Ocorre Lesão Miocárdica após uma Sessão de Exercício Aeróbico Agudo em Pacientes com Angina Refratária? / Does Myocardial Injury Occur After an Acute Aerobic Exercise Session in Patients with Refractory Angina?

Resumo Fundamento Não está claro se o exercício é seguro em pacientes com formas mais avançadas de doença arterial coronariana, como aqueles com angina refratária (AR). Objetivo Visamos determinar o efeito de uma sessão de exercício aeróbico agudo (SEAA) nos níveis de troponina T cardíaca de alta sensibilidade (TnT-as) em pacientes com AR. Métodos Trata-se de um estudo clínico longitudinal, não randomizado e não controlado. Os participantes foram recrutados de abril de 2015 a janeiro de 2019. Em uma escala visual de dor de 0 a 10, a dor classificada até 3 foi considerada como o nível máximo permitido para continuar o exercício. Avaliamos TnT-as na linha de base e 3 horas após a SEAA. O protocolo consistiu em 5 minutos de aquecimento, 30 minutos de exercício aeróbico contínuo na frequência cardíaca correspondente ao limiar anaeróbio ou limiar de angina obtido no teste de esforço cardiopulmonar e 5 minutos de resfriamento. Foram considerados estatisticamente significativos valores de p menores que 0,05. Resultados Foram incluídos 32 pacientes com AR (61 ± 9 anos, 59,4% do sexo masculino). A concentração basal de TnT-as foi de 10,9 ng/L (intervalo de confiança de 95%: 9,1 a 13,0 ng/L). A TnT-as coletada 3 horas após a SEAA foi de 11,1 ng/L (intervalo de confiança de 95%: 9,1 a 13,5 ng/L). Nenhuma diferença ocorreu na TnT-as antes e após a SEAA (p = 0,657). Conclusões Uma única SEAA realizada no limiar de angina com correspondente escala visual de dor não alterou a TnT-as em pacientes com AR, sugerindo que nenhuma lesão miocárdica significativa foi provocada pelo exercício e que este protocolo de exercício pode ser considerado seguro.

Abstract Background It is unclear whether exercise is safe in patients with more advanced forms of coronary artery disease, such as those with refractory angina (RA). Objective We aimed to determine the effect of an acute aerobic exercise session (AAES) on high-sensitivity cardiac troponin T (hs-cTnT) levels in patients with RA. Methods This was a longitudinal, non-randomized, and non-controlled clinical study. Participants were recruited from April 2015 to January 2019. On a visual pain scale from 0 to 10, pain rated up to 3 was considered as the top level allowed to continue exercising. We assessed hs-cTnT at baseline and 3 hours after the AAES. The protocol consisted of 5 minutes of warm-up, 30 minutes of continuous aerobic exercise at heart rate corresponding to the anaerobic threshold or angina threshold obtained in the cardiopulmonary exercise testing, and 5 minutes of cooling down. P values less than 0.05 were considered statistically significant. Results Thirty-two patients with RA were included (61 ± 9 years, 59.4% male). The baseline hs-cTnT concentration was 10.9 ng/L (95% confidence interval: 9.1 to 13.0 ng/L). The hs-cTnT collected 3 hours after the AAES was 11.1 ng/L (95% confidence interval: 9.1 to 13.5 ng/L). No difference occurred in hs-cTnT before and after AAES (p = 0.657). Conclusions A single AAES performed at the angina threshold with corresponding visual pain scale did not alter hs-cTnT in patients with RA, suggesting that no significant myocardial injury was elicited by exercising and that this exercise protocol can be considered safe.

Análise da participação popular e das variáveis que interferem na mesma com relação ao SUS: uma revisão / Analysis of popular participation and the variables that interfere with it in relation to SUS: a review / Análisis de la participación popular y de las variables que interfieren en ella en relación con SUS: una revisión

Para que haja um sistema de saúde eficiente, a participação da comunidade se faz essencial nesse processo, pois é direito da mesma expor suas necessidades para que novas ações relativas à saúde sejam tomadas. Nesse sentido, o Sistema Único de Saúde (SUS) tem em sua construção espaços que são destinados a esta prática, como os Conselhos e Conferências de Saúde. Todavia ainda é notório que os cidadãos brasileiros não ocupam estes espaços de maneira efetiva. Desta forma, o objetivo deste trabalho foi realizar uma revisão bibliográfica com o intuito de compreender os motivos que corroboram com a falta de participação da comunidade. As principais problemáticas levantadas após a pesquisa nas bases de dados foram a escassa compreensão da legislação vigente, sensação de obrigatoriedade (trabalho) e certa pressão do próprio sistema contra o cidadão. Todavia, nota-se que apesar das dificuldades, há formas de contornar essas barreiras, através da implementação de tecnologias de comunicação que facilitem o diálogo da população para com o Estado. Portanto, ainda que haja muitas dificuldades impostas no cotidiano dos cidadãos, existem formas do exercício da cidadania - participando da construção do SUS - que podem ser implementadas com o auxílio da tecnologia.

In order to have an efficient health system, the participation of the community is essential in this process, because it is their right to expose their needs so that new actions related to health can be taken. In this sense, the Unified Health System (SUS) has in its construction spaces that are destined to this practice, such as the Health Councils and Conferences. However, it is still notorious that Brazilian citizens do not effectively occupy these spaces. Thus, the objective of this work was to perform a literature review in order to understand the reasons that corroborate the lack of community participation. The main problems raised after the database research were the lack of understanding of the current legislation, the feeling of obligation (work), and a certain pressure of the system itself against the citizen. However, it is noted that despite the difficulties, there are ways to get around these barriers, through the implementation of communication technologies that facilitate the dialogue of the population with the State. Therefore, even though there are many difficulties imposed in the daily lives of citizens, there are ways of exercising citizenship - participating in the construction of the SUS - that can be implemented with the help of technology.

Para un sistema de salud eficiente, la participación de la comunidad es esencial en este proceso, ya que es un derecho de la comunidad exponer sus necesidades para que se tomen nuevas acciones relacionadas con la salud. En este sentido, el Sistema Único de Salud (SUS) tiene en su construcción espacios que se destinan a esta práctica, como los Consejos y Conferencias de Salud. Sin embargo, sigue siendo notorio que los ciudadanos brasileños no ocupan efectivamente estos espacios. Así, el objetivo de este trabajo fue realizar una revisión bibliográfica para conocer las razones que corroboran la falta de participación de la comunidad. Los principales problemas planteados tras la investigación en las bases de datos fueron la escasa comprensión de la legislación vigente, el sentimiento de obligación (trabajo) y una cierta presión del propio sistema contra el ciudadano. Sin embargo, se constata que, a pesar de las dificultades, hay formas de sortear estas barreras, a través de la implementación de tecnologías de comunicación que faciliten el diálogo de la población con el Estado. Por lo tanto, aunque haya muchas dificultades impuestas en la vida cotidiana de los ciudadanos, hay formas de ejercer la ciudadanía - participar en la construcción del SUS - que pueden ser implementadas con la ayuda de la tecnología.

Análise Crítica e Limitações do Diagnóstico de Insuficiência Cardíaca com Fração de Ejeção Preservada (ICFEp) / Critical Analysis and Limitations of the Diagnosis of Heart Failure with Preserved Ejection Fraction (HFpEF)

Resumo Com o aumento da expectativa de vida da população e a maior frequência de fatores de risco como obesidade, hipertensão arterial e diabetes, espera-se um aumento na prevalência de insuficiência cardíaca com fração de ejeção preservada (ICFEp). Entretanto, no momento, o diagnóstico e o tratamento de pacientes com ICFEp permanecem desafiadores. O diagnóstico sindrômico de ICFEp inclui diversas etiologias e doenças com tratamentos específicos, mas que apresentam pontos em comum em relação à apresentação clínica e à avaliação laboratorial no que diz respeito aos biomarcadores como BNP e NT-ProBNP, à avaliação ecocardiográfica do remodelamento cardíaco e às pressões de enchimento diastólico ventricular esquerdo. Extensos ensaios clínicos randomizados envolvendo a terapia nesta síndrome falharam na demonstração de benefícios para o paciente, fazendo-se necessária uma reflexão acerca do diagnóstico, dos mecanismos de morbidade, da taxa de mortalidade e da reversibilidade. Na revisão, serão abordados os conceitos atuais, as controvérsias e, especialmente, os desafios no diagnóstico da ICFEp através de uma análise crítica do escore da European Heart Failure Association.

Abstract With the increase in the population's life expectancy and the higher frequency of risk factors such as obesity, hypertension and diabetes, an increase in the prevalence of heart failure with preserved ejection fraction (HFpEF) is expected. However, to date, the diagnosis and treatment of patients with HFpEF remain challenging. The syndromic diagnosis of HFpEF includes several etiologies and diseases with specific treatments but has points in common regarding the clinical presentation, laboratory evaluation related to biomarkers, such as BNP and NT-ProBNP, and echocardiographic evaluation of cardiac remodeling and left ventricular diastolic filling pressures. Extensive randomized clinical trials involving the treatment of this condition have failed to demonstrate benefits to the patient, making it necessary to reflect on the diagnosis, mechanisms of morbidity, mortality and reversibility in this syndrome. In this review, the current concepts, controversies and challenges, especially regarding diagnosis, will be addressed, critically analyzing the European Heart Failure Association score for the diagnosis of HFpEF.

Cardiopulmonary exercise test in patients with refractory angina: functional and ischemic evaluation

Abstract Objectives Refractory angina (RA) is a chronic condition clinically characterized by low effort tolerance; therefore, physical stress testing is not usually requested for these patients. Cardiopulmonary exercise testing (CPET) is considered a gold standard examination for functional capacity evaluation, even in submaximal tests, and it has gained great prominence in detecting ischemia. The authors aimed to determine cardiorespiratory capacity by using the oxygen consumption efficiency slope (OUES) in patients with refractory angina. The authors also studied the O2 pulse response by CPET and the association of ischemic changes with contractile modifications by exercise stress echocardiography (ESE). Methods Thirty-one patients of both sexes, aged 45 to 75 years, with symptomatic (Canadian Cardiovascular Society class II to IV) angina who underwent CPET on a treadmill and exercise stress echocardiography on a lower limb cycle ergometer were studied. ClinicalTrials.gov: NCT03218891. Results The patients had low cardiorespiratory capacity (OUES of 1.74 ± 0.4 L/min; 63.9±14.7% of predicted), and 77% of patients had a flattening or drop in O2 pulse response. There was a direct association between Heart Rate (HR) at the onset of myocardial ischemia detected by ESE and HR at the onset of flattening or drop in oxygen pulse response detected by CPET (R = 0.48; p = 0.019). Conclusion Patients with refractory angina demonstrate low cardiorespiratory capacity. CPET shows good sensitivity for detecting abnormal cardiovascular response in these patients with a significant relationship between flattening O2 pulse response during CEPT and contractile alterations detected by exercise stress echocardiography. Highlights OUES analysis is useful for assessing functional capacity in refractory angina. O2 pulse curve is correlated with contractile alterations in exercise echocardiogram. Cardiopulmonary exercise test is useful toll in patients with refractory angina.

Violência simbólica na experiência de estudantes universitários LGBT / Violencia simbólica en la experiencia de estudiantes universitarios LGBT / Symbolic violence in undergraduate LGBT students' experiences

Resumo Desde a infância, a violência simbólica é um processo vivenciado por pessoas LGBT diante das sanções da heteronormatividade hegemônica. A universidade se constitui como espaço de possibilidade e mudança para muitas pessoas, com uma expectativa em particular: a de maior abertura à pluralidade moral e, portanto, à diversidade. Este artigo investiga as experiências de violência simbólica e os contornos do habitus vividos por universitários LGBT, por meio de entrevistas não estruturadas com 16 estudantes analisadas a partir do arcabouço teórico de Bourdieu. A violência simbólica se mostrou presente na vida de todos, se manifestando em diversos ambientes e instituições, inclusive na vida acadêmica universitária, mas principalmente na vida familiar e escolar. Diante das imposições do habitus heterossexual, os indivíduos desenvolvem diversos recursos, com destaque para a aquisição de capital social, como a militância LGBT. No entanto, a universidade precisa concretizar ações específicas de enfrentamento às violências e de respeito à diversidade, considerando seu papel como instituição socialmente responsável pela educação de cidadãos para além de profissionais. Esse é um desafio já presente na definição da agenda ético-política universitária, que se torna ainda mais complexo em tempos de luta pela própria manutenção do sistema democrático no Estado brasileiro.

Resumen Desde la infancia, la violencia simbólica es un proceso vivido por las personas LGBT ante las sanciones de la heteronormatividad hegemónica. La universidad se constituye como espacio de posibilidad y cambio para muchos, con una expectativa en particular: la de mayor apertura a la pluralidad moral y, por lo tanto, a la diversidad. Han sido investigadas las experiencias de violencia simbólica y los contornos del habitus vividos por universitarios LGBT. Han sido realizadas entrevistas no estructuradas con 16 estudiantes, analizadas a partir del marco teórico de Bourdieu. La violencia simbólica se mostró presente en la vida de todos. Ocurre en diversos ambientes e instituciones, con primacía en la familia y en la escuela, pero también en la vida académica universitaria. Ante las imposiciones del habitus heterosexual, los individuos desarrollan recursos, entre los cuales hay que destacar la adquisición de capital social, como la militancia LGBT. Pero la universidad, como institución socialmente responsable por la educación de ciudadanos más allá de profesionales, necesita concretar acciones específicas de enfrentamiento a las violencias y de respeto a la diversidad. Un desafío ya presente en la definición de la agenda ético-política universitaria, aún más complejo en tiempos de lucha por el propio mantenimiento del sistema democrático en el Estado brasileño.

Abstract Since childhood, symbolic violence has been a process experienced by LGBT people facing the sanctions of hegemonic heteronormativity. University is a space of possibility and change for many people, with a particular expectation: of greater openness to moral plurality and, thus, diversity. This article investigates experiences of symbolic violence, and the contours of the habitus lived by LGBT university students, by using unstructured interviews with 16 students, analyzed from the theoretical framework of Bourdieu. Symbolic violence was present in all their lives, showing itself in different environments and institutions, including the university academic life, but mostly on their family and school life. Facing impositions of the heterosexual habitus, individuals develop resources, with the acquisition of social capital, such as LGBT militancy, standing out. However, the university needs to concretize specific actions to face violence and respect diversity, considering its role as an institution socially responsible for the education of citizens on top of professionals. This is a challenge already present in the definition of the ethical-political university agenda, that becomes even more complex in times of struggle for the very maintenance of the democratic system in the Brazilian State.

3D stereophotogrammetry quantification for tissue repositioning using Botulinum toxin A: a case report / Quantificação por estereofotogrametria 3D para reposicionamento tecidual com Toxina botulínica A: relato de caso

Hereby, we objectively assessed the outcomes of a facial-lifting procedure with Botulinum toxin type A (BoNT-A) using a 3D stereophotogrammetry quantification (3D-SQ). A 46-year-old female patient received a full face BoNT-A treatment in a total dose of 180 Speywood Units (sU). Frontal, lateral and oblique photographs were taken before and 20 days after treatment, at rest and during mimic movements. Also, a facial scanning was performed before and 20 days after BoNT-A injections. The results were analyzed using a 3D-SQ software. The photographs showed a decrease in expression lines and dynamic wrinkles. In addition, a better-defined jawline and volume gain in the midface area with improvement of the profile appearance, due to the reduction of the sagging skin under the chin, was observed. The 3D-SQ showed volume gains of 1.17 ml on the right and of 1.59 ml on the left cheekbone areas, due to the cranially soft-tissue repositioning. In addition, a decrease in the volume of melomental folds areas (0.27ml on the right and 0.41 ml on the left side) was reported, compatible to the above-mentioned volume gain. Measurements considering cephalometric points showed a decrease in the total facial height (distance from Trichion to Mental points), suggesting a soft tissue dislocation in an upward direction. Finally, this case report showed quantitative results that can evidence the role of BoNT-A in facial- lifting procedures. These results reinforce the importance of using a 3D-SQ to assess the outcomes of BoNT-A and, probably, other aesthetic procedures.(AU)

No presente estudo avaliamos objetivamente os resultados de um procedimento de lifting facial com toxina botulínica tipo A (BoNT-A) usando uma quantificação de estereofotogrametria 3D (3D-SQ). Uma paciente do sexo feminino de 46 anos recebeu um tratamento facial completo com BoNT-A em uma dose total de 180 unidades Speywood (sU). Fotografias frontais, laterais e oblíquas foram tomadas antes e 20 dias após o tratamento, em repouso e durante os movimentos mímicos. Além disso, um escaneamento facial foi realizado antes e 20 dias após as injeções de BoNT-A. Os resultados foram analisados por meio de um software 3D-SQ. As fotografias mostraram uma diminuição das linhas de expressão e rugas dinâmicas. Além disso, observou-se um maxilar mais bem definido e ganho de volume na região média da face com melhora da aparência do perfil, devido à redução da flacidez da pele sob o queixo. O 3D-SQ apresentou ganho de volume de 1,17 ml à direita e 1,59 ml à esquerda, devido ao reposicionamento do tecido mole. Além disso, foi relatada diminuição do volume das áreas do sulco mentual (0,27 ml à direita e 0,41ml à esquerda), compatível com o ganho de volume acima citado. As medidas considerando os pontos cefalométricos mostraram uma diminuição da altura facial total (distância dos pontos Triquion ao Mentual), sugerindo um deslocamento superior dos tecidos moles. Em conclusão, este relato de caso mostrou resultados quantitativos que podem evidenciar o papel da BoNT-A em procedimentos de lifting facial. Esses resultados reforçam a importância da 3D-SQ para avaliar objetivamente os resultados de harmonização orofacial com BoNT-A e outros materiais. (AU)

Achados ao ecocardiograma transtorácico em pacientes hospitalizados com COVID- 19: resultados do registro brasileiro de ecocardiografia durante a pandemia de COVID-19 (ECOVID) / Transthoracic echocardiography findings of hospitalized patients with COVID-19: results from the brazilian echocardiography registry during the COVID-19 Pandemic (ECOVID)

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)

Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)

Functional capacity and rehabilitation strategies in Covid-19 patients: current knowledge and challenges

Abstract Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.

The effect of continuous positive airway pressure on blood pressure in patients with obstructive sleep apnea and uncontrolled hypertension - Study design and challenges during the COVID-19 pandemic

OBJECTIVES: To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS: MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and ≥80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index ≥15 events/hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. ClinicalTrials.gov: NCT02270658. RESULTS: The first 100 patients are predominantly males (n=69), age: 52±10 years, body mass index: 32.7±3.9 kg/m2 with frequent co-morbidities. CONCLUSIONS: The MORPHEOS trial has a unique study design including a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP.

The Clinical Course of Takotsubo Syndrome Diagnosed According to the InterTAK Criteria

Abstract Background There has been an increase in the number of cases of Takotsubo syndrome (TTS) and of scientific publications on the theme over the last years. However, little is known about the status of this disease in Brazilian hospitals. Objective To assess mortality and major adverse cardiovascular events (MACE) during hospitalization and follow-up of TTS patients seen in a tertiary hospital in Brazil. Methods This was a retrospective, observational study on 48 patients. Clinical data, signs and symptoms, complementary tests, MACE and all-cause mortality were assessed on admission and during follow-up. Kaplan-Meier curves were used for analysis of all-cause mortality and risk for MACE at median follow-up. The 95% confidence interval was also calculated for a significance level of 5%. Results Mean age of patients was 71 years (SD±13 years), and most patients were women (n=41; 85.4%). During hospitalization, four patients (8.3%) died and five (10.4%) developed MACE. At median follow-up of 354.5 days (IQR of 81.5-896.5 days), the risk of all-cause mortality and MACE was 11.1% (95% CI= 1.8-20.3%) and 12.7% (95% CI= 3.3-22.3%), respectively. Conclusion TTS was associated with high morbidity and mortality rates in a tertiary hospital in Brazil, which were comparable to those observed in acute coronary syndrome. Therefore, the severity of TTS should not be underestimated, and new therapeutic strategies are required. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0