Long Term Cardiovascular Outcome Based on Aspirin and Clopidogrel Responsiveness Status in Young ST-Elevated Myocardial Infarction Patients / Desfecho Cardiovascular em Longo Prazo com Base na Capacidade de Resposta à Aspirina e ao Clopidogrel em Pacientes Jovens com Infarto do Miocárdio com Elevação do Segmento ST

Abstract Background: A subset of patients who take antiplatelet therapy continues to have recurrent cardiovascular events which may be due to antiplatelet resistance. The effect of low response to aspirin or clopidogrel on prognosis was examined in different patient populations. Objective: We aimed to investigate the prevalence of poor response to dual antiplatelet therapy and its relationship with major adverse cardiovascular events (MACE) in young patients with ST-elevation myocardial infarction (STEMI). Methods: In our study, we included 123 patients under the age of 45 with STEMI who underwent primary percutaneous intervention. A screening procedure to determine both aspirin and clopidogrel responsiveness was performed on the fifth day of admission. We followed a 2x2 factorial design and patients were allocated to one of four groups, according to the presence of aspirin and/or clopidogrel resistance. Patients were followed for a three-year period. A p-value less than 0.05 was considered statistically significant. Results: We identified 48% of resistance against one or more antiplatelet in young patients with STEMI. More MACE was observed in patients with poor response to dual platelet therapy or to clopidogrel compared those with adequate response to the dual therapy (OR: 1.875, 1.144-3.073, p < 0.001; OR: 1.198, 0.957-1.499, p = 0.036, respectively). After adjustment for potential confounders, we found that poor responders to dual therapy had 3.3 times increased odds for three-year MACE than those with adequate response to the dual therapy. Conclusion: Attention should be paid to dual antiplatelet therapy in terms of increased risk for cardiovascular adverse events especially in young patients with STEMI.

Resumo Fundamento: Um subgrupo de pacientes que recebem terapia antiplaquetária continua a apresentar eventos cardiovasculares recorrentes, possivelmente por resistência aos medicamentos. O efeito da baixa resposta à aspirina ou ao clopidogrel sobre o prognóstico foi avaliado em diferentes populações. Objetivo: Investigar a prevalência de baixa resposta à terapia antiplaquetária e sua relação com eventos adversos cardiovasculares em pacientes jovens com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCST). Métodos: Em nosso estudo, incluímos 123 pacientes com IAMCST e idade inferior a 45 anos, submetidos à intervenção percutânea primária. No quinto dia após admissão hospitalar, os pacientes foram rastreados quanto à capacidade de resposta à aspirina e ao clopidogrel. Seguimos um delineamento fatorial 2x2 e os pacientes foram alocados a um dos quatro grupos formados segundo presença de resistência à aspirina e/ou ao clopidogrel. Os pacientes foram acompanhados por um período de três anos. Um valor de P inferior a 0,05 foi considerado estatisticamente significativo. Resultados: Nós identificamos 48% de resistência a um ou mais agentes antiplaquetários em pacientes jovens com IAMCST. Houve maior ocorrência de MACE em pacientes com baixa resposta à terapia antiplaquetária dupla ou ao clopidogrel em comparação àqueles com resposta adequada à terapia dupla (OR: 1,875; 1,144-3,073; p < 0,001; OR: 1,198; 0,957-1,499; p = 0.036, respectivamente). Após ajuste quanto a possíveis fatores de confusão, pacientes com baixa resposta à terapia dupla apresentaram risco 3,3 vezes maior para MACE em três anos em comparação àqueles com resposta adequada a essa terapia. Conclusão: Atenção deve ser dada à resistência à terapia antiplaquetária dupla quanto ao risco aumentado de eventos adversos cardiovasculares, especialmente em pacientes jovens com IAMCST.

The Influence of Comorbid Conditions on Graft Stenosis in Patients with Coronary Artery Bypass Graft Operation / A influência das condições comórbidas na estenose do enxerto em pacientes com coronariopatia Operação de enxerto de artéria

The primary goal of coronary artery bypass grafting is to achieve complete revascularization with grafts that will remain patent throughout the patient's lifetime. This study investigated the association between bypass graft patency and comorbidity burden determined by Charlson comorbidity index (CCI) among patients with previous bypass operation who underwent a control angiography. One-hundred and two patients who had undergone CABG in the past were included to the study. Critical stenosis was defined as 50% or greater coronary luminal obstruction of any coronary vessel or its lateral branch. Patients were divided into 2 groups group 1; critical graft stenosis; (54 pts; 41M, mean age 66.5 ± 7.8 years), group 2; graft patent (48 pts; 31M, mean age; 65.9 ± 8.2 years). Charlson comorbidity index (CCI) and modified CCI scores were used for detecting comorbidities. The comparison of continuous variables between the control and critical CAD groups was performed by the independent sample test. A p value less than 0.05 was considered statistically significant. The two groups were statistically similar with respect to demographic properties, time since bypass operation, cardiovascular risk factors, systolic blood pressure, heart rate, medications used, complete blood counts parameters, and lipid profiles. CCI was significantly higher in Group 1 compared to Group 2 (7.14 ± 2.02 vs4.72 ± 1.58; p < 0.001). Modified CCI scores were also higher in Group 1 than in Group 2 (6.14 ± 2.02 vs 3.73 ± 1.60; p < 0.001). Graft occlusion was more common among patients with a high comorbidity burden. CCI scoring system may be helpful for determining patients at increased risk at both the preoperative and postoperative periods

Metastatic adenocarcinoma involving the right ventricle and pulmonary artery leading to right heart failure: case report / Adenocarcinoma metastático envolvendo o ventrículo direito e artéria pulmonar levando a insuficiência cardíaca direita: relato de caso

ABSTRACT CONTEXT: Obstruction of the right ventricular outflow tract due to metastatic disease is rare. Clinical recognition of cardiac metastatic tumors is rare and continues to present a diagnostic and therapeutic challenge. CASE REPORT: We present the case of a patient who had severe respiratory insufficiency and whose clinical examinations revealed a giant tumor mass extending from the right ventricle to the pulmonary artery. We discuss the diagnostic and therapeutic options. CONCLUSION: In patients presenting with acute right heart failure, right ventricular masses should be kept in mind. Transthoracic echocardiography appears to be the most easily available, noninvasive, cost-effective and useful technique in making the differential diagnosis.

RESUMO CONTEXTO: A obstrução da via de saída do ventrículo direito devido a doença metastática é rara. O reconhecimento clínico de tumores cardíacos metastáticos é raro e continua a apresentar um desafio diagnóstico e terapêutico. RELATO DO CASO: Apresentamos o caso de um paciente com insuficiência respiratória grave e cujos exames clínicos revelaram massa de tumor gigante, estendendo-se desde o ventrículo direito até a artéria pulmonar. Discutimos as opções diagnósticas e terapêuticas. CONCLUSÃO: Em pacientes com insuficiência cardíaca direita aguda, massas do ventrículo direito devem ser mantidas em mente. Ecocardiografia transtorácica parece ser a técnica mais facilmente disponível, não invasiva, custo-efetiva e útil no diagnóstico diferencial.

The relation of HOMA index with endothelial functions determined by flow mediated dilatation method among hyperglycemic patients.

AIMS/OBJECTIVE: To research the relation between "homeostasis model assessment of insulin resistance index (HOMA-IR)" and endothelial functions, determined by the flow mediated dilatation (FMD) method with brachial artery ultrasound and the atherosclerotic factors influencing these values among hyperglycemic patients taking the same type of oral antidiabethics (sulphonylurea). METHOD: Seventy type-2 diabetes mellitus patients (33 males and 37 females, mean age 53.5 +/- 8.5 years) who took the same oral antidiabetic drugs, and 40 people (22 males, 18 females, mean age 46.9 +/- 14.6 years) as control group who had no hypertension and no cardiovascular disease were included in the study. The HOMA-IR of the patients was calculated. Patients who had HOMA-IR > or = 3.6 were assumed as insulin resistance (IR) existing and who had HOMA-IR < 3.6 were not existing. The groups were divided into the IR existing (group 1) and IR not existing (group 2). Endothelium dependent dilatation (FMD) values of the groups and the controls were calculated as percentage increase as to basic values in reactive hyperemia phase. RESULTS: FMD percentages among group 1 were significantly lower than the control group (p < 0.05). No difference was observed between group 2 and the control group (p 7gt; 0.05). Percentage increase between the basic level and reactive hyperemy phase was not found statistically significant (p > 0.05) between group 1 and 2. While the main factors influencing FMD percantages were total cholesterol, triglyceride, high-density lipoprotein, and low-density lipoprotein levels for group 1. No parameter could be found affecting the related percentages for group 2. CONCLUSION: While endothelial functions, determined by FMD method, were impaired with hyperglycemic patients whose HOMA-IR was > or = 3.6; it was normal among hyperglycemics whose HOMA-IR was < 3.6.