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2.
Arq Bras Cardiol ; 112(3): 260-268, 2019 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916204

RESUMO

BACKGROUND: Ideal Cardiovascular (CV) Health is characterized by four ideal lifestyle parameters and absence of cardiovascular risk factors. The prevalence of ideal CV health in the Amazon Basin and the influence of job strain on CV health in this setting are uncertain. OBJECTIVE: To evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. METHODS: Job strain was evaluated in 478 employees from an university in the Amazon Basin by a questionnaire that classified participants as passive, active, low or high strain, according to the demand-control model. CV health was evaluated using the American Heart Association 7 health factors (diet, physical activity, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolemia). Participants were classified as having ideal, intermediate or poor CV health. The level of significance was set at p < 0.05. RESULTS: The mean age was 44.3 ± 12 years, 65% were men, and 35% were faculty. No participant fulfilled the criteria for ideal CV health. Intermediate CV health was found in 44 (9%) and poor in 434 (91%) individuals. Considering low strain as a reference group, individuals classified as high strain, active and passive had a non-significant (p > 0.05) increase in the chances of having poor CV health. When adjusting for possible confounders, high job strain was associated with poor BMI (> 30 kg/m2), (OR 2.11, 95%CI 1.06-4.22; p = 0.034) and poor diet (OR 2.31, 95% CI 1.29-4.13; p = 0.005). CONCLUSION: Job strain was not associated with cardiovascular health, but high job strain was related to obesity and poor diet. Given the high prevalence of poor CV health and lack of participants with ideal CV health, policies focusing on health education and lifestyle interventions are paramount to this population.

3.
Arq. bras. cardiol ; 112(3): 260-268, Mar. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-989331

RESUMO

Abstract Background: Ideal Cardiovascular (CV) Health is characterized by four ideal lifestyle parameters and absence of cardiovascular risk factors. The prevalence of ideal CV health in the Amazon Basin and the influence of job strain on CV health in this setting are uncertain. Objective: To evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. Methods: Job strain was evaluated in 478 employees from an university in the Amazon Basin by a questionnaire that classified participants as passive, active, low or high strain, according to the demand-control model. CV health was evaluated using the American Heart Association 7 health factors (diet, physical activity, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolemia). Participants were classified as having ideal, intermediate or poor CV health. The level of significance was set at p < 0.05. Results: The mean age was 44.3 ± 12 years, 65% were men, and 35% were faculty. No participant fulfilled the criteria for ideal CV health. Intermediate CV health was found in 44 (9%) and poor in 434 (91%) individuals. Considering low strain as a reference group, individuals classified as high strain, active and passive had a non-significant (p > 0.05) increase in the chances of having poor CV health. When adjusting for possible confounders, high job strain was associated with poor BMI (> 30 kg/m2), (OR 2.11, 95%CI 1.06-4.22; p = 0.034) and poor diet (OR 2.31, 95% CI 1.29-4.13; p = 0.005). Conclusion: Job strain was not associated with cardiovascular health, but high job strain was related to obesity and poor diet. Given the high prevalence of poor CV health and lack of participants with ideal CV health, policies focusing on health education and lifestyle interventions are paramount to this population.


Resumo Fundamento: Saúde cardiovascular (CV) ideal é caracterizada por quatro parâmetros de estilo de vida ideal e ausência de fatores de risco CV. A prevalência da saúde CV ideal na Bacia Amazônica e sua relação com estresse no trabalho é desconhecida. Objetivo: Avaliar a prevalência da saúde CV ideal e sua relação com o estresse no trabalho em uma área isolada de um país em desenvolvimento. Métodos: O estresse no trabalho foi avaliado em 478 funcionários de uma universidade na Bacia Amazônica através de um questionário validado que classificou os participantes como passivos, ativos, baixa tensão ou alta tensão no trabalho, de acordo com o modelo de demanda e controle. A saúde CV foi avaliada usando os 7 parâmetros usados pela American Heart Association (dieta, atividade física, IMC, tabagismo, hipertensão, diabetes e hipercolesterolemia). Os participantes foram classificados em saúde CV ideal, intermediária ou ruim. O nível de significância adotado foi de 5% (p < 0,05). Resultados: A idade média foi de 44,3 ± 12 anos, 65% eram homens e 35% eram professores. Nenhum participante preencheu os critérios de saúde CV ideal. A saúde CV intermediária foi encontrada em 44 (9%) e ruim em 434 (91%) dos entrevistados. Considerando a baixa tensão como grupo de referência, indivíduos classificados como de alta tensão, ativos e passivos tiveram um aumento não significativo (p > 0,05) nas chances de ter saúde CV ruim. Ao ajustar para possíveis fatores de confusão, a alta tensão no trabalho foi associada à obesidade (IMC > 30 kg/m2): OR 2,11 (IC 95% 1,06-4,22; p = 0,034) e dieta inadequada: OR 2,31 (IC 95%: 1,29-4,13 p = 0,005). Conclusão: Não houve associação entre saúde CV e estresse no trabalho, mas a obesidade e a má alimentação foram relacionadas à alta tensão. Dada a alta prevalência de saúde CV ruim e ausência de participantes com saúde CV ideal, as políticas voltadas para a educação em saúde e as intervenções de estilo de vida são primordiais para essa população.

4.
Arq Bras Cardiol ; 2019 Jan 07.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30624532

RESUMO

BACKGROUND: Ideal Cardiovascular (CV) Health is characterized by four ideal lifestyle parameters and absence of cardiovascular risk factors. The prevalence of ideal CV health in the Amazon Basin and the influence of job strain on CV health in this setting are uncertain. OBJECTIVE: To evaluate the prevalence of ideal CV health and its relationship with job strain in a secluded area from a developing country. METHODS: Job strain was evaluated in 478 employees from an university in the Amazon Basin by a questionnaire that classified participants as passive, active, low or high strain, according to the demand-control model. CV health was evaluated using the American Heart Association 7 health factors (diet, physical activity, body mass index (BMI), smoking, hypertension, diabetes and hypercholesterolemia). Participants were classified as having ideal, intermediate or poor CV health. The level of significance was set at p < 0.05. RESULTS: The mean age was 44.3 ± 12 years, 65% were men, and 35% were faculty. No participant fulfilled the criteria for ideal CV health. Intermediate CV health was found in 44 (9%) and poor in 434 (91%) individuals. Considering low strain as a reference group, individuals classified as high strain, active and passive had a non-significant (p > 0.05) increase in the chances of having poor CV health. When adjusting for possible confounders, high job strain was associated with poor BMI (> 30 kg/m2), (OR 2.11, 95%CI 1.06-4.22; p = 0.034) and poor diet (OR 2.31, 95% CI 1.29-4.13; p = 0.005). CONCLUSION: Job strain was not associated with cardiovascular health, but high job strain was related to obesity and poor diet. Given the high prevalence of poor CV health and lack of participants with ideal CV health, policies focusing on health education and lifestyle interventions are paramount to this population.

5.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
6.
Catheter Cardiovasc Interv ; 91(5): 867-873, 2018 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-28722266

RESUMO

OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to be safe options for the treatment of proximal LAD stenosis, however associated with considerable reintervention rates. Overall, second-generation DES has proven to be superior to BMS and first-generation DES, nevertheless, its effect for proximal LAD PCI has not previously been reported. METHODS: We analyzed 2-year outcomes of 1,100 patients from the BASKET-PROVE I and II trials, referred for proximal LAD PCI with second generation DES (n = 680) or BMS (n = 420). RESULTS: The cumulative 2-year incidence of major adverse cardiac events (MACE, composite of cardiac death, myocardial infarction (MI) and target vessel revascularization (TVR)) was lower in second generation DES than in BMS treated patients (7.3% vs. 12.3%; HR 0.57, 95% CI 0.39/0.85), mainly driven by a reduced rate of TVR (3.7% vs. 10.0%; HR 0.35, CI 0.21/0.58). No difference was found in cardiac death (1.9% vs. 1.9%; HR 1.01, CI 0.42/2.44) and MI (4.4% vs. 4.7%; HR 0.93, CI 0.53/1.64). The benefit of DES use seemed to be more prominent in female patients with a reduction in MACE (P for interaction = 0.025). CONCLUSIONS: In patients with proximal LAD stenosis, treatment with second-generation DES was associated with reduced 2-year rates of adverse cardiac events and TVR compared to BMS, with reintervention rates similar to those earlier reported from bypass surgery.

7.
Einstein (Sao Paulo) ; 13(2): 310-8, 2015 Apr-Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26154552

RESUMO

Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits the achievement of a greater number of heart transplants, in which the use of mechanical circulatory support devices is increasing. With well-established indications and contraindications, as well as diagnosis and treatment of rejection through defined protocols of immunosuppression, the outcomes of heart transplantation are very favorable. Among early complications that can impact survival are primary graft failure, right ventricular dysfunction, rejection, and infections, whereas late complications include cardiac allograft vasculopathy and neoplasms. Despite the difficulties for heart transplantation, in particular, the shortage of donors and high mortality while on the waiting list, in Brazil, there is a great potential for both increasing effective donors and using circulatory assist devices, which can positively impact the number and outcomes of heart transplants.


Assuntos
Rejeição de Enxerto/complicações , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Infecções Oportunistas/complicações , Complicações Pós-Operatórias , Disfunção Primária do Enxerto/complicações , Brasil , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/cirurgia , Rejeição de Enxerto/classificação , Rejeição de Enxerto/fisiopatologia , Transplante de Coração/métodos , Transplante de Coração/tendências , Coração Auxiliar , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Neoplasias/induzido quimicamente , Neoplasias/complicações , Doadores de Tecidos/provisão & distribução
8.
Einstein (Säo Paulo) ; 13(2): 310-318, Apr-Jun/2015. tab
Artigo em Inglês | LILACS-Express | ID: lil-751427

RESUMO

ABSTRACT Heart transplantation is currently the definitive gold standard surgical approach in the treatment of refractory heart failure. However, the shortage of donors limits the achievement of a greater number of heart transplants, in which the use of mechanical circulatory support devices is increasing. With well-established indications and contraindications, as well as diagnosis and treatment of rejection through defined protocols of immunosuppression, the outcomes of heart transplantation are very favorable. Among early complications that can impact survival are primary graft failure, right ventricular dysfunction, rejection, and infections, whereas late complications include cardiac allograft vasculopathy and neoplasms. Despite the difficulties for heart transplantation, in particular, the shortage of donors and high mortality while on the waiting list, in Brazil, there is a great potential for both increasing effective donors and using circulatory assist devices, which can positively impact the number and outcomes of heart transplants.


RESUMO O transplante cardíaco é atualmente a abordagem cirúrgica definitiva padrão-ouro no tratamento da insuficiência cardíaca refratária. No entanto, a escassez de doadores limita a realização de um número maior de transplantes cardíacos, situação em que vem aumentando a utilização de dispositivos de assistência circulatória mecânica. Com indicações e contraindicações bem estabelecidas, além de diagnóstico e tratamento de rejeição, por meio de protocolos definidos de imunossupressão, os resultados do transplante cardíaco são muito favoráveis. Dentre as complicações precoces que podem impactar a sobrevida, destacamos a disfunção primária do enxerto, a disfunção do ventrículo direito, rejeição e infecções; já as complicações tardias incluem a doença vascular do enxerto e as neoplasias. Apesar das dificuldades para realização do transplante cardíaco, em especial pela escassez de doadores e pela elevada mortalidade em fila de espera, no Brasil, existe um grande potencial, tanto no aumento de doadores efetivos, quanto na utilização de dispositivos de assistência circulatória, o que pode vir a impactar positivamente no número e nos resultados do transplante cardíaco.

12.
Einstein (Sao Paulo) ; 11(3): 273-7, 2013 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24136751

RESUMO

OBJECTIVE: To correlate the serum levels of B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide, as well as to analyze the influence of age, obesity, renal failure, left ventricle ejection fraction, diastolic dysfunction, and anemia on serum levels of both markers. METHODS: An observational study in which the agreement was compared between these markers in consecutive samples of 138 patients. For the correlation, Pearson's test was used, and p<0.05 was considered statistically significant. RESULTS: A linear association was observed between the B type natriuretic peptide and N-terminal fraction of the pro-B type natriuretic peptide (r=0.907; p<0.001). When evaluating the categorized measurements as normal and altered, there was good agreement, with 90.6% of agreement classifications (p<0.001) in which altered values of the N-terminal fraction of the pro-B type natriuretic peptide and normal values of the B type natriuretic peptide represented 8.7% of the total; the opposite situation represented 1% of the total. Assessment of the influence of the clinical and laboratorial factors on the levels of natriuretic peptides showed that they rise according to age, but that they fall as the ejection fraction increases. Patients with anemia (p<0.001) or with renal failure (p=0.007) had higher values of both markers. There was no association between obesity and the B type natriuretic peptide. CONCLUSION: There was satisfactory agreement between the B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide. Age, creatinine levels, and hemoglobin, as well as ventricular function, influence the serum levels of both natriuretic peptides.


Assuntos
Insuficiência Cardíaca/sangue , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Criança , Pré-Escolar , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
13.
Einstein (Sao Paulo) ; 11(3): 367-9, 2013 Jul-Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-24136766

RESUMO

The association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Pericardite Constritiva/diagnóstico , Artéria Pulmonar/anormalidades , Anomalias dos Vasos Coronários/complicações , Humanos , Masculino , Pericardite Constritiva/complicações , Adulto Jovem
15.
Einstein (Säo Paulo) ; 11(3): 273-277, jul.-set. 2013. graf, tab
Artigo em Português | LILACS | ID: lil-688628

RESUMO

OBJETIVO: Correlacionar os níveis séricos do peptídeo natriurético tipo B e da fração N-terminal do pró-peptídeo natriurético tipo B, além de analisar a influência de idade, obesidade, insuficiência renal, fração da ejeção do ventrículo esquerdo, disfunção diastólica e anemia nos níveis séricos de ambos os marcadores. MÉTODOS: Estudo observacional, no qual se comparou a concordância entre esses marcadores em amostras consecutivas de 138 pacientes. Para a correlação, utilizou-se o teste de Pearson e foi considerado estatisticamente significante p<0,05. RESULTADOS: Observou-se associação linear entre peptídeo natriurético tipo B e fração N-terminal do pró-peptídeo natriurético tipo B (r=0,907; p<0,001). Ao se avaliarem as medidas categorizadas como normais e alteradas, encontrou-se boa concordância, com 90,6% de classificações concordantes (p<0,001), sendo que valores alterados da fração N-terminal do pró-peptídeo natriurético tipo B e normais de peptídeo natriurético tipo B representaram 8,7% do total, e o contrário representou 1% do total. A avaliação da influência dos fatores clínicos e laboratoriais nos níveis dos peptídeos natriuréticos mostrou que eles se elevam de acordo com a idade, mas que diminuem conforme aumenta a fração de ejeção. Pacientes com anemia (p<0,001) ou com insuficiência renal (p=0,007) apresentaram valores maiores de ambos os marcadores. Não houve associação entre obesidade e peptídeo natriurético tipo B. CONCLUSÃO: Houve concordância satisfatória entre peptídeo natriurético tipo B e a fração N-terminal do pró-peptídeo natriurético tipo B. Idade, níveis de creatinina e hemoglobina, assim como função ventricular, influenciam os níveis séricos de ambos os peptídeos natriuréticos.


OBJECTIVE: To correlate the serum levels of B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide, as well as to analyze the influence of age, obesity, renal failure, left ventricle ejection fraction, diastolic dysfunction, and anemia on serum levels of both markers. METHODS: An observational study in which the agreement was compared between these markers in consecutive samples of 138 patients. For the correlation, Pearson's test was used, and p<0.05 was considered statistically significant. RESULTS: A linear association was observed between the B type natriuretic peptide and N-terminal fraction of the pro-B type natriuretic peptide (r=0.907; p<0.001). When evaluating the categorized measurements as normal and altered, there was good agreement, with 90.6% of agreement classifications (p<0.001) in which altered values of the N-terminal fraction of the pro-B type natriuretic peptide and normal values of the B type natriuretic peptide represented 8.7% of the total; the opposite situation represented 1% of the total. Assessment of the influence of the clinical and laboratorial factors on the levels of natriuretic peptides showed that they rise according to age, but that they fall as the ejection fraction increases. Patients with anemia (p<0.001) or with renal failure (p=0.007) had higher values of both markers. There was no association between obesity and the B type natriuretic peptide. CONCLUSION: There was satisfactory agreement between the B type natriuretic peptide and the N-terminal fraction of the pro-B type natriuretic peptide. Age, creatinine levels, and hemoglobin, as well as ventricular function, influence the serum levels of both natriuretic peptides.


Assuntos
Insuficiência Cardíaca , Peptídeos Natriuréticos
16.
Einstein (Säo Paulo) ; 11(3): 367-369, jul.-set. 2013. ilus
Artigo em Português | LILACS | ID: lil-688643

RESUMO

A associação da artéria coronária direita anômala com origem na artéria pulmonar e pericardite constritiva ainda não foi descrita na literatura. Apresentamos aqui o primeiro caso dessa associação inusitada em um paciente com quadro de insuficiência cardíaca direita. Após o diagnóstico, o paciente foi encaminhado para tratamento cirúrgico, sendo submetido a pericardiectomia frênico a frênico, implante de enxerto da artéria mamária interna direita para a coronária direita e ligadura da origem anômala da coronária direita da artéria pulmonar. Tais procedimentos resolveram o potencial risco de morte súbita pela anomalia coronária e aliviaram os sintomas de insuficiência cardíaca causados pela pericardite constritiva.


The association of anomalous right coronary artery originating from the pulmonary artery and constrictive pericarditis has never been showed in the literature. We present the first case of this unusual association in a patient with right heart failure. After diagnosis, the patient was referred to surgery and underwent phrenic-to-phrenic pericardiectomy; graft implant of right internal thoracic artery to right coronary artery; and ligation of the anomalous origin of the right coronary artery from the pulmonary artery. Such procedures solved the potential risk of sudden death related to anomalous right coronary artery originating from the pulmonary artery and alleviated the symptoms of heart failure caused by constrictive pericarditis.


Assuntos
Doença das Coronárias , Insuficiência Cardíaca , Pericardite
18.
Ann Hepatol ; 12(1): 85-91, 2013 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23293198

RESUMO

BACKGROUND: The impact of end-stage liver disease (ESLD) in cardiac remodeling of patients with cirrhosis is unknown. Our aim was to correlate the severity of ESLD with morphologic and functional heart changes. MATERIAL AND METHODS: 184 patients underwent a protocol providing data on the severity of ESLD and undergoing echocardiography to assess the diameters of the left atrium and right ventricle; the systolic and diastolic diameters of the left ventricle, interventricular septum, and posterior wall of the left ventricle; systolic pulmonary artery pressure; ejection fraction; and diastolic function. Severity of ESLD was assessed by the Model for End-Stage Liver Disease (MELD) score. RESULTS: Left-atrial diameter (r = 0.323; IC 95% 0.190-0.455; p < 0.001), left-ventricular diastolic diameter (r = 0.177; IC 95% 0.033-0.320; p = 0.01) and systolic pulmonary artery pressure (r = 0.185; IC 95% 0.036-0.335; p = 0.02) significantly correlated with MELD score. Patients with MELD ≥ 16 had significantly higher left-atrial diameter and systolic pulmonary artery pressure, compared with patients with MELD scores < 16 points. CONCLUSIONS: Changes in cardiac structure and function correlate with the severity of ESLD.


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Doença Hepática Terminal/complicações , Hipertensão Pulmonar/diagnóstico por imagem , Cirrose Hepática/complicações , Adulto , Idoso , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Cardiomiopatias/fisiopatologia , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Dilatada/fisiopatologia , Estudos de Coortes , Ecocardiografia , Eletrocardiografia , Doença Hepática Terminal/patologia , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Fígado/patologia , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Remodelação Ventricular
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