QT Interval Dispersion Behavior in Patients With and Without Obstructive Coronary Artery Disease Undergoing Exercise Test

Abstract Background: Stress test is used to detect coronary artery disease (CAD). The QTc interval dispersion (dQTc) is an electrocardiographic index of ventricular repolarization heterogeneity. Some researchers have linked transient myocardial ischemia induced by physical exertion with increased heterogeneity of ventricular repolarization measured by dQTc. Objectives: To study the patterns of dQT in patients with and without chronic obstructive CAD and to define a reliable cutoff point for dQT that could become a diagnostic criterion for myocardial ischemia. Methods: We retrospectively analyzed the electrocardiogram in resting and in exercise of 63 patients submitted to exercise test and cardiac catheterization. We divided the patients into three groups: true negative (VN), true positive (VP) and false positive (FP). VN: patients with coronary lesion lower than 70% and exercise test without myocardial ischemia; VP: individuals with stenosis greater than 70% in coronary arteries and a test suggestive of myocardial ischemia; FP: people with stenosis lower than 70% in the coronary arteries and stress test with ischemia criteria. Values of p < 0.05 were considered statistically significant. Results: Resting dQTc was not different among the three groups. However, for the dispersion of the QTc interval in exercise was, respectively, 47 ± 17 ms, 72 ± 42 ms, and 61 ± 31 ms for VN, VP and FP (p = 0.003). Conclusions: Obstructive chronic coronary disease patients have an increase in dQTc during exercise. Measurement of dQTc may be helpful in the diagnosis of myocardial ischemia in the stress test.

Association between Hemogram Parameters and Coronary Collateral Development in Subjects with Non-ST-Elevation Myocardial Infarction

SUMMARY OBJECTIVE Coronary collateral development (CCD) predicts the severity of coronary heart disease. Hemogram parameters, such as mean platelet volume (MPV), eosinophil, red cell distribution width, and platelet distribution width (PDW), are supposed novel inflammatory markers. We aimed to compare hemogram parameter values in patients presenting with non-ST-elevation myocardial infarction (NSTEMI) with adequate or inadequate CCD. METHODS A total of 177 patients with NSTEMI undergoing coronary arteriography were enrolled and divided into two groups based on the development of CCD: one group with adequate CCD (n=88) and the other with impaired CCD (n=89). RESULTS Baseline demographics and clinical risk factors were similar between the groups. Hemogram parameters were not significantly different between the two groups. However, compared to the inadequate CCD group, the median PDW was significantly higher in the adequate CCD group, 17.6 (1.4) vs. 17.8 (1.6) p=0.004. In a multivariate analysis, PDW (p=0.001, 95% CI for OR: 0.489(0,319-0,750) was found to be significantly different in the adequate CCD group compared to the inadequate CCD group. Pearson's correlation analysis revealed that PDW was significantly correlated with the Rentrop score (r=0.26, p<0.001). CONCLUSIONS We suggest that since PDW is an index that is inexpensive and easy to assess, it could serve as a marker of CCD in patients with NSTEMI.

RESUMO OBJETIVO O desenvolvimento colateral coronariano (CCD) prediz a gravidade da doença coronariana. Parâmetros de hemograma como volume plaquetário médio (VPM), eosinófilo, largura de distribuição de glóbulos vermelhos e largura de distribuição de plaquetas (PDW) são supostos novos marcadores inflamatórios. Nosso objetivo foi comparar os valores do parâmetro hemograma em pacientes com infarto do miocárdio sem supradesnivelamento do segmento ST (IAMSSST) com DCC adequado ou inadequado. MÉTODOS Um total de 177 pacientes com NSTEMI submetidos à arteriografia coronariana foram incluídos e divididos, com base no desenvolvimento de CCD, em dois grupos: grupo com CCD adequado (n = 88) e grupo com CCD alterado (n = 89). RESULTADOS Os dados demográficos e os fatores de risco clínicos basais foram semelhantes entre os grupos. Os parâmetros do hemograma não foram significativamente diferentes entre os dois grupos. Mas, em comparação com a mediana inadequada do grupo CCD, o PDW foi significativamente maior em CCD adequado de 17,6 (1,4) vs. 17,8 (1,6) p = 0,004. Na análise multivariada, PDW (p = 0,001, IC 95% para OR: 0,489 (0,319-0,750) foi significativamente diferente no grupo CCD adequado em comparação com o grupo CCD inadequado. A análise de correlação de Pearson revelou que PDW foi significativamente correlacionado com escore de aluguel (r = 0,26, p <0,001). CONCLUSÃO Sugerimos que, uma vez que a PDW é um índice barato e de fácil avaliação, pode servir como um marcador de DCC em pacientes com IAMSSST.

Influence of the hydration on autonomic modulation and cardiorespiratory parameters of coronary heart disease patients submitted to a cardiovascular rehabilitation session: crossover clinical trial protocol

Abstract Aims: The influence of fluid replacement, realized during and after the exercise on individuals with coronary artery disease (CAD) remains poorly understood. To investigate the influence of hydration on cardiac autonomic modulation, cardiorespiratory parameters and perceived exertion and discommodity, of coronary heart patients submitted to cardiac rehabilitation (CR) session. Methods: This cross-over clinical trial, will recruit 31 adults with more than 45 years old, participants of a cardiovascular rehabilitation program, with CAD diagnosis. The participants will be submitted to an experimental protocol composed of three phases: I) Maximal stress test; II) Control protocol (CP); and III) Hydration protocol (HP). The CP and HP will consist of 10 min of rest in a supine position, 15 min of warming, 40 min of treadmill exercise, 5 min of cooling down and 60 min of rest in a supine position. In the HP, the participants will be hydrated with mineral water, based on the bodyweight reduction of the CP. The water intake will be divided into eight equal portions, offered during the treadmill exercise and recovery period. On CP and HP will be evaluated linear and nonlinear indices of heart rate variability, the heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen partial saturation, perceived exertion and discommodity on specifics moments. Conclusion: The results of this study will allow us to identify if the proposed protocol will be able to positively influence the outcomes and, consequently, if could be implement in the clinical practice.

Physical Activity Levels in Peripheral Artery Disease Patients / Níveis de Atividade Física Em Pacientes Com Doença Arterial Periférica

Abstract Background: Increases in daily physical activity levels is recommended for patients with peripheral artery disease (PAD). However, despite this recommendation, little is known about the physical activity patterns of PAD patients. Objective: To describe the physical activity patterns of patients with symptomatic peripheral artery (PAD) disease. Methods: This cross-sectional study included 174 PAD patients with intermittent claudication symptoms. Patients were submitted to clinical, hemodynamic and functional evaluations. Physical activity was objectively measured by an accelerometer, and the time spent in sedentary, low-light, high-light and moderate-vigorous physical activities (MVPA) were obtained. Descriptive analysis was performed to summarize patient data and binary logistic regression was used to test the crude and adjusted associations between adherence to physical activity recommendation and sociodemographic and clinical factors. For all the statistical analyses, significance was accepted at p < 0.05. Results: Patients spent in average of 640 ± 121 min/day, 269 ± 94 min/day, 36 ± 27 min/day and 15 ± 16 min/day in sedentary, low-light, high-light and MVPA, respectively. The prevalence of patients who achieved physical activity recommendations was 3.4%. After adjustment for confounders, a significant inverse association was observed between adherence to physical activity recommendation and age (OR = 0.925; p = 0.004), while time of disease, ankle brachial index and total walking distance were not associated with this adherence criteria (p > 0.05). Conclusion: The patterns of physical activity of PAD patients are characterized by a large amount of time spent in sedentary behaviors and a low engagement in MVPA. Younger patients, regardless of the clinical and functional factors, were more likely to meet the current physical activity recommendations.

Resumo Fundamento: Aumentos nos níveis de atividade física diária são recomendados para pacientes com doença arterial periférica (DAP). No entanto, apesar dessa recomendação, pouco se sabe sobre os padrões de atividade física dos pacientes com DAP. Objetivo: Descrever os padrões de atividade física de pacientes com DAP sintomática. Métodos: Este estudo transversal incluiu 174 pacientes com DAP com sintomas de claudicação intermitente. Os pacientes foram submetidos a avaliações clínicas, hemodinâmicas e funcionais. A atividade física foi objetivamente medida por um acelerômetro, e o tempo gasto em atividades sedentárias, de baixa intensidade, de alta intensidade e atividade física moderada-a-vigorosa (AFMV) foi obtido. A análise descritiva foi realizada para resumir os dados dos pacientes e a regressão logística binária foi utilizada para testar as associações brutas e ajustadas entre a adesão à recomendação de atividade física e os fatores sociodemográficos e clínicos. Para todas as análises estatísticas, a significância foi estabelecida em p < 0,05. Resultados: Os pacientes gastaram em média 640 ± 121 min/dia, 269 ± 94 min / dia, 36 ± 27 min/dia e 15 ± 16 min/dia em atividades sedentárias, de baixa intensidade, alta intensidade e AFMV, respectivamente. A prevalência de pacientes que atingiram as recomendações de atividade física foi de 3,4%. Após ajuste para fatores de confusão, observou-se associação inversa significativa entre adesão à recomendação de atividade física e idade (OR = 0,925; p = 0,004), enquanto tempo de doença, ITB e distância total de caminhada não se associaram a esse critério de adesão (p> 0,05). Conclusão: Os padrões de atividade física dos pacientes com DAP são caracterizados por uma grande quantidade de tempo gasto em comportamentos sedentários e um baixo envolvimento na AFMV. Pacientes mais jovens, independentemente dos fatores clínicos e funcionais, apresentaram maior probabilidade de atender às recomendações atuais de atividade física.

Comparing the short - term outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors in patients with coronary artery disese: a prospective, randomized, controlled study

ABSTRACT Introduction: To compare the perioperative outcomes and complications of monopolar and bipolar transurethral resection of bladder tumors (TURBT) in patients with coronary artery disease (CAD). Materials and Methods: A total of 90 CAD patients with newly diagnosed bladder cancer who underwent TURBT were randomized into monopolar TURBT (M-TURBT) and bipolar TURBT (B-TURBT) groups. Primary outcome was safety of the procedures including obturator jerk, bladder perforation, clot retention, febrile urinary tract infection and TUR syndrome. The secondary outcome was the efficacy of TURBT procedures, including complete tumor resection, sampling of the deep muscle tissue and sampling of the qualified tissues without any thermal damage. Results: Mean ages of the patients in M-TURBT and B-TURBT groups were 71.36±7.49 and 73.71±8.15 years, respectively (p=0.157). No significant differences were found between M-TURBT and B-TURBT groups regarding complete tumor resection (76.2% vs. 87.5%, p=0.162) and muscle tissue sampling rates (71.4% vs. 64.6%,p=0.252). Obturator jerk was detected in 16.7% of the patients in M-TURBT group and 2.1% in B-TURBT group (p=0.007). No statistically significant differences were found between the groups regarding intraoperative and postoperative complications. Conclusions: Both monopolar and bipolar systems can be used safely and effectively during TURBT procedure in CAD patients. Due to the more frequently seen obturator jerk in M-TURBT than B-TURBT, careful surgical approach is needed during M-TURBT.

Insuficiência cardíaca: relação entre parâmetros antropométricos, composição corporal e integridade celular / Heart failure: correlation between anthropometric parameters, body composition and cell integrity

Fundamentos: O conhecimento do ângulo de fase e seu uso como determinante prognóstico em pacientes com insuficiência cardíaca ainda é escasso. Objetivo: Avaliar a relação entre indicadores antropométricos, função cardíaca e integridade celular em pacientes com insuficiência cardíaca com fração de ejeção reduzida. Métodos: Trata-se de um estudo transversal que avaliou pacientes com insuficiência cardíaca com fração de ejeção reduzida por meio da antropometria e da bioimpedância elétrica. Foram empregados os testes do Qui-quadrado e teste t de student para analisar as diferenças e a correlação linear de Pearson para avaliar associação, adotando p < 0,05 para indicar significância estatística.Resultados: Foram avaliados 41 indivíduos, com idade entre 30-74 anos, sendo 34 homens (82,9%). O ângulo de fase mostrou-se com maior média entre as mulheres (7,1°), porém houve diferença estatisticamente significativa entre os sexos apenas para as médias do percentual de gordura. O ângulo de fase correlacionou-se com o índice de massa corporal (r = 0,44; p = 0,004) e houve uma tendência na correlação do ângulo de fase com a razão cintura/estatura (r = 0,29; p = 0,06) e fração de ejeção do ventrículo esquerdo (r = 0,29; p = 0,07). Conclusões: O ângulo de fase apresentou boa correlação com o índice de massa corporal e mostrou uma tendência de correlação com a fração de ejeção do ventrículo esquerdo, sustentando o paradoxo da obesidade e a importância prognóstica deste marcador. Ressalta-se ainda, a necessidade de novos estudos sobre a aplicabilidade do ângulo de fase no prognóstico nesta população

Background: Knowledge about phase angle and its use as a prognostic determinant in patients with heart failure is still scarce. Objective: To evaluate the correlation between anthropometric indicators, cardiac function and cell integrity in patients with heart failure with reduced ejection fraction. Methods: This was a cross-sectional study that evaluated patients with heart failure with reduced ejection fraction by anthropometry and bioelectrical impedance analysis. Chi-square test and Student's t test were used to analyze differences, and Pearson's linear correlation was used to evaluate associations, using p < 0.05 to indicate statistical significance. Results: We evaluated 41 subjects aged 30-74 years, of which 34 were men (82.9%). Mean phase angle was higher among women (7.1%), but significant differences between men and women were found only for body fat percentage. Phase angle correlated with body mass index (r = 0.44, p = 0.004) and there was a trend of correlation of the phase angle with waist-to-height ratio (r = 0.29, p = 0.06) and the left ventricular ejection fraction (r = 0.29, p = 0.07). Conclusions: Phase angle showed a good correlation with body mass index and showed a trend of correlation with the left ventricular ejection fraction, supporting the obesity paradox and the prognostic importance of this marker. Further studies on the applicability of the phase angle in the prognosis of these patients are still needed

Applicability of Longitudinal Strain of Left Ventricle in Unstable Angina / Aplicabilidade do Strain Longitudinal do Ventrículo Esquerdo na Angina Instável

Abstract Background: Unstable angina (UA) is a common cause of hospital admission; risk stratification helps determine strategies for treatment. Objective: To determine the applicability of two-dimensional longitudinal strain (SL2D) for the identification of myocardial ischemia in patients with UA. Methods: Cross-sectional, descriptive, observational study lasting 60 days. The sample consisted of 78 patients, of which fifteen (19.2%) were eligible for longitudinal strain analysis. The value of p < 0.05 was considered significant. Results: The group of ineligible patients presented: a lower proportion of women, a higher prevalence of diabetes mellitus (DM), use of ASA, statins and beta-blockers and larger cavity diameters. The main causes of non-applicability were: presence of previous infarction (56.4%), previous CTA (22.1%), previous MRI (11.5%) or both (16.7%) and the presence of specific electrocardiographic abnormalities (12.8%). SL2D assessment revealed a lower global strain value in those with stenosis greater than 70% in some epicardial coronary arteries (17.1 [3.1] versus 20.2 [6.7], with p = 0.014). Segmental strain assessment showed an association between severe CX and RD lesions with longitudinal strain reduction of lateral and inferior walls basal segments; (14 [5] versus 21 [10], with p = 0.04) and (12.5 [6] versus 19 [8], respectively). Conclusion: There was very low SL2D applicability to assess ischemia in the studied population. However, the global strain showed a correlation with the presence of significant coronary lesion, which could be included in the UA diagnostic arsenal in the future.

Resumo Fundamento: A angina instável (AI) é uma causa comum de internação hospitalar, a estratificação de risco ajuda a determinar estratégias para o tratamento. Objetivo: Determinar a aplicabilidade do strain longitudinal bidimensional (SL2D) para identificação de isquemia miocárdica, em pacientes com AI. Métodos: Estudo observacional transversal, descritivo, com duração de 60 dias. A amostra foi composta por 78 pacientes, sendo quinze (19,2%) elegíveis para análise do strain longitudinal. O valor de p < 0.05 foi considerado significativo. Resultados: O grupo dos não elegíveis apresentou: menor proporção de mulheres, maior prevalência de diabetes mellitus (DM), do uso de AAS, estatinas e betabloqueadores e maiores diâmetros cavitários. As principais causas da não aplicabilidade foram: presença de infarto prévio (56,4%), ATC prévia (22,1%), RM prévia (11,5%) ou ambos (16,7%) e presença de alterações eletrocardiográficas específicas (12,8%). A avaliação do SL2D revelou um valor de strain global inferior naqueles com estenose maior que 70% em alguma coronária epicárdica (17,1 [3,1] versus 20,2 [6,7], com p = 0,014). A avaliação do strain segmentar demonstrou associação entre lesão grave nas coronárias CX e CD com redução do strain longitudinal dos segmentos basais das paredes lateral e inferior; (14 [5] versus 21 [10], com p = 0,04) e (12,5 [6] versus 19 [8], com p = 0,026), respectivamente. Conclusão: Houve aplicabilidade muito baixa do SL2D para avaliar isquemia na população estudada. Entretanto, o strain global apresentou correlação com presença de lesão coronária significativa, podendo, futuramente, ser incluído no arsenal diagnóstico da AI.

Atualizações em doença cardíaca isquêmica aguda e crônica / Acute and chronic ischemic heart disease

A doença arterial coronariana é a principal causa de morte no Brasil e no mundo. É um grande desafio para o clínico o acompanhamento destes pacientes, pois são casos cada vez mais prevalentes, complexos, normalmente associados a comorbidades, com maior acometimento nos indivíduos idosos e taxas de insucesso terapêutico elevadas. Apresentamos uma revisão narrativa da literatura atual sobre fisiopatologia, sintomatologia, diagnóstico, tratamentos possíveis e prognóstico, tanto na forma aguda como crônica desta enfermidade.(AU)

The coronary artery disease is the leading cause of death in Brazil and worldwide. It is a great challenge for the clinician to follow these patients, because they are increasingly more prevalent, complex, usually associated with comorbidities, with a greater involvement in elderly individuals, and with high therapeutic failure rates. We present a narrative review of the current literature on pathophysiology, symptomatology, diagnosis, possible treatments, and prognosis in both the acute and chronic forms of this disease.(AU)

Association of Severity of Coronary Lesions with Bone Mineral Density in Postmenopausal Women / Associação entre Gravidade das Lesões Coronarianas e Densidade Mineral Óssea em Mulheres Pós-Menopausa

Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score - patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores (b = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions.

Resumo Fundamento: A doença arterial coronariana (DAC) e a osteoporose são doenças comuns em mulheres pós-menopausa. Tanto em estudos transversais como em estudos epidemiológicos longitudinais, a massa óssea diminuída foi relacionada à frequência aumentada de DAC. No entanto, dados disponíveis sobre a relação entre densidade mineral óssea (DMO) e gravidade das lesões coronarianas são limitados. Objetivo: Investigar a associação entre DMO e gravidade das lesões coronarianas avaliadas pelo escore de Gensini em mulheres pós-menopausa. Métodos: Este estudo incluiu 122 mulheres pós-menopausa diagnosticadas com DAC. As pacientes foram divididas em dois grupos de acordo com a gravidade das lesões coronarianas avaliada pelo escore de Gensini - pacientes com lesões coronarianas leves (escore de Gensini < 25) e pacientes com lesões coronarianas graves (escore de Gensini ≥ 25). A densidade mineral do colo femoral foi medida por absorção de raios-X de dupla energia (DXA). Resultados: O estudo incluiu mulheres pós-menopausa com idade de 64,31 ± 4,71 anos, 85 delas (69,7%) com lesões coronarianas graves. Pacientes com lesões coronarianas graves apresentaram um escore T mais elevado que aquelas com lesões coronarianas leves no colo femoral (p < 0,05). O escore T médio foi -0,84 ± 1,01 no grupo com lesões leves, e -1,42 ± 1,39 no grupo com lesões graves (p < 0,05). A análise de regressão logística multivariada mostrou que a osteopenia-osteoporose no colo femoral (odds ratio 2,73; intervalo de confiança de 95% 1,06 - 6,13) esteve associada com um risco aumentado de se desenvolver lesões coronarianas graves. O modelo de regressão múltipla mostrou que os escores T (b = -0,407; EP= 0,151; p = 0,007) foram preditores independentes do escore de Gensini. Conclusão: Encontrou-se uma relação significativa entre a gravidade das lesões coronarianas e a DMO em mulheres pós-menopausa. DMO, uma técnica de baixo custo que envolve mínima exposição à radiação, e amplamente utilizada no rastreamento de osteoporose, é um marcador promissor da gravidade de lesões coronarianas graves.

Association between premature ventricular complexes during exercise, long-term occurrence of life-threatening arrhythmia and mortality / Asociación entre ectopia ventricular en ejercicio, la ocurrencia de arritmias potencialmente mortales y mortalidad a largo plazo

Abstract Objective: Exercise-induced premature ventricular complexes (EiPVCs) are often considered as benign arrhythmias, although they are associated with a high risk of all-cause death in the general healthy population. However, an intermediate pathophysiological process remains unclear, particularly in patients with known cardiovascular disease. The aim of this study was to find an association between EiPVCs, the occurrence of life-threatening ventricular arrhythmias (LACO), and all-cause mortality in patients with cardiovascular disease. Methods: This was an observational study of a cohort of patients with coronary artery disease (CAD) or idiopathic cardiomyopathy (ICM). Stress testing was performed as a part of the routine cardiovascular evaluation. The occurrence of EiPVCs was evaluated during exercise testing (ET). At follow-up, long-term occurrence of LACO was evaluated. A bivariate and multivariate analysis was performed. Results: Out of the total of 1442 patients analysed, 700 (49%) had EiPVCs. During 14 years of following-up after ET, 106 LACO outcomes were observed. Long-term all-cause mortality was 4% (n = 61). A bivariate analysis showed that patients with EiPVCs had an increased risk for LACO (RR = 2.81, 95% CI; 1.9---4.3, P < .001), and for mortality (RR = 2.1, CI95% 1.2---3.4, P < .01). Occurrence of LACO was also associated with a higher mortality risk (RR = 5.7, 95% CI; 3.4---9.4, P < .001). After a post hoc analysis, LACO remained as a highly predictive variable for mortality. Conclusion: Patients with EiPVCs have a high risk of LACO and all-cause mortality. The presence of LACO could be an intermediate stage between EiPVCs and mortality in subjects with cardiovascular disease.

Resumen Objetivo: La extrasistolia ventricular inducida por ejercicio (EVIE) suele considerarse una arritmia benigna, sin embargo, ha sido asociada a mayor mortalidad en población general. Hasta hoy no se ha encontrado el proceso fisiopatológico involucrado, particularmente en pacientes con enfermedad cardiovascular. El objetivo del estudio fue establecer una asociación entre EVIE con la ocurrencia de arritmias ventriculares potencialmente malignas (APM) y letalidad a largo plazo, en sujetos con enfermedad cardiovascular. Método: Estudiamos una cohorte de pacientes con enfermedad coronaria o miocardiopatía dilatada, que realizaron una prueba de ejercicio al inicio del estudio. Inicialmente evaluamos la ocurrencia de EVIE, APM y letalidad a largo plazo y posteriormente se realizó un estudio bivariable y multivariable. Resultados: Se incluyeron 1,442 pacientes de los cuales 700 presentaron EVIE (49%). Durante 14 an˜os de seguimiento, 106 sujetos presentaron APM y la mortalidad total fue de 61 casos (4%). El estudio bivariable mostró que aquellos pacientes con EVIE tuvieron un riesgo de presentar APM de 2.81 (IC95% de 1.9 a 4.3, p < 0.001) y de mortalidad de 2.1 (IC95% de 1.2 a 3.4, p < 0.01). Los individuos con APM tuvieron mayor riesgo de mortalidad (RR= 5.7, IC95% de 3.4 a 9.4, p < 0.001). Después de un análisis multivariable, la APM continuó siendo una variable altamente predictiva de mortalidad. Conclusión: Los pacientes con EVIE tienen un riesgo elevado de presentar APM y de mortalidad a largo plazo. Los resultados sugieren que las APM podrían representar un estado intermedio entre la presencia de EVIE y la mortalidad en pacientes con enfermedad cardiovascular.

Factores determinantes de éxito de la rehabilitación cardiovascular en pacientes coronarios sometidos a revascularización miocárdica / Cardiovascular Rehabilitation in patients following myocardial revascularization: factors associated to program success

Resumen: Introducción: La rehabilitación cardiovascular ha demostrado tener efectos beneficiosos en pacientes con antecedentes de patología coronaria. Objetivos: Identificar los factores que determinan el resultado de un programa de rehabilitación cardiovascular (PRC) aplicado a pacientes coronarios revascularizados. Métodos: 67 pacientes sometidos a cirugía de bypass o angioplastia fueron evaluados en su capacidad funcional mediante el test de marcha de 6 minutos (TM) al inicio y al completar el programa de rehabilitación cardiovascular. La distancia recorrida en el test de marcha fue correlacionada con la edad, capacidad funcional previa al PRC, tiempo en completar el pro-grama, tiempo que media entre la intervención y el inicio del programa, duración del programa y tipo de revascularización. Además, se comparó el incremento de la capacidad funcional entre los pacientes que fueron derivados a 36 sesiones con los referidos a solo 12. Resultados: 67 pacientes cumplieron los criterios para evaluación del PRC. Globalmente, se observó una mejoría de 12% (511,4 a 573,4 m) en la distancia del TM (p<0.001)). El mayor beneficio, en términos de distancia en el TM se obtuvo al efectuar un programa con más sesiones (36 vs 12) con valores de 20% y 8%, respectivamente (p<0.002). El poder terminar el PRC de 36 sesiones más rápidamente (entre 10 y 13 semanas vs entre 14 y 24 semanas se asoció a una mayor incremente en el TM con valores de 19% vs 10%, respectivamente (p<0,003). El incremento en el TM no difirió entre 3 grupos de edad (desde 49 a 85 años); en el tiempo que transcurre entre la intervención y el inicio del PRC (antes vs después de la 8a semana post revascularización), al tipo de revascularización a la que fue sometido el paciente (cirugía o angioplastía) y a la capacidad funcional previa que estos presentan al inicio del PRC. Conclusión: El PRC es efectivo en mejorar significativamente la capacidad funcional de pacientes revascularizados, especialmente cuando el número de sesiones del programa es mayor y cuando se realiza con una frecuencia de al menos 3 veces por semana. El PRC es igualmente efectivo en pacientes enviados a rehabilitación en forma más precoz, como también lo es en sujetos más añosos. Estos efectos fueron independientes del tipo de revascularización.

Abstracts: Introduction : Background: Cardiovascular Rehabilitation Programs (CRP) have been shown to produce be-neficial effects in patients with coronary artery disease. Aim: to identify factors associated to CRP success in patients who underwent myocardial revascularization Methods: 67 patients who underwent coronary artery bypass surgery (CABG) or percutaneous coronary artery angioplasty (PTCA) were evaluated for functional capacity by means of a standard 6 min walking test (6mWT), before and after completion of the CRP. Distance covered during the test was correlated with age, prior functional class, time employed to complete CRP, time from coronary intervention and CRP initiation, CRP duration and type of revascularization. In addition, patients referred for a 36 sessions CRP were compared to those referred to only 12 sessions. Results: 67 patients met inclusion criteria. Overall, there was a 12% increase (511,4 to 573,4 m) in 6mWT distance (p<0.001). The greatest benefit was obtained with the 36 session CRP as compared to a 12 session CRP (20 vs 8% (p<0.002). Also, completion of a 36 session CRP between 10 and 13 weeks compared to 14 to 24 weeks revealed a greater benefit in the former group (19% vs 10%, respectively (p<0.003). There was no difference in 6minWT distance in 3 groups of age (extending from 49 to 85 years-old); In addition, time from intervention to initiation of CRP (before vs after 8 weeks), type of revascularization or functional capacity at the beginning of CRP showed any difference in 6mWT distance. Conclusion: CRP is a highly effective intervention to improve functional capacity in patients following myocardial revascularization, more so when more sessions are employed and when at least 3 sessions per week are implemented. The program is equally effective in patients starting CRP early after revascularization, and benefit is independent from patient age.

Associação entre Disfunção Erétil e Piora na Qualidade de Vida de Pacientes com Doença Arterial Coronariana / Association between Erectile Dysfunction and Quality of Life in Patients with Coronary Artery Disease

Fundamentos: A disfunção erétil (DE) e a doença arterial coronariana (DAC) compartilham os mesmos fatores de risco e as associações entre DE, qualidade de vida (QV) e DAC têm sido motivo de estudos recentes. Objetivo: Avaliar se a DE está associada a piora da QV em pacientes com DAC. Métodos: Estudo transversal, multicêntrico, prospectivo e analítico, realizado de dezembro de 2014 a abril de 2016, que recrutou 304 homens (idade média: 57 ± 9,9 anos) com diagnóstico clínico de DAC. A QV foi avaliada através do Short Form-36 e a DE pelo Índice Internacional de Função Erétil. Foram realizadas análises estatísticas descritiva e analítica, sendo que o teste não paramétrico Kruskal-Wallis foi usado para analisar se existem diferenças significativas em cada domínio de qualidade de vida quando se comparam os diferentes tipos de DE. Para todos os testes, valor de p ≤ 0,05 foi considerado significante. Resultados: A prevalência de DE foi de 76,3%. As medianas e percentis 25 e 75 de cada domínio de qualidade de vida de acordo com a ausência de DE, DE leve, leve a moderada, moderada e grave, respectivamente, foram: Capacidade funcional: 85 (63-100), 75 (50-95), 60 (32-85), 55 (35-75), 50 (30-70), p < 0,001; Aspectos físicos: 87 (0-100), 40 (0-100), 0 (0-100), 0 (0-31), 0 (0-12), p < 0,001; Dor: 72 (51-100), 66 (51-100), 74 (51-100), 62 (51-100), 51 (31-62), p = 0,001; Estado geral de saúde: 77 (62-87), 72 (57-77), 67 (55-82), 67 (59-75), 52 (37-68), p < 0,001; Vitalidade: 75 (60-85), 65 (50-75), 65 (55-75), 60 (43-75), 50 (32-65), p < 0,001; Aspectos sociais: 87 (62-100), 87 (62-100), 87 (68-100), 75 (62-100), 75 (50-93), p = 0,139; Aspectos emocionais: 100 (58-100), 100 (33-100), 100 (33-100), 100 (0-100), 0 (0-100), p = 0,001; Saúde mental: 80 (67-89), 72 (60-84), 72 (66-80), 68 (58-80), 56 (50-74), p < 0,001. Conclusões: A prevalência de disfunção erétil foi elevada. A DE esteve associada a piora da QV em pacientes com DAC

Background: Erectile dysfunction (ED) and coronary artery disease (CAD) share the same risk factors and the associations between ED, quality of life (QoL) and CAD have been the subject of recent studies. Objective: To evaluate whether ED is associated with worsening QoL in patients with CAD. Methods:A cross-sectional, multicenter, prospective and analytic study was carried out from EDcember 2014 to April 2016, which recruited 304 men (mean age: 57 ± 9.9 years) with clinical diagnosis of CAD. QoL was assessed using Short Form-36 and ED by the International Erectile Function InEDx. EDscriptive and analytical statistical analyzes were performed, and the Kruskal-Wallis non-parametric test was used to test whether there are significant differences in each quality of life domain when comparing different types of ED. For all tests, p ≤ 0.05 was consiEDred significant. Results: The prevalence of ED was 76.3%. The median and percentiles 25 and 75 of each life quality domain according to the absence of ED; mild ED, mild to moderate, moderate and severe ED and severe ED, respectively, were: Functional capacity: 85 (63-100), 75 (50 -95), 60 (32-85), 55 (35-75), 50 (30-70), p < 0.001; Physical aspects: 87 (0-100), 40 (0-100), 0 (0-100), 0 (0-31), 0 (0-12), p < 0.001; Pain: 72 (51-100), 66 (51-100), 74 (51-100), 62 (51-100), 51 (31-62), p = 0.001; General state of health: 77 (62-87), 72 (57-77), 67 (55-82), 67(59-75), 52 (37-68), p < 0.001; Vitality: 75 (60-85), 65 (50-75), 65 (55-75), 60 (43-75), 50 (32-65), p < 0.001; Social Aspects: 87 (62-100), 87 (62-100), 87 (68-100), 75 (62-100), 75 (50-93), p = 0.139; Emotional Aspects: 100 (58-100), 100 (33-100), 100 (33-100), 100 (0-100), 0 (0-100), p = 0.001; Mental health: 80 (67-89), 72 (60-84), 72 (66-80), 68 (58-80), 56 (50-74), p < 0.001. Conclusions: The prevalence of erectile dysfunction was high. ED was associated with worsening of QoL in patients with CAD

Dobutamine Stress Echocardiography Safety in Chagas Disease Patients / Segurança do Ecocardiograma sob Estresse com Dobutamina-Atropina em Pacientes com Doença de Chagas

Abstract Background: A few decades ago, patients with Chagas disease were predominantly rural workers, with a low risk profile for obstructive coronary artery disease (CAD). As urbanization has increased, they became exposed to the same risk factors for CAD of uninfected individuals. Dobutamine stress echocardiography (DSE) has proven to be an important tool in CAD diagnosis. Despite being a potentially arrhythmogenic method, it is safe for coronary patients without Chagas disease. For Chagas disease patients, however, the indication of DSE in clinical practice is uncertain, because of the arrhythmogenic potential of that heart disease. Objectives: To assess DSE safety in Chagas disease patients with clinical suspicion of CAD, as well as the incidence of arrhythmias and adverse events during the exam. Methods: Retrospective analysis of a database of patients referred for DSE from May/2012 to February/2015. This study assessed 205 consecutive patients with Chagas disease suspected of having CAD. All of them had their serology for Chagas disease confirmed. Results: Their mean age was 64±10 years and most patients were females (65.4%). No patient had significant adverse events, such as acute myocardial infarction, ventricular fibrillation, asystole, stroke, cardiac rupture and death. Regarding arrhythmias, ventricular extrasystoles occurred in 48% of patients, and non-sustained ventricular tachycardia in 7.3%. Conclusion: DSE proved to be safe in this population of Chagas disease patients, in which no potentially life-threatening outcome was found.

Resumo Fundamento: Até poucas décadas atrás, os pacientes chagásicos eram predominantemente trabalhadores rurais, com baixo perfil de risco para doença obstrutiva coronária. Com a crescente urbanização, passaram a ter os mesmos fatores de risco para doença aterosclerótica que indivíduos não infectados. O ecocardiograma sob estresse com dobutamina (EED) é uma importante ferramenta no diagnóstico de coronariopatia. É referido, porém, como um método potencialmente arritmogênico, mas seguro, em pacientes coronarianos não chagásicos. Entretanto, há insegurança na prática clínica de indicá-lo no paciente chagásico, devido ao potencial arritmogênico já intrínseco nesta cardiopatia. Objetivos: Analisar a segurança do EED em uma população de chagásicos com suspeita clínica de coronariopatia. Métodos: Análise retrospectiva de um banco de dados de pacientes encaminhados para a realização do EED entre maio/2012 e fevereiro/2015. Avaliou-se pacientes consecutivos portadores de doença de Chagas e com suspeita de coronariopatia. Confirmou-se a sorologia para doença de Chagas em todos os pacientes. Resultados: A média etária dos 205 pacientes analisados foi de 64 ± 10 anos, sendo a maioria do sexo feminino (65,4%). Nenhum paciente apresentou eventos adversos significativos, como infarto agudo do miocárdio, fibrilação ventricular, assistolia, acidente vascular encefálico, ruptura cardíaca ou morte. Quanto às arritmias, extrassístoles ventriculares frequentes ocorreram em 48% dos pacientes, taquicardia ventricular não sustentada em 7,3%, bigeminismo em 4,4%, taquicardia supraventricular e taquicardia ventricular sustentada em 1% e fibrilação atrial em 0,5%. Conclusão: O EED mostrou ser um exame seguro nessa população de pacientes chagásicos, onde nenhum desfecho grave foi encontrado.

Comparative Study between Perfusion Changes and Positive Findings on Coronary Flow Reserve / Estudo Comparativo entre Alterações de Perfusão e Achados Positivos da Reserva de Fluxo Coronariano

Abstract Background: Functional assessment of coronary artery obstruction is used in cardiology practice to correlate anatomic obstructions with flow decrease. Among such assessments, the study of the coronary fractional flow reserve (FFR) has become the most widely used. Objective: To evaluate the correlation between FFR and findings of ischemia obtained by noninvasive methods including stress echocardiography and nuclear medicine and the presence of critical coronary artery obstruction. Methods: Retrospective study of cases treated with systematized and standardized procedures for coronary disease between March 2011 and August 2014. We included 96 patients with 107 critical coronary obstructions (> 50% in the coronary trunk and/or ≥ 70% in other segments) estimated by quantitative coronary angiography (QCA) and intracoronary ultrasound (ICUS). All cases presented ischemia in one of the noninvasive studies. Results: All 96 patients presented ischemia (100%) in one of the functional tests. On FFR study with adenosine 140 g/kg/min, 52% of the cases had values ≤ 0.80. On correlation analysis for FFR ≤ 0.80, the evaluation of sensitivity, specificity, positive and negative predictive values, accuracy, and ROC curve in relation to the stenosis degree and length, and presence of ischemia, no significant values or strong correlation were observed. Conclusion: Coronary FFR using a cut-off value of 0.80 showed no correlation with noninvasive ischemia tests in patients with severe coronary artery obstructions on QCA and ICUS.

Resumo Fundamento: A avaliação funcional da obstrução arterial coronariana é empregada na prática cardiológica para correlacionar a obstrução anatômica e a queda de fluxo. Dentre as formas de avaliação, o estudo da reserva fracionada de fluxo (RFF) coronariano se tornou a mais utilizada. Objetivo: Avaliar a correlação entre a RFF com achados de isquemia, obtidos por métodos não invasivos como a ecocardiografia de estresse ou medicina nuclear, e a presença de obstrução crítica da artéria coronária. Métodos: Estudo retrospectivo de casos tratados com procedimentos sistematizados e padronizados para doença coronariana entre março de 2011 e agosto de 2014. Foram incluídos 96 pacientes com 107 obstruções coronarianas críticas (> 50% no tronco da coronária e/ou ≥ 70% nos demais segmentos) estimadas por angiografia coronariana quantitativa (ACQ) e ultrassonografia intracoronariana (USIC). Todos os casos apresentaram isquemia em um dos estudos não invasivos. Resultados: Ao estudo da RFF com adenosina na dose de 140 µg/kg/min, valores ≤ 0,80 foram encontrados em 52% dos casos. Na análise de correlação para RFF ≤ 0,80, avaliando-se sensibilidade/especificidade, valor preditivo positivo/negativo, acurácia e curva ROC em relação ao grau de estenose, extensão da estenose e presença de isquemia, não foram observados valores de significância ou de forte correlação. Conclusão: A RFF coronariana a um valor de corte de 0,80 não apresentou correlação com testes não invasivos de isquemia em pacientes com obstruções coronarianas graves à ACQ e USIC.

Analysis of the Use of Extracorporeal Circulation on the In-Hospital Outcomes of Dialytic Patients Who Underwent Myocardial Revascularization Surgery / Análise do Uso da Circulação Extracorpórea na Evolução Intra-Hospitalar de Pacientes Dialíticos Submetidos à Revascularização Cirúrgica do Miocárdio

Abstract Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. Conclusion: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.

Resumo Fundamento: A revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com doença coronariana multiarterial. Contudo, o procedimento ainda apresenta elevada morbimortalidade. O uso da circulação extracorpórea (CEC) pode impactar de maneira negativa na evolução intra-hospitalar desses pacientes. Objetivos: Avaliar a diferença entre as técnicas com ou sem CEC na evolução intra-hospitalar de pacientes dialíticos submetidos a cirurgia de revascularização do miocárdio. Métodos: Estudo unicêntrico de 102 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2014. Resultados: 63 pacientes foram operados com CEC e 39 sem o uso de CEC. Foi observada alta prevalência de fatores de risco cardiovascular em ambos grupos, porém sem diferença estatisticamente significante entre eles. O grupo "com CEC" apresentou maior número de coronárias revascularizadas (2,4 vs 1,7; p <0,0001), maior necessidade de hemocomponentes (77,7% vs 25,6%; p <0,0001) e apoio inotrópico (82,5% vs 35,8%; p <0,0001). Na evolução pós-operatória, o grupo "sem CEC" apresentou menor necessidade de drogas vasoativas (61,5% vs 82,5%; p = 0,0340), maior taxa de extubação em sala cirúrgica (58,9% vs 23,8%, p = 0,0006), menor tempo de ventilação mecânica (13,0 horas vs 36,3 horas, p = 0,0217), menor taxa de infecções (7,6% vs 28,5%; p = 0,0120) e menor tempo de internação em UTI (5,2 dias vs 8,1 dias; p = 0,0054) em comparação ao grupo "com CEC". Não houve diferença de mortalidade entre os grupos. Conclusão: O uso da CEC na revascularização do miocárdio em pacientes dialíticos resultou em maior morbidade no período perioperatório em comparação ao procedimento realizado sem CEC, contudo, sem diferença de mortalidade.

Periodontal disease and inflammatory blood cytokines in patients with stable coronary artery disease

ABSTRACT Periodontal disease has been associated with elevations of blood cytokines involved in atherosclerosis in systemically healthy individuals, but little is known about this association in stable cardiovascular patients. The aim of this study was to assess the association between periodontal disease (exposure) and blood cytokine levels (outcomes) in a target population of patients with stable coronary artery disease (CAD). Material and Methods This cross-sectional study included 91 patients with stable CAD who had been under optimized cardiovascular care. Blood levels of IL-1β, IL-6, IL-8, IL-10, IFN-γ, and TNF-α were measured by Luminex technology. A full-mouth periodontal examination was conducted to record probing depth (PD) and clinical attachment (CA) loss. Multiple linear regression models, adjusting for gender, body mass index, oral hypoglycemic drugs, smoking, and occurre:nce of acute myocardial infarction were applied. Results CAD patients that experienced major events had higher concentrations of IFN-γ (median: 5.05 pg/mL vs. 3.01 pg/mL; p=0.01), IL-10 (median: 2.33 pg/mL vs. 1.01 pg/mL; p=0.03), and TNF-α (median: 9.17 pg/mL vs. 7.47 pg/mL; p=0.02). Higher numbers of teeth with at least 6 mm of CA loss (R2=0.07) and PD (R2=0.06) were significantly associated with higher IFN-γ log concentrations. Mean CA loss (R2=0.05) and PD (R2=0.06) were significantly related to IL-10 concentrations. Elevated concentrations of TNF-α were associated with higher mean CA loss (R2=0.07). Conclusion Periodontal disease is associated with increased systemic inflammation in stable cardiovascular patients. These findings provide additional evidence supporting the idea that periodontal disease can be a prognostic factor in cardiovascular patients.

Exposição aos níveis de colesterol ao longo da vida e doença coronariana / Lifetime exposure to cholesterol evels and coronarysrtery disease disease

A doença aterosclerótica compreende amplo espectro de entidades clínicas com envolvimento genético e ambiental. A exposição ao longo da vida a níveis elevados de colesterol e de sua fração LDL determinam um limiar a partir do qual a doença aterosclerótica se desenvolve. Assim, nas formas genéticas de dislipidemias, como a hipercolesterolemia familiar, a idade do aparecimento da doença aterosclerótica vai depender da carga cumulativa de exposição aos níveis de LDL-colesterol, sendo tanto mais precoce quanto maiores os níveis de LDL-colesterol e a presença de fatores de risco adicionais, e mais tardia na ausência destes, e no sexo feminino. A prevenção ao longo da vida parece ser extremamente efetiva, e a avaliação individual com a implementação de medidas preventivas precoces e terapêuticas deve ser estimulada. Assim, parece lógico que reduções de colesterol, por mudanças no estilo de vida ou pelo uso de fármacos na adolescência e ao longo da vida apresentem inestimável benefício para a redução dos desfechos cardiovasculares na vida adulta

The atherosclerotic process comprises a broad spectrum of clinical entities, with genetic and environmental involvement. Lifetime exposure to high levels of cholesterol and LDL-cholesterol determine a trigger that can lead to the development of atherosclerotic disease. Therefore, in genetic forms of dyslipidemia, such as familial hypercholesterolemia, the age of onset of atherosclerotic disease will depend on the cumulative burden of exposure to LDL-cholesterol levels, being earlier with higher levels of LDL-cholesterol, the presence of other risk factors and later, in the absence of risk factors, and in females. Prevention throughout life appears to be extremely effective, and individual assessment, with the implementation of early preventive measures, should be encouraged. Thus, it seems logical that cholesterol reductions, changes in lifestyle, or the use of specific medications in adolescence and throughout life present inestimable benefit in reducing cardiovascular outcomes in adulthood

Impacto da Doença Periodontal no Perfil Lipídico de Pacientes com Doença Arterial Coronariana Crônica: uma Coorte Retrospectiva de 3 anos / Impact of Periodontal Disease in the Lipid Profile of Patients With Chronic Coronary Artery Disease: a 3-Year, Retrospective Cohort

Fundamento: A inflamação tem sido reconhecida como um importante fator de risco para as doenças cardiovasculares. A doença periodontal pode acarretar alterações de alguns marcadores plasmáticos envolvidos no processo aterogênico. Objetivo: Avaliar a associação entre a doença periodontal e os níveis lipídicos ao longo do tempo em pacientes com doença arterial coronariana crônica. Métodos: Este estudo de coorte retrospectivo incluiu uma amostra de pacientes cardiopatas crônicos recebendo atendimento em um ambulatório de atenção terciária de cardiopatia isquêmica. Dos 239 pacientes elegíveis, foram incluídos 80 que apresentavam dados retrospectivos de perfil lipídico entre 2009 e 2011. Foram realizados exames periodontais de todos os dentes presentes em 2011. Modelos múltiplos de equações de estimação generalizada foram aplicados para avaliar a associação entre parâmetros periodontais e alterações ao longo do tempo nos seguintes desfechos: triglicerídeos, colesterol total, LDL-colesterol e HDL-colesterol, com ajustes para idade, índice de massa corporal, fumo, uso de hipoglicemiante oral e tempo de acompanhamento. Resultados: Durante um tempo médio de acompanhamento de 713 dias, não houve mudanças significativas nas concentrações de triglicerídeos, colesterol total e LDL-colesterol. Um aumento significativo de 31,6% nos níveis de HDL-colesterol foi observado entre 2009 e 2011. Observamos uma associação negativa e significativa entre a média individual de perda de inserção periodontal e nível de HDL-colesterol, indicando que quanto maior a perda de inserção, mais baixos os níveis de HDL-colesterol ao longo do tempo. Conclusão: A doença periodontal destrutiva pode estar relacionada com um pior controle lipídico, particularmente relacionado a níveis de HDL-colesterol, em pacientes cardiopatas crônicos

Background: Inflammation has been recognized as an important risk factor for cardiovascular diseases. Periodontal disease may alter some plasma markers involved in the atherogenic process. Objective: To assess the association between periodontal disease and lipid levels over time in patients with chronic coronary artery disease.Methods: This retrospective cohort study included a sample of patients with chronic heart disease receiving care in an outpatient tertiary care for ischemic heart disease. Of 239 patients eligible for the study, we included 80 patients who had available retrospective data of lipid profile between 2009 and 2011. We performed periodontal examinations of all teeth present in 2011. Multiple models of generalized estimating equations were applied to assess the association between periodontal parameters and changes over time in the following outcomes: triglycerides, total cholesterol, LDL-cholesterol, and HDL-cholesterol levels adjusted for age, body mass index, smoking, use of oral hypoglycemic, and follow-up duration. Results: During a mean follow-up time of 713 days, there were no significant changes in the concentrations of triglycerides, total cholesterol, and LDL-cholesterol. A significant 31.6% increase in HDL-cholesterol levels was observed between 2009 and 2011. We observed a significant negative association between mean individual periodontal attachment loss and HDL- cholesterol levels, indicating that the greater the attachment loss, the lower the HDL-cholesterol level over time. Conclusion: Destructive periodontal disease may be related to a worse lipid control, specifically regarding HDL-cholesterol levels, in chronic cardiac patients

Severity of erectile dysfunction is highly correlated with the syntax score in patients undergoing coronariography

ABSTRACT Objective To investigate the association between the severity of erectile dysfunction (ED) and coronary artery disease (CAD) in men undergoing coronary angiography for angina or acute myocardial infarct (AMI). Material and Methods We studied 132 males who underwent coronary angiography for first time between January and November 2010. ED severity was assessed by the international index of erectile function (IIEF-5) and CAD severity was assessed by the Syntax score. Patients with CAD (cases) and without CAD (controls) had their IIEF-5 compared. In the group with CAD, their IIEF-5 scores were compared to their Syntax score results. Results We identified 86 patients with and 46 without CAD. The IIEF-5 score of the group without CAD (22.6±0.8) was significantly higher than the group with CAD (12.5±0.5; p<0.0001). In patients without ED, the Syntax score average was 6.3±3.5, while those with moderate or severe ED had a mean Syntax score of 39.0±11.1. After adjustment, ED was independently associated to CAD, with an odds ratio of 40.6 (CI 95%, 14.3-115.3, p<0.0001). The accuracy of the logistic model to correctly identify presence or absence of CAD was 87%, with 92% sensitivity and 78% specificity. The average time that ED was present in patients with CAD was 38.8±2.3 months before coronary symptoms, about twice as high as patients without CAD (18.0±5.1 months). Conclusions ED severity is strongly and independently correlated with CAD complexity, as assessed by the Syntax score in patients undergoing coronariography for evaluation of new onset coronary symptoms.

Use of the Wasserman equation in optimization of the duration of the power ramp in a cardiopulmonary exercise test: a study of Brazilian men

This study aimed to analyze the agreement between measurements of unloaded oxygen uptake and peak oxygen uptake based on equations proposed by Wasserman and on real measurements directly obtained with the ergospirometry system. We performed an incremental cardiopulmonary exercise test (CPET), which was applied to two groups of sedentary male subjects: one apparently healthy group (HG, n=12) and the other had stable coronary artery disease (n=16). The mean age in the HG was 47±4 years and that in the coronary artery disease group (CG) was 57±8 years. Both groups performed CPET on a cycle ergometer with a ramp-type protocol at an intensity that was calculated according to the Wasserman equation. In the HG, there was no significant difference between measurements predicted by the formula and real measurements obtained in CPET in the unloaded condition. However, at peak effort, a significant difference was observed between oxygen uptake (V˙O2)peak(predicted)and V˙O2peak(real)(nonparametric Wilcoxon test). In the CG, there was a significant difference of 116.26 mL/min between the predicted values by the formula and the real values obtained in the unloaded condition. A significant difference in peak effort was found, where V˙O2peak(real)was 40% lower than V˙O2peak(predicted)(nonparametric Wilcoxon test). There was no agreement between the real and predicted measurements as analyzed by Lin’s coefficient or the Bland and Altman model. The Wasserman formula does not appear to be appropriate for prediction of functional capacity of volunteers. Therefore, this formula cannot precisely predict the increase in power in incremental CPET on a cycle ergometer.