Análise dos desfechos em intervenção coronária percutânea de tronco de coronária esquerda não protegido / Analysis of percutaneous coronary intervention outcomes in unprotected left main coronary artery lesions

Introdução: Lesões significativas no tronco de coronária esquerda são encontradas em aproximadamente 5% dos pacientes submetidos à coronariografia, sendo a maioria dos casos multiarteriais e com envolvimento do tronco distal. A cirurgia de revascularização do miocárdio é considerada o tratamento preferencial para lesões de tronco de coronária esquerda não protegido. No entanto, com o avanço de técnicas e a introdução dos novos stents liberadores de fármacos, a intervenção coronariana percutânea tem sido considerada estratégia viável, apresentando resultados favoráveis. O objetivo deste estudo foi analisar os desfechos em pacientes com lesões de tronco de coronária esquerda não protegido submetidos à intervenção coronariana percutânea. Métodos: Foram analisados dados eletrônicos de pacientes submetidos à intervenção coronariana percutânea entre dezembro de 2017 e janeiro de 2020 em um único centro, com o objetivo de avaliar características clínicas, angiográficas e os desfechos clínicos. Resultados: Foram incluídos 103 pacientes portadores de lesões significativas de tronco não protegido, 66% eram do sexo masculino, 88,3% eram hipertensos, e 87,4% possuíam função ventricular normal. Lesões envolvendo a bifurcação foram identificadas em 73,8% dos pacientes, 36,9% apresentavam lesões concomitantes nos três grandes vasos epicárdicos e 42,7% com escore SYNTAX intermediário (23 a 32 pontos). O sucesso angiográfico foi obtido em 100% dos casos, com quatro (3,9%) eventos cardíacos e cerebrovasculares adversos, sendo 2,9% de mortalidade. Conclusão: Os resultados hospitalares sustentam a intervenção coronariana percutânea como um procedimento seguro, de excelente resultado angiográfico e eventos cardíacos e cerebrovasculares adversos comparáveis aos da cirurgia de revascularização do miocárdio, configurando opção bastante viável em relação ao tratamento cirúrgico.

Background: Significant lesions in the left main coronary artery are found in approximately 5% of patients undergoing coronary angiography, with most cases involving multiple vessels and affecting the distal bifurcation. A coronary artery bypass graft surgery is considered the preferred treatment for unprotected left main coronary artery lesions. However, with the advancement of techniques and the introduction of new drug-eluting stents, percutaneous coronary intervention has been considered a viable strategy, with favorable results. The objective of this study was to analyze the outcomes in patients with unprotected left main coronary artery lesions undergoing percutaneous coronary intervention. Methods: Electronic data from patients undergoing percutaneous coronary intervention between December 2017 and January 2020 at a single center were analyzed to assess clinical and angiographic characteristics and clinical outcomes. Results: A total of 103 patients with significant unprotected left main coronary artery lesions were included; in that, 66% were male, 88.3% were hypertensive, and 87.4% had normal ventricular function. Lesions involving the bifurcation were identified in 73.8% of patients, 36.9% had concomitant lesions in the three major epicardial vessels, and 42.7% had an intermediate SYNTAX score (23 to 32 points). Angiographic success was achieved in 100% of cases, with four (3.9%) adverse cardiac and cerebrovascular events, with 2.9% mortality. Conclusion: Hospital results support percutaneous coronary intervention as a safe procedure, with excellent angiographic results and low rates of adverse cardiac and cerebrovascular events. We concluded that percutaneous coronary intervention is an option to coronary artery bypass graft surgery and is a very viable option for surgical treatment of unprotected left main coronary artery lesions.

Overweight and abdominal obesity in adults living with HIV/AIDS / Excesso de peso e obesidade abdominal em adultos vivendo com HIV/aids

Summary Objective: To investigate the prevalence of overweight, abdominal obesity and associated factors in people living with HIV/AIDS (PLWHA). Method: Cross-sectional study with 270 PLWHA. A questionnaire was applied to investigate sociodemographic, clinical and lifestyle characteristics. Weight, height and waist circumference were measured. BMI ≥25 kg/m2 was considered overweight, while abdominal obesity referred to waist circumference ≥102 cm for men and ≥88 cm for women. The authors used multiple Poisson regression with 5% significance level. Results: The prevalence of overweight and abdominal obesity was 33.7% and 12.6%, respectively, referring to 37.9% of women and 5.7% of men (p<0.001). Overweight was associated with age of 40-49 years and ≥50 years, non-use of ARV therapy, and lower tertile of consumption of risk foods. Abdominal obesity was associated with: female gender, age of 40-49 years and ≥50 years, income greater than four times the minimum wage, and CD4+ lymphocyte count >350 cells/mm3. Conclusion: There was a high prevalence of overweight and abdominal obesity associated with sociodemographic and clinical conditions, and consumption of risk foods. This scenario indicates the need for reorientation of the health care focus in this population.

Resumo Objetivo: investigar em pessoas vivendo com HIV/aids (PVHA) a prevalência de excesso de peso, obesidade abdominal e fatores associados. Método: estudo transversal com 270 PVHA. Aplicou-se questionário para investigar características sociodemográficas, clínicas e estilo de vida. Coletaram-se peso, altura e circunferência de cintura. Consideraram-se excesso de peso o IMC ≥25 kg/m2 e obesidade abdominal a circunferência de cintura ≥102 cm para homens e ≥88 cm para mulheres. Utilizou-se regressão de Poisson múltipla com nível de significância de 5%. Resultados: a prevalência de excesso de peso foi de 33,7% e de obesidade abdominal foi de 12,6%, sendo 37,9% nas mulheres e 5,7% nos homens (p<0,001). Excesso de peso foi associado com idade de 40 a 49 anos e ≥50 anos, não uso de terapia antirretroviral (TARV) e menor tercil de consumo de alimentos de risco. Obesidade abdominal se associou com sexo feminino, idade de 40 a 49 anos e ≥50 anos, renda própria maior que quatros salários mínimos e contagem de linfócitos T CD4+ >350 células/mm3. Conclusão: constatou-se elevada prevalência de excesso de peso e obesidade abdominal, associados a condições sociodemográficas, clínicas e consumo de alimentos de risco. Esse panorama sinaliza a necessidade de reorientação do foco de atenção à saúde dessa população.

Uso do dispositivo de assistência ventricular Impella® em adulto jovem com choque cardiogênico secundário à dissecção coronária espontânea / Use of the Impella™ ventricular assist device in a young adult with cardiogenic shock secondary to spontaneous coronary dissection

Em pacientes com choque cardiogênico pós-infarto a mortalidade é alta. A reversão da hipoperfusão tecidual é essencial para a preservação orgânica durante o período de recuperação funcional do miocárdio. Relatamos o caso de uma paciente que, após seguidos episódios de parada cardiorrespiratória, evoluiu com choque cardiogênico secundário à dissecção espontânea do tronco de coronária esquerda. Após a restauração do fluxo coronariano, por meio da intervenção percutânea primária com uso de stent, optouse pelo implante do dispositivo de assistência circulatória Impella® 2.5, que permitiu melhorar as condições hemodinâmicas da paciente, contribuindo para um desfecho favorável

Mortality is high in patients with post-infarction cardiogenic shock. Reversal of tissue hypoperfusion is essential for organ preservation during the myocardial functional recovery period. The authors report the case of a female patient who, after consecutive episodes of cardiorespiratory arrest, developed cardiogenic shock secondary to spontaneous dissection of the left main coronary artery. After restoration of coronary flow through primary percutaneous intervention with stent implantation, the Impella™ 2.5 circulatory assist device was implanted, which allowed the patient's hemodynamic improvement, contributing to a favorable outcome

Avaliação crítica sobre acurácia do teste ergométrico na prática clínica: experiência de centro único / Critical evaluation of treadmill test accuracy in clinical practice: single center experience

Fundamentos: Na avaliação da doença arterial coronariana, o teste ergométrico deve ser interpretado através da análise de dados clínicos, hemodinâmicos eeletrocardiográficos, mas na prática clínica algumas dessas informações não são adequadamente identificadas.Objetivo: Analisar a prática de realização do teste ergométrico para avaliação da doença ateroscleróticacoronariana em relação às recomendações consensuais. Métodos: Estudo de série de casos, transversal,observacional e descritivo. Entre maio e junho 2011 analisaram-se os resultados dos testes ergométricos de 166 pacientes submetidos a cineangiocoronariografiasconsecutivas. Resultados: População predominante masculina (60,8%)submetida a teste ergométrico e cineangiocoronariografia, com elevada frequência de fatores de risco cardiovascular. Observada baixa frequência de precordialgia típica(6,4%), com maioria (80,8%) dos testes sem relatos de precordialgia. Teste ergométrico máximo em 17,5% daamostra e submáximo na maioria (60,8%); sugestivo de isquemia em 63,9%, não sugestivo ou inconclusivo nos demais. A cineangiocoronariografia identificou aterosclerose significativa em 60,2% (100/166) dos pacientes. A sensibilidade do teste de esforço foi 65% (IC95% 54,8-74,2), especificidade 37,8% (IC95% 26,2-50,6), valor preditivo positivo 61,3% (IC95% 51,3-70,6) e valor preditivo negativo do teste ergométrico em relação ao padrão-ouro foi 41,6% (IC95% 29,0-55,1). A acurácia foide apenas 54,2% (IC95% 43,6-66,6) dos exames de esforço. Informações importantes para análise adequada do teste ergométrico não foram encontradas na maioria dos exames.

Dyslipidemia in AIDS patients on highly active antiretroviral therapy

Highly active antiretroviral therapy (HAART) reduces AIDS-related morbidity and mortality, however it has been associated with metabolic abnormalities. This study estimated the prevalence of lipid abnormalities and related factors among patients on HAART. A cross-sectional study was conducted on adult patients, in central Brazil. Patients were interviewed, and blood obtained for lipids measurement. Dyslipidemia was defined as total cholesterol (TC) > 240 mg/dL, low-density lipoprotein (LDL) > 160 mg/dL, triglycerides (TG) > 200 and/or high-density lipoprotein (HDL) < 40 mg/dL. Multiple logistic regression analyses were performed (SPSS 13.0). One hundred and thirteen patients were recruited. Mean age was 39.3 years; 68.1 percent were males; 50.4 percent were on nucleoside reverse transcriptase inhibitors (NRTI) in combination with non-nucleoside reverse transcriptase inhibitors (NNRTI), while 42.5 percent were on NRTI in combination with protease inhibitors (PIs). The prevalence of dyslipidemia was 66.7 percent. Low HDL was the most frequent abnormality (53.5 percent), followed by high TG (36.1 percent). Patients on a PI regimen had a 5.2-fold higher risk (95 percent CI: 1.8-14.8) of dyslipidemia, even after adjusting for sex, age, and duration of HIV infection/AIDS. The study discloses a high prevalence rate of dyslipidemia and points out a need for intervention programs to reduce future cardiovascular events in patients, on HAART.

Lipoma de átrio direito / Lipoma of the right atrium

The patient is a 54-year-old asymptomatic male with a tumor in the right atrium that was diagnosed on transesophageal echocardiography and confirmed as a lipoma of the right atrium on computerized tomography. The patient underwent surgical repair with extracorporeal circulation. The tumor was resected, and its base of implantation in the atrium was repaired with a flap of bovine pericardium. The diagnosis of lipoma was confirmed on histopathological examination. Locating of the tumor with the aid of transesophageal echocardiography was very useful in the strategy of cannulation of the venae cava for installation of the circuit of extracorporeal circulation. The patient had a good postoperative evolution

Evoluçäo imediata de pacientes submetidos a aneurismectomia de ventrículo esquerdo / Short-term follow-up of patients after aneurysmectomy of the left ventricle

OBJECTIVE: Left ventricular aneurysm is a complication of myocardial infarction that can best be treated by reconstructive surgeries that can restore ventricular geometry. We analyzed immediate results in a group of consecutive patients who underwent surgical correction of left ventricular aneurysms. METHODS: From January '90 to August '99, 94 patients - mean age 58.4 (ranging from 36 to 73 years), 65 (69.1 percent) males and 9 ( 30.8 percent) females - were operated upon. Pre-operative ejection fraction ranged from 0.22 to 0.58 (mean = 0.52), and the aneurysm was located in the antero-lateral area in 90.4 percent of the cases. Functional class III and IV (NYHA) was present in 82 (87.2 percent) patients, and 12 (12.7 percent) were in functional class I and II. Congestive heart failure was the most frequent cause (77.6 percent), occurring in isolation in 24.4 percent or associated with coronary artery diseases in 53.2 percent. RESULTS: Short-term follow-up showed a 7.4 percent mortality, and low cardiac output was the main cause of death. Coming off pump was uneventful in 73 patients (77.6 percent), with a 3.2 percent mortality and with the use of inotropics in 20 (21.3 percent). One patient (1 percent) did not come off the pump. CONCLUSION: Surgical correction was adequate in the immediate follow-up of operated patients, and mortality was higher in patients with higher functional class