The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings.

Comparison of Early and Mid-Term Outcomes After Classic and Modified Morrow Septal Myectomy in Patients with Hypertrophic Obstructive Cardiomyopathy

ABSTRACT Introduction: The aim of our study is to compare the early and mid-term outcomes of patients with hypertrophic obstructive cardiomyopathy who underwent classic and modified Morrow septal myectomy. Methods: Between 2014 and 2019, 48 patients (24 males; mean age 49.27±16.41 years) who underwent septal myectomy were evaluated. The patients were divided into two groups - those who underwent classic septal myectomy (n=28) and those who underwent modified septal myectomy (n=20). Results: Mitral valve intervention was higher in the classic Morrow group than in the modified Morrow group, but there was no significant difference (P=0.42). Mortality was found to be lower in the modified Morrow group than in the classic Morrow group (P=0.01). In both groups, the mean immediate postoperative gradient was significantly higher than the mean of the 3rd and 12th postoperative months. The preoperative and postoperative gradient difference of the modified Morrow group was significantly higher than of the classic Morrow group (P<0.001). Conclusion: Classic Morrow and modified Morrow procedures are effective methods for reducing left ventricular outflow tract obstruction. The modified Morrow procedure was found to be superior to the classic Morrow procedure in terms of reducing the incidence of mitral valve intervention with the reduction of the left ventricular outflow tract gradient.

Difference Between Cardiopulmonary Bypass Time and Aortic Cross-Clamping Time as a Predictor of Complications After Coronary Artery Bypass Grafting

ABSTRACT Introduction: Along with cardiopulmonary bypass time, aortic cross-clamping time is directly related to the risk of complications after heart surgery. The influence of the time difference between cardiopulmonary bypass and cross-clamping times (TDC-C) remains poorly understood. Objective: To assess the impact of cardiopulmonary bypass time in relation to cross-clamping time on immediate results after coronary artery bypass grafting in the Registro Paulista de Cirurgia Cardiovascular (REPLICCAR) II. Methods: Analysis of 3,090 patients included in REPLICCAR II database was performed. The Society of Thoracic Surgeons outcomes were evaluated (mortality, kidney failure, deep wound infection, reoperation, cerebrovascular accident, and prolonged ventilation time). A cutoff point was adopted, from which the increase of this difference would affect each outcome. Results: After a cutoff point determination, all patients were divided into Group 1 (cardiopulmonary bypass time < 140 min., TDC-C < 30 min.), Group 2 (cardiopulmonary bypass time < 140 min., TDC-C > 30 min.), Group 3 (cardiopulmonary bypass time > 140 min., TDC-C < 30 min.), and Group 4 (cardiopulmonary bypass time > 140 min., TDC-C > 30 min.). After univariate logistic regression, Group 2 showed significant association with reoperation (odds ratio: 1.64, 95% confidence interval: 1.01-2.66), stroke (odds ratio: 3.85, 95% confidence interval: 1.99-7.63), kidney failure (odds ratio: 1.90, 95% confidence interval: 1.32-2.74), and in-hospital mortality (odds ratio: 2.17, 95% confidence interval: 1.30-3.60). Conclusion: TDC-C serves as a predictive factor for complications following coronary artery bypass grafting. We strongly recommend that future studies incorporate this metric to improve the prediction of complications.

Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience

ABSTRACT Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease. Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint. Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found. Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

Caregiver burden, family adaptation, partnership, growth, affection, and resolve, anxiety levels, and perceived social support in relatives of patients with open heart surgery

SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between caregiver burden, family adaptation, partnership, growth, affection, and resolve score, anxiety levels, and the perceived social support of the relatives of patients who had open heart surgery. METHODS: Volunteers among the relatives of patients who had open heart surgery in our cardiovascular surgery clinic and were followed up in the first 3 months were included in the study. The cardiovascular surgeons recorded the sociodemographic data of the relatives of the patients and directed them to a psychiatry clinic for further evaluation. The caregiver burden scale, family adaptation, partnership, growth, affection, and resolve scale, anxiety level scale, and perceived social support scale were applied to the relatives of the patients who participated in the study. RESULTS: Within the scope of the study, a total of 51 individuals, 29.4% (n=15) men and 70.6% (n=36) women, were included in the evaluation. The participants' ages ranged from 32 to 68 years, with an average age of 48 years. There was a statistically significant relationship between the caregiving burden scale score and the scale scores other than age (p<0.05). There was a statistically significant difference in terms of caregiving burden scale score, working status, physical and psychological problems, changes in home life, and changes in family relationships (p<0.05). CONCLUSION: The fact that the need for security and intimacy is related to anxiety and depression can be interpreted as the caregiving problems of the relatives of the patients who think that their patients are safe and feel closer to the intensive care personnel will decrease. Their depression and anxiety levels will also decrease.

Is Trimethylamine N-oxide (TMAO) Associated with NF-κB mRNA Expression in Patients with Coronary Artery Disease?

Abstract Background: Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, is associated with cardiovascular disease (CVD) development. TMAO can trigger an inflammatory response by inducing the nuclear factor-kappa B (NF-κB) signaling cascade and increasing the expression of pro-inflammatory cytokines, contributing to the worsening of CVD. This study aimed to evaluate the association between TMAO plasma levels and inflammation in patients with coronary artery disease (CAD). Methods: A cross-sectional study was carried out including 29 patients with CAD. Peripheral blood mononuclear cells (PBMC) were isolated from fasting blood samples, and NF-κB and vascular cell adhesion protein 1 (VCAM1) mRNA expression were estimated using real-time quantitative PCR. We determined TMAO plasma levels by LC-MS/MS and TNF-α by ELISA. Routine biochemical parameters were evaluated using an automatic biochemical analyzer. Correlations were estimated by Spearman or Pearson test. Statistical significance was set at the level of p < 0.05. Results: All patients presented TMAO levels within the normal range according to EUTox (normal range: 2.83 ± 1.53 mg/L; CAD patients: 0.2 [0.1 to 0.2] ng/μL). TMAO plasma levels were positively correlated with NF-κB mRNA expression (0.555; p = 0.002). Conclusion: TMAO plasma levels may be associated with NF-κB mRNA expression in patients with CAD and may contribute to the pathogenesis of this disease.

Descripción angiográfica de los aspectos anatómicos y clínicos de la arteria interventricular anterior en un grupo de personas colombianas

Introducción. La arteria interventricular anterior se origina en la coronaria izquierda, irriga la cara anterior de los ventrículos, el ápex y el tabique interventricular; es la segunda arteria más relevante del corazón. Objetivo. Describir las características anatómicas y clínicas de la arteria interventricular anterior mediante angiografía. Materiales y métodos. Se realizó un estudio descriptivo con 200 reportes angiográficos de personas colombianas; se valoraron el origen, el trayecto y la permeabilidad de la arteria interventricular anterior, así como la dominancia coronaria. Se incluyeron datos relacionados con dolor precordial, infarto agudo de miocardio, dislipidemia y alteración electrocardiográfica. No fue posible hacer pruebas estadísticas, debido a la escasa prevalencia de variaciones anatómicas de dicha arteria. Resultados. Se encontró una arteria interventricular anterior con su origen en el seno aórtico izquierdo, sin puente miocárdico, sin alteración de la permeabilidad y con dominancia izquierda. La frecuencia de los puentes fue del 2 % y la dominancia más frecuente fue la derecha en el 86 %. Se presentaron alteraciones de permeabilidad en el 43 % de los casos, las cuales afectaron principalmente al S13. El 25 % de los pacientes presentó dolor precordial; el 40 %, alteraciones ecocardiográficas; el 5 %, cardiopatía isquémica, y el 59 %, alguna alteración electrocardiográfica. Conclusiones. Las variaciones en el origen de la arteria interventricular anterior son poco prevalentes, según reportes de Chile, Colombia y España. Los puentes miocárdicos de esta arteria fueron escasos respecto a otros estudios, lo cual sugiere mejor especificidad de los hallazgos de la angiotomografía o de la disección directa. La permeabilidad coronaria se valora con la escala TIMI (Thrombolysis in Myocardial Infarction); puntajes de 0 y 1 indican una lesión oclusiva asociada con cardiopatía isquémica. La dominancia coronaria más frecuente, según diversas técnicas, es la derecha, seguida de la izquierda en hombres y de una circulación balanceada en mujeres.

Introduction. The anterior interventricular artery originates from the left coronary artery and irrigates the anterior surface of the ventricles, apex, and interventricular septum, making it the second most relevant artery of the heart. Objective. To describe the anatomical and clinical aspects of the anterior interventricular artery through angiography. Materials and methods. A descriptive study was conducted using 200 angiographic reports of Colombian individuals. The anterior interventricular artery's origin, course, patency, and coronary dominance were evaluated. Data related to chest pain, acute myocardial infarction, dyslipidemia, and electrocardiographic abnormalities were included. Statistical tests could not be performed due to this artery's low prevalence of anatomical variations. Results. One anterior interventricular artery was found to have originated from the left coronary sinus without a myocardial bridge, with no alteration in permeability, and with left dominance. The frequency of bridges was 2%, and the most frequent dominance was right in 86; permeability alterations occurred in 43% mainly affecting S13. Twenty-five per cent presented chest pain; 40%, echocardiographic alterations; 5%, ischemic heart disease, and 59%, electrocardiographic alterations. Conclusions. Variations of origin of the anterior interventricular artery have a low prevalence according to reports from Chile, Colombia, and Spain. anterior interventricular artery myocardial bridges were scarce compared to other studies, suggesting better specificity of computed tomography angiography or direct dissection for these findings. The assessment of coronary permeability is graded with the thrombolysis in myocardial infarction scale; values 0 and 1 indicate occlusive lesion associated with ischemic heart disease. According to various techniques, the most frequent coronary dominance the right, followed by the left in men and balanced circulation in women.

Cirugía coronaria sin circulación extracorpórea

La cirugía de revascularización coronaria (CABG) es el estándar de tratamiento para la revascularización de la enfermedad de la arteria coronaria izquierda y/o de tres vasos. La cirugía coronaria sin bomba (OPCAB) evita el uso de derivación cardiopulmonar y puede mejorar los resultados a largo plazo al reducir las tasas de lesión miocárdica perioperatoria, accidente cerebrovascular (ACV), deterioro neurocognitivo y mortalidad de causa cardiaca. En la actualidad, se han llevado a cabo diversos ensayos clínicos desde la popularización del OPCAB en la década de los 90. Sin embargo, hasta el momento no se ha demostrado ningún beneficio del OPCAB en comparación con la cirugía tradicional a pesar de las reducciones favorables a corto plazo en los requerimientos de transfusión y otras complicaciones postoperatorias. Además, OPCAB se asocia con una revascularización miocárdica menos eficaz y no previene por completo las complicaciones tradicionalmente asociadas con la circulación extracorpórea (CEC). Este artículo revisa la evidencia actual de OPCAB en comparación con CABG tradicional en cuanto a los resultados clínicos a corto y largo plazo. Se analizan los resultados de la cirugía coronaria sin circulación extracorpórea (CEC) , comparándola con la cirugía convencional (con CEC). La revascularización coronaria sin CEC presenta resultados similares a la convencional, siempre que se cumplan determinadas condiciones en la selección de los pacientes. Una de ellas, muy importante, es la mayor experiencia del cirujano con el procedimiento.

The results of coronary artery revascularization performed without extracorporeal circulation (off pump) are compared to those of the traditional ("on pump") procedure. Compliance with selective conditions are required to obtain similar results. The most important being the experience of the surgeon performing the off pump procedure.

Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study

Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients' demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.

Herramientas para la toma de decisiones en pacientes con enfermedad de múltiples vasos / Tools for Decision Making in Patients with Multivessel Disease

RESUMEN La decisión sobre la mejor estrategia de revascularización para los pacientes con enfermedad de múltiples vasos se ha tornado una tarea compleja a medida que la angioplastia coronaria ha mejorado sus resultados. En la siguiente revisión nos propusimos evaluar las variables que en nuestra experiencia definen el beneficio de una técnica sobre la otra, entendiendo que de esta manera la decisión del médico tratante se hace más sencilla y objetiva. Por otro lado, y festejando el saludable protagonismo que se le da al paciente, creemos que esta evaluación permite ofrecer argumentos sólidos para ayudarlo en la toma de la decisión.

ABSTRACT The decision on the best revascularization strategy for patients with multivessel disease has become a complex task as coronary angioplasty has improved its results. In the following review, we set out to evaluate the variables that, in our experience, define the benefit of one technique over the other, understanding that in this way the treating physician's decision will become simpler and more objective. On the other hand, and celebrating the healthy prominence given to patients, we believe that this evaluation allows solid arguments to help them in decision making.

Factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria / Factors that influence health literacy in patients with coronary artery disease / Fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana

Objetivo: investigar los factores que influyen en la alfabetización en salud de los pacientes con enfermedad arterial coronaria. Método: estudio transversal, que incluyó 122 pacientes con enfermedades coronarias (60,7% del sexo masculino; 62,07±8,8 años); se evaluó la alfabetización en salud y el conocimiento específico sobre la enfermedad mediante entrevistas con los participantes, utilizando el Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Los datos fueron descritos por medidas de tendencia central y frecuencias. Los factores que influyen en la alfabetización en salud se determinaron mediante un modelo de regresión lineal. El nivel de significación adoptado fue del 5%. El estudio fue aprobado por el Comité de Ética e Investigación. Resultados: la edad y la hipertensión mostraron una relación inversa y significativa con la alfabetización en salud. Por otro lado, un mayor nivel educativo y tener empleo se asociaron con puntajes más altos en el instrumento de alfabetización en salud. El conocimiento específico sobre la enfermedad no influyó en la alfabetización en salud. Las variables del modelo de regresión explicaron el 55,3% de alfabetización inadecuada. Conclusión: en el presente estudio, se concluyó que el conocimiento sobre la enfermedad no influye en la alfabetización en salud, pero los profesionales deben considerar los factores sociodemográficos y clínicos para planificar las intervenciones.

Objective: to investigate the factors that exert an influence on health literacy in patients with coronary artery disease. Methods: a crosssectional study, including 122 patients with coronary diseases (60.7% male; 62.07 ± 8.8 years old). Health literacy and specific knowledge about the disease were evaluated through interviews with the participants by means of the Short Test of Functional Health Literacy in Adults and the Short version of the coronary artery disease education questionnaire. The data were described by means of central tendency measures and frequencies. The factors that exert an influence on health literacy were determined by means of a linear regression model. The significance level adopted was 5%. The study was approved by the Research Ethics Committee. Results: age and arterial hypertension presented an inverse and significant relationship with health literacy. On the other hand, higher schooling levels and having a job were associated with better scores in the health literacy instrument. Specific knowledge about the disease did not exert any influence on health literacy. The variables included in the regression model explained 55.3% of inadequate literacy. Conclusion: this study, knowledge about the disease exerts no influence on health literacy: however, the professionals should consider the sociodemographic and clinical factors to plan the interventions.

Objetivo: investigar os fatores que influenciam o letramento em saúde em pacientes com doença arterial coronariana. Método: estudo transversal, incluindo 122 pacientes com coronariopatias (60,7% do sexo masculino; 62,07±8,8 anos); letramento em saúde e conhecimento específico da doença foram avaliados por meio de entrevista com os participantes, pelo Short Test of Functional Health Literacy in Adults e Short version of the coronary artery disease education questionnaire. Os dados foram descritos por medidas de tendência central e frequências. Fatores que influenciam o letramento em saúde foram determinados por modelo de regressão linear. O nível de significância adotado foi de 5%. O estudo foi aprovado pelo Comitê de Ética e Pesquisa. Resultados: idade e hipertensão apresentaram uma relação inversa e significativa com letramento em saúde. Por outro lado, maior escolaridade e estar empregado associaram-se com maiores pontuações no instrumento de letramento em saúde. O conhecimento específico da doença não influenciou o letramento em saúde. As variáveis do modelo de regressão explicaram 55,3% do letramento inadequado. Conclusão: no presente estudo o conhecimento sobre a doença não influência o letramento em saúde, mas os profissionais devem considerar os fatores sociodemográficos e clínicos para planejar as intervenções.

Blood group as a novel predictor of postoperative atrial fibrillation after off-pump coronary artery bypass grafting

SUMMARY OBJECTIVE: The objective of this study was to reveal whether there was a possible relationship between the blood group and postoperative atrial fibrillation after off-pump coronary artery bypass grafting. METHODS: Between January 2020 and January 2022, 452 patients undergoing off-pump coronary artery bypass grafting surgery consisted of the research population. Patients were divided into two groups based on the occurrence of new-onset atrial fibrillation from the time of operation until discharge. Group 1 (atrial fibrillation group) had 122 patients, whereas group 2 (non-atrial fibrillation group) contained 350 patients. Patients' baseline clinical characteristics and operative and postoperative data were recorded and then compared between the groups. Moreover, a multivariate logistic regression analysis was also conducted to identify the predictors of postoperative atrial fibrillation. RESULTS: Non-O blood groups were substantially more common in the atrial fibrillation group than in the non-atrial fibrillation group. Patient age differences between the atrial fibrillation and non-atrial fibrillation groups were statistically significant, and patients in the atrial fibrillation group were detected to be older. Mean left atrial diameter, rates of obesity and prior percutaneous coronary intervention history, and perioperative intraaortic balloon pump requirement were significantly greater in the atrial fibrillation group than in the non-atrial fibrillation group. According to logistic regression analysis, blood group, age, left atrial diameter, obesity, and prior percutaneous coronary intervention were identified as predictors of postoperative atrial fibrillation. CONCLUSION: We demonstrated for the first time in the literature that ABO blood type was a novel and significant predictor of new-onset atrial fibrillation after off-pump coronary artery bypass grafting.

Robotic percutaneous coronary intervention (R-PCI): Time to focus on the pros and cons

Aim: To assess the safety, efficiency, and device compatibility of the Second Generation Robotic System. Methods: Data on Robot-Assisted PCI (RePCI) is frequently insufficient in India. Many articles were published in national, non-indexed journals that are not available online and are difficult to obtain. Recognizing these constraints, the current review is intended to compile the available data on this important new innovation technique. This review could encourage future research and serve as a valuable source of information. Results/Conclusion: In terms of procedure efficiency, operator radiation reduction, and safety, the recent implementation and development of second-generation robotic systems have had a significant impact on interventional cardiology. This technology will play a significant role in the future of interventional cardiology as advancements eliminate the need for manual assistance, improve devices compatibility, and expand the use of robotics for telestenting procedures. A larger study demonstrating the safety and feasibility of tele-stenting over greater geographic distances, as well as addressing fundamental technical difficulties, would be required before attempting RePCI

Left Main Coronary Artery Aneurysm with Fistula to Superior Vena Cava: A Challenging Case

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25?year?old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography

Evaluation of Frontal QRS-T Angle in Patients with Coronary Artery Ectasia

Abstract Background: Coronary artery ectasia (CAE) is defined by focal enlargement of the coronary artery exceeding 1.5 times the adjacent normal segment. CAE can often cause arrhythmias, heart failure, sudden death, and myocardial ischemia. Ischemia due to microvascular dysfunction may be responsible for the ventricular heterogeneity in CAE. Objectives: The aim of our study was to evaluate the frontal QRS-T angle in patients with CAE. Methods: Our study included 55 patients with CAE and 50 individuals in the control group. Demographic characteristics and electrocardiographic parameters were compared between the two groups. Categorical variables were compared using the chi-square test. Continuous variables were compared using unpaired Student's t-test. P values < 0.05 were considered statistically significant. The frontal QRS-T angle was calculated from 12-lead electrocardiograms (ECGs) using the automatic report from the electrocardiography machine. Results: The average age of patients with CAE was 63.2 ± 3.4 years, with 18 women among them. The control group had an average age of 61.1 ± 3.2 years, with 28 women included. There was no significant difference in demographic parameters between the two groups. Compared to the control group, patients with CAE had significantly wider frontal QRS-T angle (p < 0.001), as well as longer QTmax duration, p = 0.002; Tp-Te interval, p = 0.02; and QT dispersion (QTd), p = 0.04. Conclusion: The frontal QRS-T angle can be calculated easily and time-efficiently using surface electrocardiography. In this study, we showed for the first time that the frontal QRS-T angle was significantly increased in patients with CAE.

Religiosity and Spirituality: The Relationship Between Psychosocial Factors and Cardiovascular Health

Abstract Background: Religiosity and Spirituality (R/S), despite being different entities, are multidimensional constructs, whose influence on cardiovascular health has been increasingly studied in recent decades. Objectives: To discriminate patients into subgroups according to R/S levels, in order to compare them regarding the distribution of cardiovascular comorbidities and clinical events. Methods: This is an observational, cross-sectional, analytical study. Two R/S scales were applied to a sample of patients seen at cardiology outpatient clinics. A cluster analysis was used to discriminate individuals into subgroups regarding R/S levels, which were subsequently compared regarding the frequencies of clinical variables related to cardiovascular health. A significance level of 5% was set for the statistical tests. Results: The sample included 237 patients with a mean age of 60.8 years (±10.7), of which 132 were female (55.7%). Cluster analysis (C) distinguished two groups: C1, with lower levels of R/S, and C2, with higher levels of R/S (p<0.001). C2 had a lower frequency of alcohol consumption (29.5% vs. 76.0%; p<0.001), smoking (12.9% vs. 51.0%; p<0.001), systemic arterial hypertension (SAH — 65.5% vs. 82.3%; p=0.005), dyslipidemia (58.3% vs. 77.1%; p=0.003), chronic coronary syndrome (36.7% vs. 58.3%; p=0.001), and prior cardiovascular events (15.8% vs. 36.5%; p<0.001) when compared to C1. There was also a higher frequency of females in C2 (82.0% vs. 17.7%; p<0.001). Conclusions: A better cardiovascular morbidity profile was observed in the group of patients with higher R/S levels, suggesting a probable positive relationship between R/S and cardiovascular health.

Quality of Life in Patients After Acute ST-Segment Elevation Myocardial Infarction

Abstract Background: ST-segment elevation myocardial infarction (STEMI) is the acute coronary syndrome with the highest severity and mortality. It can affect physical health and well-being of patients, and consequently their quality of life (QoL). Objective: To describe the QoL of patients at 30 days and 180 days after STEMI, focusing on sex differences and repercussions on physical and mental dimensions. Methods: Observational study with 174 STEMI patients included in the study on STEMI conducted in the city of Salvador, Brazil (PERSISST). The QoL of patients at 30 days (D30) and 180 days (D180) after the coronary event was assessed using the 12-item short form health survey (SF-12). Physical and mental components of QoL were calculated using the SF-12 OrthoToolKit. Descriptive analysis of data was made using the IBM SPSS software, version 25.0. Results: Mean age of participants at D30 and D180 was 57.1±11.4 years and 60.5±10.9 years, respectively, with a higher prevalence of men (55.8% and 56.8%). In general, patients had a poor QoL at both time points (scores 49.1±8.9 and 49.9±8.4, respectively). Analysis by sex, however, showed that men had a good QoL at both 30D (score 51.8±7.4) and 180 D (score 51.3±7.7), whereas a poor QoL was found among women at these time points (45.7±9.6 and 48.1±9.0, respectively). Men showed higher physical and mental health scale scores than women at both D30 and D180, and there was a greater impairment of the physical component in both sexes. Conclusion: Patients had poor QoL at 30 days and 180 days after STEMI, with a greater impairment of the physical component and a worse QoL perception among women than men at both time points.

The Relationship between CHA2DS2-VASc Score and Reperfusion Success in Elective Percutaneous Saphenous Vein Graft Interventions

Abstract Background Patients with degenerated saphenous vein grafts (SVG) have a higher risk of developing no-reflow. The CHA2DS2-VASc score was established as a no-reflow predictor in patients with acute coronary syndrome (ACS). Objectives In our study, we aimed to assess the association between CHA2DS2-VASc score and no-reflow after the procedure and short-term mortality in patients with SVG who underwent elective percutaneous coronary intervention (PCI). Methods Our retrospective study comprised 118 patients who were divided into two groups according to the occurrence of the no-reflow phenomenon. The groups were compared on the basis of demographic characteristics, angiographic parameters, CHA2DS2-VASc scores, and outcome. A logistic regression analysis was additionally performed to determine the predictors of no-reflow. A p value of < 0.05 was considered statistically significant. Results Mean age of the participants was 66.4 ± 9.2 years, and 25.4% of them were female. Apart from the history of diabetes (p = 0.032), demographic data, blood parameters, ejection fraction, total stent length and diameter, medication use, median CHA2DS2-VASc score, and adverse cardiac events did not differ between the groups. In univariate logistic regression analysis, the presence of diabetes and stent length appeared to be associated with no-reflow, but not in multivariate analysis. The median CHA2DS2-VASc score was higher in non-survivors at 1-year follow-up (4.5 versus 3, p = 0.047). Conclusions In our study, we did not observe a significant relationship between no-reflow and CHA2DS2-VASc score. Larger studies are needed to reveal the indicators of improved post-intervention reperfusion in elective SVG PCI.

Clinical Profile and its Associations with Coronary Angiography Results in a Public University Hospital

Abstract Background: Ischemic heart disease is one of the most common causes of death worldwide. There are few data in the literature about the association of clinical profile and coronary angiography results in the Brazilian population. Objectives: To assess clinical variables and their associations with the results of coronary angiography and to evaluate the safety of coronary angiography in a public university hospital. Methods: From August 2015 to April 2018, 1 844 patients submitted to coronary angiography at the Pedro Ernesto University Hospital (HUPE, acronym in Portuguese) were enrolled in this cross-sectional study. They were evaluated by their clinical variables, angiographic results, and procedure complications. Logistic regression was used, and the criterion for determining significance was set at 5%. Results: The median age was 62 years, and most of the population (71%) were outpatients. Stable angina was the most common indication (62.9%). Only 19.7% underwent noninvasive cardiac testing. Arterial hypertension was the most prevalent (88.2%), followed by dyslipidemia (60.2%). Most patients (65%) had obstructive coronary artery disease (CAD). Left main coronary artery (LMCA) stenosis was found in 8.1% of patients. Older age, male sex, quantity of risk factors (RF), and peripheral artery disease were risk predictors for CAD. Death occurred only in 0.16% of the population, and acute coronary artery occlusion in 0.2%. Conclusion: Classic RF showed an association with CAD. The low incidence of complications suggests that coronary angiography is a safe procedure to be conducted in a public university hospital.

miR-27a/b Level is Associated with ABCA1 Expression and is a Potential PBMC-Based Biomarker for Coronary Artery Disease

Abstract Background: Coronary artery disease (CAD) is the most common form of cardiac disease with high morbidity and mortality rates. Objectives: In this study, we evaluated the expression of miR-27a and miR-27b as biomarkers in peripheral blood mononuclear cells (PBMCs) of patients with CAD and investigated its correlation with cholesterol-efflux transporter, ATP-binding cassette transporter A1 (ABCA1). Method: This study was performed on 54 men with CAD and 51 healthy, sex- and age-matched control participants. The expression of miR-27a/b and ABCA1 genes in PBMCs were measured by quantitative real-time polymerase chain reaction (qRT-PCR). The protein expression of ABCA1 was assessed by Western blotting. Concurrently, the specificity and sensitivity of miR-27a/b was evaluated through receiver operating characteristic (ROC) curve. The significance level adopted in the statistical analysis was 5%. Results: We found that miR-27a and miR-27b expression were significantly increased, while both mRNA and protein expression of ABCA1 were markedly reduced in the PBMCs of CAD patients in comparison to non-CAD controls. miR-27a/27b expression was also shown to be inversely correlated with ABCA1. ROC analysis showed that the miR-27a had an area under the ROC curve (AUC) of about 92.6 (sensitivity 83.3٪ and specificity 86.6٪) and miR-27b had an AUC of about 93.0 (sensitivity 86.6٪ and specificity 80.0 (%, suggesting the diagnostic potential of miR-27a/b in CAD patients. Conclusions: Our data suggested a possible role of miR-27a/b in CAD pathogenesis. Additionally, we proposed that miR-27a/b expression in PBMCs may have potential clinical implications in the diagnosis of CAD patients, but further validations in large cohorts are required.