Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease.

Background: Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods: This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results: COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion: COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.

Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease.

Background: Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods: In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results: COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21-10.34; P < 0.001). Conclusion: In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.

Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography.

BACKGROUND: Stress echocardiography is well validated for diagnosis and risk stratification of coronary artery disease. Exercise stress echocardiography (ESE) has been shown to be the most physiological among the modalities of stress, but its safety is not well established. OBJECTIVE: To study the complications related to ESE and clinical and echocardiographic variables most commonly associated with their occurrence. METHODS: Cross-sectional study consisting of 10250 patients submitted to ESE for convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were the most frequent complications observed during the examination. The volunteers were divided into two groups according to the occurrence of CA during ESE: G1 group, composed of patients who have CA, and G2 formed by individuals who did not show such complication. RESULTS: Group G1, consisting of 2843 patients (27.7%), and Group G2 consisting of 7407 patients (72.3%). There was no death, acute myocardial infarction, ventricular fibrillation or asystole. Predominant CAs were: supraventricular extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a higher mean age, higher frequency of hypertension and smoking, larger aortic roots and left atrium (LA) and lower ejection fraction than G2. G1 group also had more ischemic changes (p < 0.001). The predictor variables were age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from 1.448 to 1.872). CONCLUSION: ESE proved to be a safe modality of stress, with non-fatal complications only. Advanced age and enlargement of the left atrium are predictive of cardiac arrhythmias.

Preditores de Placa Aterosclerótica em Assintomáticos Isquêmicos à Ecocardiografia sob Estresse Físico / Predictors of Atherosclerotic Plaque in Individuals with Asymptomatic Ischemia on Physical Stress Echocardiography

A isquemia miocárdica pode ocorrer em pacientes assintomáticos e sem história de doença arterial coronariana (DAC). A ecocardiografia sob estresse físico (EEF) é um método de boa acurácia diagnóstica, enquanto a cineangiocoronariografia (CATE) é o método padrão-ouro para detecção de DAC obstrutiva. Todavia, muitos portadores de isquemia em testes funcionais apresentam lesões não obstrutivas à CATE. Objetivo: Identificar a presença de preditores de placas ateroscleróticas obstrutivas à CATE em indivíduos assintomáticos com EEF positiva para isquemia miocárdica. Métodos: Estudo transversal com 278 pacientes assintomáticos submetidos à EEF e à CATE, divididos em grupo G1 (lesões ateroscleróticas obstrutivas ≥ 50%) e G2 (placas inferiores a 50% ou inexistentes). Variáveis quantitativas foram comparadas com os testes t de Student ou Mann-Whitney para grupos independentes, segundo a normalidade da amostra. Para variáveis categóricas, utilizou-se os testes do qui-quadrado ou exato de Fisher, quando apropriado. Para identificação de preditores independentes de lesão aterosclerótica, foi utilizada regressão logística. Resultados: O número de pacientes nos grupos G1 e G2 foi de 233 (83,3%) e 45 (16,2%), respectivamente. A média de idade foi maior no G1 (60,9 ± 9,56 anos versus 51,8 ± 10,05 anos, respectivamente, p < 0,001). O G1 em comparação ao G2 apresentou mais pacientes hipertensos (65,2% versus 48,9%, p = 0,03) e dislipidêmicos (77,3% versus 57,8%, respectivamente, p = 0,006). O G2 em comparação ao G1 apresentou maior frequência de obesidade leve (33,3% versus 14,2%, respectivamente, p = 0,002), que demonstrou ser um fator protetor para lesão aterosclerótica. Conclusão: Os preditores de placa aterosclerótica em assintomáticos isquêmicos à EEF foram idade, gênero masculino e isquemia do tipo fixa.

Myocardial ischemia may occur in asymptomatic patients without a history of coronary artery disease (CAD). Stress echocardiography (SE) is a method with good diagnostic accuracy, while coronary cineangiography (CCA) is the gold standard method to detect obstructive CAD. However, many patients with ischemia on functional tests show nonobstructive lesions on CCA. Objective: To assess the presence of predictors of obstructive atherosclerotic plaques in asymptomatic individuals with an SE positive for myocardial ischemia. Methods: Cross-sectional study with 278 asymptomatic individuals who underwent SE and CCA, divided into groups G1 (obstructive atherosclerotic lesions ≥ 50%) and G2 (plaques below 50% or nonexistent). Quantitative variables were compared with Student's t test or Mann-Whitney test for independent groups, according to the normality of the sample. For categorical variables, we used the chi-square test or Fisher's exact test, as appropriate. Logistic regression was used to identify independent predictors of atherosclerotic lesions. Results: The numbers of patients in G1 and G2 were 233 (83.3%) and 45 (16.2%), respectively. The mean age was higher in G1 (60.9 ± 9.56 years versus 51.8 ± 10.05 years, p < 0.001). G1, when compared with G2, had more patients with hypertension (65.2% versus 48.9%, respectively, p = 0.03) and dyslipidemia (77.3% versus 57.8%, respectively, p = 0.006). G2, when compared with G1, had a higher frequency of mild obesity (33.3% versus 14.2%, respectively, p = 0.002), which emerged as a protective factor for atherosclerotic lesions. Conclusion: The predictors of atherosclerotic plaques in asymptomatic patients with ischemia on SE were age, male gender, and fixed ischemia.

Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography / Baixa Prevalência de Eventos Adversos Maiores à Ecocardiografia sob Estresse Físico

Abstract Background: Stress echocardiography is well validated for diagnosis and risk stratification of coronary artery disease. Exercise stress echocardiography (ESE) has been shown to be the most physiological among the modalities of stress, but its safety is not well established. Objective: To study the complications related to ESE and clinical and echocardiographic variables most commonly associated with their occurrence. Methods: Cross-sectional study consisting of 10250 patients submitted to ESE for convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were the most frequent complications observed during the examination. The volunteers were divided into two groups according to the occurrence of CA during ESE: G1 group, composed of patients who have CA, and G2 formed by individuals who did not show such complication. Results: Group G1, consisting of 2843 patients (27.7%), and Group G2 consisting of 7407 patients (72.3%). There was no death, acute myocardial infarction, ventricular fibrillation or asystole. Predominant CAs were: supraventricular extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a higher mean age, higher frequency of hypertension and smoking, larger aortic roots and left atrium (LA) and lower ejection fraction than G2. G1 group also had more ischemic changes (p < 0.001). The predictor variables were age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from 1.448 to 1.872). Conclusion: ESE proved to be a safe modality of stress, with non-fatal complications only. Advanced age and enlargement of the left atrium are predictive of cardiac arrhythmias.

Resumo Fundamento: A ecocardiografia sob estresse constitui metodologia validada para diagnóstico e estratificação de risco da doença arterial coronária. A ecocardiografia sob estresse físico (EEF) tem se destacado como a mais fisiológica dentre as modalidades de estresse, todavia sua segurança não está bem estabelecida. Objetivo: Estudar as complicações relacionadas à EEF e as variáveis clínicas e ecocardiográficas preditoras dessas ocorrências. Método: Estudo transversal composto por 10250 pacientes submetidos à EEF por conveniência, de janeiro de 2000 a junho de 2014. As arritmias cardíacas (AC) foram as complicações mais frequentemente encontradas durante o exame. Os voluntários foramdivididos em dois grupos, de acordo com a ocorrência de AC à EEF: grupo G1 - composto por pacientes que apresentaram AC e grupo G2 - formado por indivíduos que não exibiram tal complicação. Resultados: O grupo G1 com 2843 (27,7%) pacientes, e grupo G2 formado por 7407 (72,3%). Não foram registrados óbitos, infarto agudo do miocárdio, assistolia ou fibrilação ventricular. As extrassístoles supraventriculares (13,7%) e as ventriculares (11,5%) foram as AC predominantes. O grupo G1 apresentou idade média mais elevada, maior frequência de hipertensão arterial sistêmica e tabagismo, maiores dimensões da raiz da aorta e do átrio esquerdo (AE) e menor fração de ejeção do ventrículo esquerdo que o G2. O grupo G1 exibiu também, mais alterações isquêmicas (p < 0,001). As variáveis preditoras foram idade (RR 1,04; [IC] 95% 1,038 - 1,049) e AE (RR 1,64; [IC] 95% 1,448 - 1,872). Conclusão: A presente investigação demonstrou que a EEF é uma modalidade segura, ocorrendo apenas complicações não-fatais. Idade avançada e aumento da dimensão do AE são preditores da presença de arritmias cardíacas.

Sintomas osteomusculares de servidores de uma universidade pública brasileira: um estudo ergonômico / Musculoskeletal symptoms in servers of a Brazilian public university: an ergonomic study / Síntomas oesteomusculares de empleados de una universidad pública brasileña: un estudio ergonômico

Objetivo: Verificar a prevalência de sintomas osteomusculares e as possíveis relações com as condições de trabalho de servidores de uma universidade pública brasileira. Métodos: Estudo transversal e analítico com 105 servidores da Universidade Estadual do Sudoeste da Bahia (UESB), utilizando um instrumento estruturado para coleta de informações sobre organização do trabalho e perfil sociodemográfico dos participantes. Na avaliação dos sintomas musculoesqueléticos, utilizou-se o Questionário Nórdico de Sintomas Osteomusculares (QNSO), ferramenta já validada. Na análise e interpretação dos dados, utilizou-se o Teste de Shapiro-Wilk para avaliar a normalidade dos dados, e o Teste Qui-quadrado de Pearson ou Exato de Fisher para o teste de hipóteses, com nível de significância de 5%. Resultados: Os participantes trabalharam em média 5 (±6,04) anos na UESB, tinham idade média de 39,01(± 11,03) anos e 53,3% (n=56) eram do sexo feminino. Todos apresentavam alguma dor no sistema osteomuscular. As consultas com profissionais de saúde foram mais evidentes entre os servidores administrativos do que entre os professores (p=0,04). Os regimes de trabalho (horas de trabalho) de dedicação exclusiva (DE) e 40h semanais foram correlacionados considerando os domínios do Questionário Nórdico apenas no grupo dos professores. Nos sete dias precedentes, houve diferença entre os grupos de professores (DE versus 40h) nos sintomas apresentados nos ombros (p=0,008) e parte superior das costas (p=0,004), além de cotovelo (p=0,01) e punho/mão (p=0,004) em relação à consulta com algum profissional de saúde. Conclusão: Existe uma grande prevalência de queixas musculoesqueléticas nessa amostra, independentemente de ser professor ou servidor administrativo, podendo-se relacioná-las com as condições de trabalho; ou seja, há inadequações laborais.

Objective: To determine the prevalence of musculoskeletal symptoms and possible relations with the working conditions of teachers and administrative staff of a Brazilian public university. Methods: Cross-sectional analytical study conducted with 105 servers of the Universidade Estadual do Sudoeste da Bahia (UESB - Southwest Bahia State University), using a structured instrument for collecting information on the labour organization and the participants? sociodemographic profile. The Nordic Musculoskeletal Questionnaire (NMQ), a previously validated tool, was used in the musculoskeletal symptoms evaluation. The Shapiro- Wilk test was used to check normality of data, and the Pearson?s chi-square test or Fisher?s exact test for hypothesis testing, at 5% significance level. Results: Participants worked on average 5 (± 6.04) years in UESB, their mean age was 39.01 (± 11.03) years, and 53.3% (n=56) were female. All featured some pain in the musculoskeletal system. Consultations with health professionals were more evident among the administrative staff than in teachers (p=0.04). The working arrangements (working hours) under an exclusive contract (EC) and 40 hours per week were correlated considering the domains of the Nordic Questionnaire only in the group of teachers. In the previous seven days, there were differences between the groups of teachers (EC versus 40h) in symptoms of the shoulders (p=0.008) and upper back (p=0.004), and of the elbow (p=0.01) and wrist/hand (p = 0.004) in relation to consultation with a health professional. Conclusion: There is a high prevalence of musculoskeletal complaints in this sample, regardless of being a teacher or an administrative server, being possibly related to the working conditions, meaning that there are workplace inadequacies.

Objetivo: Verificar la prevalencia de síntomas osteomusculares y las posibles relaciones con las condiciones de trabajo de empleados de una universidad pública brasileña. Métodos: Estudio transversal y analítico con 105 empleados de La Universidad Estadual del Sudoeste de Bahía (UESB), utilizando un instrumento estructurado para la recogida de informaciones sobre organización del trabajo y el perfil sociodemográfico de los participantes. Para la evaluación de los sintomas musculoesqueléticos se utilizó el Cuestionario Nórdico de Síntomas Osteomusculares (CNSO), herramienta ya validada. Para el análisis e interpretación de los datos, se utilizó la prueba de Shapiro-Wilk para evaluar la normalidad de los datos y la prueba del Chi-cuadrado de Pearson o Exacto de Fisher para testar las hipótesis, con nivel de significancia del 5%. Resultados: Los participantes trabajaron una media de 5 (±6,04) años en la UESB, tenían edad media de 39,01(± 11,03) años y el 53,3% (n=56) eran del sexo femenino. Todos presentaron algún dolor en el sistema osteomuscular. Las consultas con los profesionales de salud fueron más evidentes en los empleados administrativos que los profesores (p=0,04). Las horas de trabajo de dedicación exclusiva (DE) y 40h semanales estuvieron correlacionados solamente en El grupo de profesores considerando los dominios del Cuestionario Nórdico. En los siete días precedentes, hubo diferencia entre los grupos de profesores (DE versus 40h) en los síntomas presentados en los hombros (p=0,008) y la parte superior de la espalda (p=0,004), además del codo (p=0,01) y puño/mano (p=0,004) respecto la consulta con algún profesional de salud. Conclusión: Existe una prevalencia elevada de quejas musculo esqueléticas em la muestra independiente del hecho de ser profesor o empleado administrativo, lo que se puede relacionar a las condiciones de trabajo, o sea, existen inadecuaciones laborales.