diagnóstico , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/prevenção & controle , Assistência Perioperatória/métodos , Modelos de Riscos Proporcionais , Medição de Risco , Troponina/sangue
3.
Arq. bras. cardiol ; 105(5): 457-565, Nov. 2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-764997

RESUMO

AbstractBackground:Human tissue kallikrein (hK1) is a key enzyme in the kallikrein–kinin system (KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary artery disease (CAD) remains unclear.Objective:To evaluate hK1-specific amidase activity in the urine of CAD patientsMethods:Sixty-five individuals (18–75 years) who underwent cardiac catheterism (CATH) were included. Random midstream urine samples were collected immediately before CATH. Patients were classified in two groups according to the presence of coronary lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was determined using Jaffé’s method. Urinary hK1-specific amidase activity was expressed as µM/(min · mg creatinine) to correct for differences in urine flow rates.Results:Urinary hK1-specific amidase activity levels were similar between CAD [0.146 µM/(min ·mg creatinine)] and non-CAD [0.189 µM/(min . mg creatinine)] patients (p = 0.803) and remained similar to values previously reported for hypertensive patients [0.210 µM/(min . mg creatinine)] and HF patients [0.104 µM/(min . mg creatinine)]. CAD severity and hypertension were not observed to significantly affect urinary hK1-specific amidase activity.Conclusion:CAD patients had low levels of urinary hK1-specific amidase activity, suggesting that renal KKS activity may be reduced in patients with this disease.


ResumoFundamento:A calicreína tecidual humana (hK1) é enzima-chave do sistema calicreína-cinina (SCC). A atividade amidásica da hK1 está reduzida na urina de pacientes com hipertensão e insuficiência cardíaca (IC); seu papel na doença arterial (DAC) coronariana ainda não está esclarecido.Objetivo:Avaliar a atividade amidásica da hK1 na urina de pacientes com DAC.Métodos:Sessenta e cinco indivíduos (18 a 75 anos) que se submeteram ao cateterismo cardíaco (CAT) coletaram amostra do jato médio de urina imediatamente antes do CAT. Baseando-se na presença de lesões coronarianas, os pacientes eram classificados em dois grupos: DAC (43 pacientes) e sem DAC (22 indivíduos). A atividade amidásica da hK1 foi estimada com o substrato cromogênico D-Val-Leu-Arg-Nan. Creatinina foi determinada pelo método de Jaffé. A atividade amidásica específica da hK1 urinária foi expressa em µM/(min . mg de creatinina) para corrigir diferenças no fluxo urinário.Resultados:A atividade amidásica da hK1 urinária foi semelhante entre os pacientes com DAC [0,146 µM/(min . mg de creatinina)] e aqueles sem DAC [0,189 µM/(min . mg de creatinina)] (p = 0,803), e permaneceu entre os baixos valores previamente publicados para pacientes com hipertensão primária [0,210 µM/(min . mg de creatinina)] e para aqueles com IC [0,104 µM/(min . mg de creatinina)], respectivamente. Nenhum efeito estatisticamente significativo da gravidade da DAC e da hipertensão sobre a atividade amidásica da hK1 urinária foi observado.Conclusão:A atividade amidásica da hK1 na urina estava reduzida nos pacientes com DAC, o que pode sugerir que a atividade do SCC renal esteja reduzida nessa doença.


Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Amidoidrolases/urina , Doença da Artéria Coronariana/urina , Calicreínas Teciduais/urina , Biomarcadores/urina , Estudos Transversais , Doença da Artéria Coronariana/fisiopatologia , Creatinina/urina , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/urina , Hipertensão/fisiopatologia , Hipertensão/urina , Sistema Calicreína-Cinina/fisiologia , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas
4.
Arq Bras Cardiol ; 105(5): 457-565, 2015 Nov.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26351984

RESUMO

BACKGROUND: Human tissue kallikrein (hK1) is a key enzyme in the kallikrein-kinin system (KKS). hK1-specific amidase activity is reduced in urine samples from hypertensive and heart failure (HF) patients. The pathophysiologic role of hK1 in coronary artery disease (CAD) remains unclear. OBJECTIVE: To evaluate hK1-specific amidase activity in the urine of CAD patientsMethods:Sixty-five individuals (18-75 years) who underwent cardiac catheterism (CATH) were included. Random midstream urine samples were collected immediately before CATH. Patients were classified in two groups according to the presence of coronary lesions: CAD (43 patients) and non-CAD (22 patients). hK1 amidase activity was estimated using the chromogenic substrate D-Val-Leu-Arg-Nan. Creatinine was determined using Jaffé's method. Urinary hK1-specific amidase activity was expressed as µM/(min · mg creatinine) to correct for differences in urine flow rates. RESULTS: Urinary hK1-specific amidase activity levels were similar between CAD [0.146 µM/(min ·mg creatinine)] and non-CAD [0.189 µM/(min . mg creatinine)] patients (p = 0.803) and remained similar to values previously reported for hypertensive patients [0.210 µM/(min . mg creatinine)] and HF patients [0.104 µM/(min . mg creatinine)]. CAD severity and hypertension were not observed to significantly affect urinary hK1-specific amidase activity. CONCLUSION: CAD patients had low levels of urinary hK1-specific amidase activity, suggesting that renal KKS activity may be reduced in patients with this disease.


Assuntos
Amidoidrolases/urina , Doença da Artéria Coronariana/urina , Calicreínas Teciduais/urina , Adolescente , Adulto , Idoso , Biomarcadores/urina , Doença da Artéria Coronariana/fisiopatologia , Creatinina/urina , Estudos Transversais , Feminino , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/urina , Humanos , Hipertensão/fisiopatologia , Hipertensão/urina , Sistema Calicreína-Cinina/fisiologia , Masculino , Pessoa de Meia-Idade , Valores de Referência , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto Jovem
5.
Arq Bras Cardiol ; 100(3): 212-20, 2013 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23598574

RESUMO

BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.


Assuntos
Assistência Ambulatorial/normas , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/terapia , Medicina Baseada em Evidências/normas , Estilo de Vida , Guias de Prática Clínica como Assunto/normas , Idoso , Brasil , Fármacos Cardiovasculares/classificação , Métodos Epidemiológicos , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Masculino , Fatores de Risco
6.
Arq. bras. cardiol ; 100(3): 212-220, mar. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-670878

RESUMO

FUNDAMENTO: Dados de atendimento ambulatorial ao paciente de alto risco cardiovascular no Brasil são insuficientes. OBJETIVO: Descrever o perfil e documentar a prática clínica do atendimento ambulatorial de pacientes de alto risco cardiovascular no Brasil, no que diz respeito à prescrição de terapias baseadas em evidências. MÉTODOS: Registro prospectivo que documentou a prática clínica ambulatorial de indivíduos de alto risco cardiovascular, que foi definido como a presença de um dos seguintes fatores: doença arterial coronariana, cerebrovascular e vascular periférica; diabetes; ou aqueles com pelo menos três dos seguintes fatores: hipertensão arterial, tabagismo, dislipidemia, maiores 70 anos, histórico familiar de doença arterial coronariana, nefropatia crônica ou doença carotídea assintomática. Foram avaliadas características basais e a taxa de prescrição das intervenções medicamentosas e não medicamentosas. RESULTADOS: Foram incluídos 2.364 pacientes consecutivos, sendo 52,2% do gênero masculino, idade média de 66,0 anos (± 10,1). Dentre os pacientes incluídos, 78,3% utilizavam antiplaquetários, 77,0% estatinas e, dos pacientes com história de infarto do miocárdio, 58,0% receberam betabloqueadores. O uso concomitante destas três classes foi de 34%. Não atingiram as metas preconizadas pelas diretrizes 50,9% dos hipertensos, 67% dos diabéticos e 25,7% dos dislipidêmicos. Os principais preditores de prescrição de terapias com benefício comprovado foram centro com cardiologista e histórico de doença arterial coronariana. CONCLUSÃO: Este registro nacional e representativo identificou hiatos importantes na incorporação de terapias com benefício comprovado, oferecendo um panorama real dos pacientes de alto risco cardiovascular.


BACKGROUND: Data on outpatient care provided to patients at high cardiovascular risk in Brazil are insufficient. OBJECTIVE: To describe the profile and document the clinical practice of outpatient care in patients at high cardiovascular risk in Brazil, regarding the prescription of evidence-based therapies. METHODS: Prospective registry that documented the ambulatory clinical practice in individuals at high cardiovascular risk, which was defined as the presence of the following factors: coronary artery disease, cerebrovascular and peripheral vascular diseases, diabetes, or those with at least three of the following factors: hypertension, smoking, dyslipidemia, age > 70 years, family history of coronary artery disease, chronic kidney disease or asymptomatic carotid artery disease. Basal characteristics were assessed and the rate of prescription of pharmacological and non-pharmacological interventions was analyzed. RESULTS: A total of 2364 consecutive patients were included, of which 52.2% were males, with a mean age of 66.0 years (± 10.1). Of these, 78.3% used antiplatelet agents, 77.0% used statins and of patients with a history of myocardial infarction, 58.0% received beta-blockers. Concomitant use of these three classes of drugs was 34%; 50.9% of hypertensive, 67% of diabetic and 25.7% of dyslipidemic patients did not achieve the goals recommended by guidelines. The main predictors of prescription therapies with proven benefit were centers with a cardiologist and history of coronary artery disease. CONCLUSION: This national and representative registry identified important gaps in the incorporation of therapies with proven benefit, offering a realistic outlook of patients at high cardiovascular risk.


Assuntos
Idoso , Feminino , Humanos , Masculino , Assistência Ambulatorial/normas , Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/terapia , Medicina Baseada em Evidências/normas , Estilo de Vida , Guias de Prática Clínica como Assunto/normas , Brasil , Fármacos Cardiovasculares/classificação , Métodos Epidemiológicos , Medicina Baseada em Evidências/métodos , Fatores de Risco
7.
Insuf. card ; 5(2): 59-64, abr.-jun. 2010. ilus
Artigo em Inglês | LILACS-Express | ID: lil-633370

RESUMO

Digitalis, particularly digoxin, have played an important role in the treatment of heart failure (HF) for over 200 years. In the past three decades, with the greatest knowledge of the pathophysiology of the disease, neurohumoral blockers were more effective in reducing morbidity and mortality and gained greater prominence. In addition, studies have suggested that digoxin does not reduce the risk of death and, in some cases, may even increase it. Thus, its use has been questioned and discouraged. This review aims to look at the pharmacology of digoxin, studies on its benefits and risks in patients with moderate to severe systolic HF and diastolic HF also. This review looks forward to answering the following question: Is there still room for the use of digitalis in HF?.


Los digitálicos, y digoxina en particular, han jugado un papel importante en el tratamiento de la insuficiencia cardíaca (IC) por más de 200 años. En las últimas tres décadas, con un mayor conocimiento de la fisiopatología de la enfermedad, los bloqueadores neurohumorales se mostraron más eficaces en la reducción de la morbi-mortalidad y ganaron mayor prominencia. Además, los estudios han sugerido que digoxina no reduce el riesgo de muerte y, en algunos casos, puede incluso aumentarlo. De esta manera, su uso ha sido muy cuestionado y desalentado. Esta revisión trata de contemplar la farmacología de digoxina, los estudios sobre sus beneficios y los riesgos en pacientes con IC sistólica moderada a severa y también en la IC diastólica. Se busca con esta revisión, contestar la siguiente pregunta: ¿existe todavía espacio para el uso del digitálicos en la IC?.


Os digitais, e a digoxina em especial, têm desempenhado papel importante no tratamento da Insuficiência Cardíaca (IC) há mais de 200 anos. Nas últimas três décadas, com o maior conhecimento da fisiopatologia da doença, os bloqueadores neuro-humorais mostraram-se mais eficazes em reduzir a morbi-mortalidade e ganharam maior destaque. Além disso, estudos sugeriram que a digoxina não reduz o risco de morrer e, em algumas situações, pode, inclusive, aumentá-lo. Desta forma, seu uso chegou a ser bastante questionado e desestimulado. Esta revisão procura contemplar a farmacologia da digoxina, os estudos sobre seus benefícios e riscos em pacientes com IC sistólica moderada a grave e também na IC diastólica. Procuramos, com esta revisão, responder à seguinte questão: ainda existe espaço para o uso de digitais na IC?.

9.
J Card Fail ; 12(8): 653-8, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17045186

RESUMO

BACKGROUND: Heart failure (HF) is a clinical syndrome that activates several neurohumoral systems. There is little information on the participation of renal kallikrein-kinin system (KKS) in HF. Kallikreins are key enzymes in this system. Thus it was decided to evaluate the role of renal human tissue kallikrein (hK1) in HF patients and, indirectly, to evaluate the role of renal KKS in this disease. METHODS AND RESULTS: Twenty-eight systolic HF patients, > or =18 years, in New York Heart Association's functional classes II-IV, with left ventricular ejection fraction (LVEF) < or =40%, not receiving angiotensin-converting enzyme inhibitors were selected. Twenty-eight healthy individuals, paired according to gender, ethnics and age, were used as controls. Early-morning midstream urine from every subject was used. hK1 amidase activity was estimated with D-Val-Leu-Arg-Nan substrate. Creatinine was determined by Jaffe's method. hK1 amidase activity was expressed in muM.min(-1).mL(-1) urine and in muM.min(-1).mg(-1) creatinine to correct for differences in urine flow rate. hK1 amidase activities were significantly lower in the urine of HF patients. CONCLUSION: Because the hK1 amidase activity is significantly lower in the urine of systolic HF patients, it can be supposed that the activity of renal KKS may be suppressed in this disease.


Assuntos
Amidoidrolases/urina , Baixo Débito Cardíaco/metabolismo , Rim/metabolismo , Calicreínas Teciduais/metabolismo , Adulto , Idoso , Baixo Débito Cardíaco/fisiopatologia , Baixo Débito Cardíaco/urina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sístole
10.
Rev. méd. Minas Gerais ; 15(3): 167-169, jul.-set. 2005. ilus
Artigo em Português | LILACS | ID: lil-571168

RESUMO

As miocardites (inflamações do músculo cardíaco, podendo envolver os miócitos, o interstício, estruturas vasculares e/ou o pericárdio) são importantes causas de morte súbita e inesperada em adultos com menos de 40 anos de idade e atletas jovens. Têm etiologia diversa, incluindo vírus, bactérias, protozoários, drogas e doenças sistêmicas. Sua fisiopatologia envolve a ativação prolongada das imunidades celular e humoral. Seu curso geralmente é assintomático ou insidioso, havendo considerável dificuldade no estabelecimento do diagnóstico, devido à inespecificidade de seu quadro clínico e à baixa sensibilidade dos exames complementares. O tratamento é basicamente suportivo e direcionado às possíveis complicações ou às causas de base. Possuem prognóstico variável, dependendo da causa-base, sendo pior nas doenças sistêmicas e na infecção pelo HIV.


Myocarditis are defined as inflammation of the cardiac muscle, which may involve the myocite, the interstitium, the vascular structures and/or the pericardium. They are important causes of sudden and unexpected death in adults and in young athletes. There are many known etiologies for myocarditis, including virus, bacteria, protozoan, drugs and systemic diseases. Its pathophysiology involves the continuum activation of humoral and cellular immunity. The course of the disease usually is assymptomatic or insidious, clinical manifestations are quite non-specific and complementary, exams show poor sensibility and specificity, making diagnosis difficult. Treatment is basically supportive and addressed to the possible complications or its causes. The prognosis is somewhat variable, depending on the underlying cause, being worse in systemic diseases and in HIV infections.


Assuntos
Humanos , Miocardite/diagnóstico , Miocardite/epidemiologia , Miocardite/fisiopatologia , Miocardite/terapia
11.
Arq Bras Cardiol ; 79(2): 183-6, 2002 Aug.
Artigo em Inglês, Português | MEDLINE | ID: mdl-12219193

RESUMO

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.


Assuntos
Pré-Eclâmpsia/complicações , Descolamento Retiniano/etiologia , Adulto , Feminino , Humanos , Gravidez , Descolamento Retiniano/diagnóstico
12.
Arq. bras. cardiol ; 79(2): 183-186, Aug. 2002. ilus
Artigo em Português, Inglês | LILACS | ID: lil-317892

RESUMO

Preeclampsia is an obstetric disease of unknown cause that affects approximately 5 percent of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision


Assuntos
Humanos , Feminino , Gravidez , Adulto , Pré-Eclâmpsia , Descolamento Retiniano , Pré-Eclâmpsia , Descolamento Retiniano
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