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1.
Rev. inf. cient ; 100(3): e3327, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289637

ABSTRACT

RESUMEN - Introducción: Se revelan controversias respecto a los mecanismos que determinan la vulnerabilidad de los pacientes con insuficiencia cardiaca a la infección por el virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), que produce el síndrome respiratorio llamado Coronavirus Infectious Disease-19 (COVID-19). Objetivo: Recopilar información sobre la fisiopatología de la insuficiencia cardiaca aguda en el contexto de la COVID-19. Método: En el Policlínico Comunitario "Ramón López Peña" de Santiago de Cuba, entre septiembre y noviembre del 2020, se realizó una revisión narrativa sobre este tema. La búsqueda se efectuó consultando las bases de datos Pubmed, Infomed y SciELO, sin restricción de fecha, en los idiomas español e inglés. Desarrollo: Se manifiestan incertidumbre en los mecanismos implicados en la fisiopatología de la insuficiencia cardiaca de los pacientes con esta enfermedad infecciosa. El daño miocárdico se debe a los efectos directos de la infección viral sobre el miocito, que se expresa como una respuesta inflamatoria local y a la participación del corazón como órgano diana de respuesta inflamatoria sistémica e inapropiada generada por la marcada liberación de citocinas. Esta última, además, genera un daño endotelial que desencadena complicaciones tromboembólicas e isquémicas, disfunción sistodiastólica del corazón, y finalmente la falla multiorgánica. Consideraciones finales: A pesar de los avances en el conocimiento de la etiopatogenia de esta enfermedad, aún se requiere que se esclarezcan con precisión los mecanismos fisiopatológicos que determinan la presentación de la insuficiencia cardiaca, si bien se reconoce la influencia de la respuesta inflamatoria inapropiada, inducida por citoquinas, en la presentación del daño miocárdico.


ABSTRACT - Introduction: The mechanisms that are suggested as determinant in the vulnerability of patients with heart failure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and which cause the respiratory syndrome labeled COVID-19 (Coronavirus Infectious Disease-19), has revealed controversial. Objective: To gather information on the pathophysiological features of acute heart failure in the context of COVID-19. Method: Concerning this topic, from September to November 2020 at the Policlínico Comunitario "Ramón López Peña" in Santiago de Cuba, a narrative review was carried out. The search was conducted checking the databases Pubmed, Infomed and SciELO, without date restriction, and in Spanish and English language. Development: The mechanisms involved on the pathophysiological features of heart failure in patients with this infectious disease revealed uncertainty. Myocardial damage is achievement of two aspects, the direct effect of viral respiratory infection on the myocyte, which is expressed as a local inflammatory response, and the heart participation as a target organ to the systemic and inappropriate inflammatory response, generated by a marked cytokines release. Conclusions: Despite the advances in understanding the etiopathogenesis of this disease, the pathophysiological mechanisms that determine on the heart failure still require to be precisely clarified, although the influence of the inappropriate inflammatory response, induced by cytokines, it is recognized in the onset myocardial damage.


RESUMO - Introdução: Revelam-se controvérsias a respeito dos mecanismos que determinam a vulnerabilidade dos pacientes com insuficiência cardíaca à infecção pelo vírus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), gerador da síndrome respiratória denominada Coronavirus Infectious Disease-19 (COVID-19). Objetivo: Coletar informações sobre a fisiopatologia da insuficiência cardíaca aguda no contexto da COVID-19. Método: Na Policlínica Comunitária "Ramón López Peña" de Santiago de Cuba, entre setembro e novembro de 2020, foi realizada uma revisão narrativa sobre o tema. A busca foi realizada por meio de consulta às bases de dados Pubmed, Infomed e SciELO, sem restrição de datas, nos idiomas espanhol e inglês. Desenvolvimento: A incerteza se manifesta nos mecanismos envolvidos na fisiopatologia da insuficiência cardíaca em pacientes com essa doença infecciosa. O dano miocárdico se deve aos efeitos diretos da infecção viral no miócito, que se expressa como resposta inflamatória local, e ao envolvimento do coração como órgão alvo da resposta inflamatória sistêmica e inadequada gerada pela liberação acentuada de citocinas. Esta última também gera dano endotelial que desencadeia complicações tromboembólicas e isquêmicas, disfunção cardíaca sistodiastólica e, finalmente, falência de múltiplos órgãos. Conclusões: Apesar dos avanços no conhecimento da etiopatogenia desta doença, ainda é necessário esclarecer com precisão os mecanismos fisiopatológicos que determinam a apresentação da insuficiência cardíaca, embora se reconheça a influência da resposta inflamatória inadequada, induzida por citocinas, na apresentação de dano miocárdico.


Subject(s)
Humans , COVID-19/complications , Heart Failure/etiology , Heart Failure/physiopathology
2.
ABC., imagem cardiovasc ; 34(3)2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1291983

ABSTRACT

Introdução: A doença de Chagas é uma infecção causada pelo protozoário Trypanosoma cruzi. É considerada um importante problema de saúde do mundo, tendo como manifestações a dilatação cardíaca, arritmias e morte. A insuficiência cardíaca é uma síndrome complexa e de elevada morbimortalidade, que evolui com complicações semelhantes. Para categorizar a gravidade da insuficiência cardíaca, utilizamos a classificação funcional da New York Heart Association, para estratificar risco e terapias para cardiopatias. Além disso, a reduzida fração de ejeção do ventrículo esquerdo, medida pelo ecocardiograma, tem relação direta com mau prognóstico. Objetivo: Comparar a relação entre a classificação funcional pela New York Heart Association e a medida da fração de ejeção do ventrículo esquerdo em pacientes ambulatoriais chagásicos e não chagásicos. Metódos: Estudo de corte transversal na coorte, composto de pacientes acompanhados em ambulatório de insuficiência cardíaca. Foram realizadas avaliação de prontuários, entrevista clínica e verificação da classificação funcional e da fração de ejeção do ventrículo esquerdo pelo ecocardiograma. Os dados foram arquivados em banco de dados e analisados pelo Statistical Package for the Social Sciences. Resultados: No período de agosto de 2018 a julho de 2019, foram selecionados 127 indivíduos com insuficiência cardíaca. Destes, 34 (26,8%) eram portadores da doença de Chagas e 93 (73,3%) eram não Chagas. Observou-se predominância do sexo masculino (53,5%) e de idade >60 anos (61,4%). Houve predomínio da classe funcional II nos grupos. Em relação à fração de ejeção dos pacientes chagásicos e não chagas, observou-se que, respectivamente, 71% contra 93% dos pacientes tinham fração de ejeção reduzida, 21% versus 6% tinham fração de ejeção intermediária e 8% versus 1% fração de ejeção preservada. Conclusão: Houve associação entre classe funcional avançada e reduzida fração de ejeção do ventrículo esquerdo principalmente em chagásicos, podendo ser usada para acompanhamento evolutivo ambulatorial. (AU)


Introduction: Chagas disease, an infection caused by the protozoan Trypanosoma cruzi, is an important health problem worldwide that causes cardiac dilation, arrhythmias, and death. Heart failure is a complex syndrome with high morbidity and mortality rates that progresses with similar complications. The New York Heart Association functional classification is used to categorize heart failure severity and stratify heart disease risks and therapies. A reduced left ventricular ejection fraction measured by echocardiography is directly related to a poor prognosis. Objective: To compare the relationship between New York Heart Association functional classification and left ventricular ejection fraction in Chagas versus no Chagas disease outpatients. Methods: Cross-sectional study in a cohort of patients followed at a heart failure clinic. Medical records, clinical interviews, functional classification, and left ventricular ejection fraction by echocardiography were analyzed. The data were filed in a database and analyzed using SPSS software. Results: A total of 127 patients with heart failure were selected from August 2018 to July 2019. Of them, 34 (26.8%) had Chagas disease and 93 (73.3%) had no Chagas disease. There was a predominance of men (53.5%) and patients aged > 60 years (61.4%). There was also a predominance of functional class II. Of the Chagas and no Chagas disease patients, 71% versus 93% had a reduced ejection fraction, 21% versus 6% had a mid-range ejection fraction, and 8% versus 1% had a preserved ejection fraction, respectively. Conclusion: There was an association between advanced functional class and reduced left ventricular ejection fraction, especially in Chagas patients, information that can be used for outpatient follow-up. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Stroke Volume , Chagas Cardiomyopathy/physiopathology , Heart Failure/classification , Heart Failure/physiopathology , Cross-Sectional Studies , Heart Failure, Systolic/classification , Heart Failure, Systolic/etiology , Heart Failure, Systolic/physiopathology , Heart Failure/etiology
4.
ABC., imagem cardiovasc ; 34(4): eabc215, 2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1358883

ABSTRACT

Fundamento: A quimioterapia para o câncer de mama está associada a complicações cardiovasculares graves, como a insuficiência cardíaca. A fração de ejeção do ventrículo esquerdo é o principal parâmetro para avaliar a função sistólica nessas pacientes. Todavia, a ocorrência de disfunção diastólica pode preceder à disfunção sistólica. Objetivos: Avaliar as funções diastólica e sistólica do ventrículo esquerdo de portadoras de câncer de mama em tratamento quimioterápico com antraciclinas. Métodos: Trata-se de estudo observacional, longitudinal, analítico e prospectivo. Estudaram-se 62 mulheres com câncer de mama, com idades de 21 a 75 anos, que realizaram ecocardiogramas basais e após 3 meses de tratamento. Avaliaram-se parâmetros de função diastólica, e as pacientes foram classificadas em disfunção diastólica tipos:1, 2 ou 3. Definiu-se a disfunção sistólica como fração de ejeção do ventrículo esquerdo ≤ 53%. Resultados: Decorridos 3 meses de tratamento, 35 pacientes (56,4%) apresentavam disfunção diastólica tipo 1, e apenas uma (1,6%) do tipo 2. A disfunção diastólica ocorreu em 26 pacientes já na etapa basal e surgiu em dez indivíduos no decurso do tratamento. Os parâmetros de função diastólica velocidade de onda E e relação E/A diminuíram significativamente (p < 0,05) com a quimioterapia, todavia, os demais não tiveram variação significativa. Apenas três pacientes apresentaram disfunção sistólica, porém verificou-se maior redução da fração de ejeção do ventrículo esquerdo no grupo que desenvolveu disfunção diastólica durante o tratamento comparativamente ao grupo que apresentava já disfunção diastólica no período basal (p = 0,04). Conclusão: A disfunção diastólica ocorre precocemente em portadoras de câncer de mama submetidas à quimioterapia. O surgimento de disfunção diastólica no decurso do tratamento se associa à redução significativa da fração de ejeção do ventrículo esquerdo. (AU)


Background: Chemotherapy for breast cancer is associated with serious cardiovascular complications such as heart failure. The left ventricular ejection fraction is the main parameter used to assess systolic function in these patients. However, the occurrence of diastolic dysfunction may precede that of systolic dysfunction. Objectives: To evaluate left ventricle diastolic and systolic functions in women with breast cancer undergoing chemotherapy using anthracyclines. Methods: This observational, longitudinal, analytical, and prospective study included 62 women with breast cancer aged 21­75 years old who underwent echocardiography at baseline and after three months of treatment. Diastolic function parameters were evaluated, and the patients were classified as diastolic dysfunction type 1, 2, or 3. Systolic dysfunction was defined as a left ventricular ejection fraction ≤ 53%. Results: After three months of treatment, 35 patients (56.4%) had type 1 diastolic dysfunction, while one (1.6%) had type 2. Diastolic dysfunction was identified in 26 patients at baseline and developed in 10 patients during treatment. Diastolic function parameters, E wave velocity, and E/A ratio decreased significantly (p < 0.05) with chemotherapy; however, the others showed no significant variations. Only three patients had systolic dysfunction, but there was a greater reduction in left ventricular ejection fraction in the group that developed diastolic dysfunction during treatment versus the group with diastolic dysfunction at baseline (p = 0.04). Conclusion: Diastolic dysfunction occurs early in women with breast cancer undergoing chemotherapy. Its onset during the course of treatment is associated with a significantly reduced left ventricular ejection fraction. (AU)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Young Adult , Breast Neoplasms/drug therapy , Ventricular Dysfunction, Left/etiology , Cardiotoxicity/complications , Heart Failure/physiopathology , Heart Failure/mortality , Time Factors , Echocardiography/methods , Anthracyclines/administration & dosage , Anthracyclines/toxicity , Anthracyclines/therapeutic use
5.
ABC., imagem cardiovasc ; 34(2)2021. ilus, tab
Article in Portuguese | LILACS | ID: biblio-1283771

ABSTRACT

Fundamento: A elevação das pressões de enchimento secundária à disfunção diastólica do ventrículo esquerdo ocupa papel central na fisiopatologia da insuficiência cardíaca. Mesmo assim, as diretrizes internacionais falham em detectar a disfunção diastólica em uma parte dos casos. Objetivo: Avaliar a função de reserva do átrio esquerdo, estimada pelo strain longitudinal de pico do átrio esquerdo, nos casos de função diastólica indeterminada. Método: Estudo observacional com indivíduos em ritmo sinusal e fração de ejeção do ventrículo esquerdo preservada, submetidos ao ecocardiograma e divididos em três grupos conforme a análise conjunta da relação E/e´ e do volume de átrio esquerdo indexado: Grupo 1, se pressões de enchimento normais; Grupo 2, se pressões de enchimento elevadas e Grupo 3, se pressões de enchimento indeterminadas. Speckle tracking bidimensional foi empregado para medir o strain longitudinal de pico do átrio esquerdo. Análise de variância, teste t Student e curva receptor-operador (ROC) foram empregados na análise estatística. Resultado: Foram incluídos 58 pacientes, com 61 ± 14 anos, sendo 57% mulheres, com fração de ejeção do ventrículo esquerdo de 62 ± 7%. Os Grupos 2 e 3 tiveram strain longitudinal de pico do átrio esquerdo menor que o Grupo 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectivamente, p=0,004), mas não diferiram entre si (p=0,93). O strain longitudinal de pico do átrio esquerdo foi preditor de pressões de enchimento elevadas (p=0,026, área sob a curva=0,80), obtendo-se sensibilidade de 60% e especificidade de 80% com valor de corte ≤ 20%. Conclusão: A função de reserva do átrio esquerdo dos indivíduos com função diastólica indeterminada é similar à dos indivíduos com disfunção diastólica avançada, conferindo ao strain longitudinal de pico do átrio esquerdo o potencial de auxiliar na reclassificação da função diastólica indeterminada.(AU)


Background: Elevation of left ventricular filling pressures secondary to diastolic dysfunction plays a central role in the pathophysiology of heart failure. However, international guidelines still fail to diagnose diastolic dysfunction in some cases. Objective: To evaluate left atrial reservoir function in indeterminate diastolic function Method: Observational study with individuals in sinus rhythm and preserved left ventricular ejection fraction, submitted to echocardiogram and divided into three groups according to the combined analysis of E/e´ ratio and indexed left atrium volume: Group 1, if normal left ventricular filling pressures; Group 2, if increased left ventricular filling pressures and Group 3, if indeterminate left ventricular filling pressures. Twodimensional speckle tracking was used to measure peak left atrial strain (LAS). Analysis of variance, Student's t test and receiver-operator curve (ROC) were used in the statistical analysis. Results: We included 58 patients who had 61 ± 14 years old, 57% of whom were women, and had average left ventricular ejection fraction 62 ± 7%. Groups 2 and 3 had lower LAS than Group 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectively, p = 0.004), but did not differ between them (p = 0.93). LAS was a good predictor of elevated left ventricular filling pressures (p = 0.026; area under the curve = 0.80), obtaining sensitivity of 60% and specificity of 80% with a cut-off value ≤ 20%. Conclusion: The findings suggest that the left atrial reservoir function of individuals with indeterminate diastolic function is similar to that of individuals with advanced diastolic dysfunction, rendering LAS the potential to support the reclassification of indeterminate diastolic function.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Ventricular Dysfunction, Left/diagnostic imaging , Heart Atria/diagnostic imaging , Heart Failure/physiopathology , Echocardiography, Doppler , Comorbidity , Observational Study
7.
Rev. chil. cardiol ; 39(1): 24-33, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115446

ABSTRACT

INTRODUCCIÓN: Los ratones SR-B1 KO/ApoER6 1h/h que son alimentados con una dieta rica en grasas saturadas, desarrollan enfermedad coronaria aterosclerótica severa, complicaciones isquémicas e insuficiencia cardíaca, con alta mortalidad. Los estudios con este modelo se han enfocado fundamentalmente en la enfermedad coronaria y menos en el remodelado cardíaco. El OBJETIVO del trabajo ha sido caracterizar el remodelado miocárdico, evaluar la evolución temporal de la función ventricular izquierda y la sobrevida asociada a enfermedad cardíaca por ateromatosis. MÉTODO: Ratones homocigotos SR-B1 KO/ApoER6 1h/h fueron alimentados por 8 semanas con dieta aterogénica o dieta normal y se comparó la sobrevida en ambos grupos. A las 4 semanas se realizó un ecocardiograma bidimensional. En los ratones eutanasiados se evaluó en la pared cardíaca fibrosis miocárdica y tamaño de los cardiomiocitos por morfometría, apoptosis con técnica de TUNEL e infiltración por células inflamatorias mononucleares (ED1) por inmunohistoquímica. RESULTADOS: En el grupo que recibió dieta aterogénica la sobrevida se redujo en 46,7% (p < 0.001), debido a muerte súbita y a falla cardíaca progresiva. En este grupo, a las 4 semanas se observó dilatación de cavidades izquierdas y disminución de la fracción de eyección del ventrículo izquierdo en comparación con el grupo control (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01). También se observó aumento de la masa cardíaca relativa de 2.1 veces (p<0,001) y del peso pulmonar relativo en 80% (p<0,001), sin cambios en las dimensiones de los cardiomiocitos. En el miocardio de los ratones que recibieron dieta aterogénica hubo un aumento de la fibrosis cardíaca de 7.9 veces (p < 0.01) y del número de cardiomiocitos apoptóticos en 55.9 veces (p < 0.01), junto a un aumento del número de células inflamatorias mononucleares ED1. CONCLUSIONES: En el modelo de falla cardíaca severa de etiología isquémica con alta mortalidad en el ratón homocigoto SR-B1 KO/ApoER6 1h/h sometido a una dieta aterogénica, con falla cardíaca izquierda por disfunción sistólica, el remodelado patológico del miocardio está dado fundamentalmente por apoptosis y fibrosis. También se observa un aumento discreto de macrófagos en la pared cardíaca. Es posible que el edema parietal también pueda ser un mecanismo de remodelado relevante en este modelo.


Abstract: SR-B1 KO/ApoER6 1h/h mice fed a high saturated fat diet develop severe coronary atheromatosis, and cardiac failure with a high mortality rate. Cardiac remodeling under these conditions has not been well studied. AIM: To evaluate the time course of left ventricular function, cardiac remodeling and survival associated to the administration of an atherogenic diet. METHOD: Homozygote SR-B1 KO/ApoER6 1h/h mice received an atherogenic diet for 8 weeks. Mice receiving a normal diet served as controls. Survival rate, myocardial fibrosis, cardiomyocyte size, apoptosis and infiltration by inflammatory or mononuclear cells were compared between groups. A TUNEL technique was used to evaluate apoptosis. RESULTS: A 46.7% survival reduction compared to controls was observed in the experimental group (p<0.01), due to left ventricular and atrial dilatation associated to a decrease in ejection fraction (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01, respectively). Also, an increased cardiac weight, 2.6 times greater was observed in the experimental group, compared to controls. Mice receiving the atherogenic diet showed an 80% increased lung weight. There was no evident change in cardiomyocytes, but there was more (7.9 times) cardiac fibrosis (p<0.01) and 55.9 times more apoptotic cells. (p<0.01), along with a greater number of inflammatory cells and ED1 mononuclear cells. CONCLUSION: Mice receiving an atherogenic diet develop heart failure and reduced survival rate. This is associated with cardiac remodeling with underlying apoptosis an ventricular wall fibrosis. It is posible that wall edema might contribute to the observed cardiac remodeling.


Subject(s)
Animals , Mice , Ventricular Remodeling , Diet, Atherogenic , Heart Failure/etiology , Hyperlipidemias/pathology , Ischemia/etiology , Fibrosis , Survival Analysis , Ventricular Function, Left , Apoptosis , Mice, Knockout , Ventricular Dysfunction , Disease Models, Animal , Heart Failure/physiopathology , Heart Failure/mortality , Heart Failure/pathology , Ischemia/physiopathology , Ischemia/mortality , Ischemia/pathology
8.
Arq. bras. cardiol ; 114(2): 209-218, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088870

ABSTRACT

Abstract Background: Atrial fibrillation (AF) is associated with increased mortality in heart failure (HF) patients. Objective: To evaluate whether the risk of AF patients can be precisely stratified by relation with cardiopulmonary exercise test (CPET) cut-offs for heart transplantation (HT) selection. Methods: Prospective evaluation of 274 consecutive HF patients with left ventricular ejection fraction ≤ 40%. The primary endpoint was a composite of cardiac death or urgent HT in 1-year follow-up. The primary endpoint was analysed by several CPET parameters for the highest area under the curve and for positive (PPV) and negative predictive value (NPV) in AF and sinus rhythm (SR) patients to detect if the current cut-offs for HT selection can precisely stratify the AF group. Statistical differences with a p-value <0.05 were considered significant. Results: There were 51 patients in the AF group and 223 in the SR group. The primary outcome was higher in the AF group (17.6% vs 8.1%, p = 0.038). The cut-off value of pVO2 for HT selection showed a PPV of 100% and an NPV of 95.5% for the primary outcome in the AF group, with a PPV of 38.5% and an NPV of 94.3% in the SR group. The cut-off value of VE/VCO2 slope showed lower values of PPV (33.3%) and similar NPV (92.3%) to pVO2 results in the AF group. Conclusion: Despite the fact that AF carries a worse prognosis for HF patients, the current cut-off of pVO2 for HT selection can precisely stratify this high-risk group.


Resumo Fundamento: A fibrilação atrial (FA) está associada ao aumento da mortalidade em pacientes com insuficiência cardíaca (IC). Objetivo: Avaliar se o risco de pacientes com FA pode ser estratificado com precisão em relação aos pontos de corte do teste de esforço cardiopulmonar (TECP) para seleção do transplante cardíaco (TC). Métodos: Avaliação prospectiva de 274 pacientes consecutivos com IC com fração de ejeção do ventrículo esquerdo ≤ 40%. O endpoint primário foi um composto de morte cardíaca ou TC urgente no seguimento de 1 ano. O endpoint primário foi analisado através de vários parâmetros do TECP para a maior área sob a curva e para o valor preditivo positivo (VPP) e negativo (VPN) em pacientes com FA e ritmo sinusal (RS) para detectar se os atuais pontos de corte para a seleção de TC podem estratificar com precisão o grupo com FA. Diferenças estatísticas com valor de p < 0,05 foram consideradas significativas. Resultados: Havia 51 pacientes no grupo de FA e 223 no grupo RS. O endpoint primário foi maior no grupo FA (17,6% vs. 8,1%, p = 0,038). O valor de corte de pVO2 para a seleção do TC mostrou um VPP de 100% e um VPN de 95,5% para o endpoint primário no grupo FA, com um VPP de 38,5% e um VPN de 94,3% no grupo RS. O valor de corte da inclinação VE/VCO2 apresentou valores mais baixos de VPP (33,3%) e valor semelhante de VPN (92,3%) aos resultados de pVO2 no grupo FA. Conclusões: Apesar do fato de a FA apresentar um pior prognóstico para os pacientes com IC, o atual ponto de corte de pVO2 para a seleção de TC pode estratificar com precisão esse grupo de alto risco.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Atrial Fibrillation/physiopathology , Atrial Fibrillation/mortality , Risk Assessment/standards , Exercise Test/standards , Heart Failure/physiopathology , Oxygen/metabolism , Oxygen Consumption/physiology , Prognosis , Reference Standards , Stroke Volume/physiology , Time Factors , Proportional Hazards Models , Multivariate Analysis , Prospective Studies , Risk Factors , Follow-Up Studies , Statistics, Nonparametric , Exercise Test/methods , Heart Failure/mortality
9.
Arq. bras. cardiol ; 114(1): 59-65, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055104

ABSTRACT

Abstract Background: Left ventricular remodeling (LVR) is related to both non-fatal and fatal outcomes. Objective: To describe the geometric patterns of the LV and their associations. Methods: A total of 636 individuals between the ages of 45 and 99 years in Rio de Janeiro, Brazil, were submitted to clinical evaluation, laboratory tests, electrocardiogram, and tissue Doppler echocardiography (TDE). The difference between categories was tested with Kruskall-Wallis with post hoc tests, once all variables studied are non-normally distributed and Pearson's Qui-square (categorical variables). Gross and adjusted ORs were estimated by logistic regression. The level of significance was 5% for all tests. Subjects had LVR characterized as: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results: The prevalence of altered patterns was 33%. Subjects presented NG (n = 423; 67%); EH (n = 186; 29%); CH (n = 14; 2%); and CR (n = 13; 2%). The variables of gender, age, level of education and albumin/creatinine ratio (A/C), showed a relationship with the chance of EH even after adjustment. Conclusion: Approximately one third of the studied individuals had LVR and were at risk for developing heart failure. Altered A/C in urine was associated with EH, indicating an early relationship between cardiac and renal dysfunction.


Resumo Fundamento: O remodelamento ventricular esquerdo (RVE) está relacionado a desfechos não fatais e fatais. Objetivo: Descrever os padrões geométricos do VE e suas associações. Métodos: Um total de 636 indivíduos entre 45 e 99 anos no Rio de Janeiro, Brasil, foi submetido a avaliação clínica, exames laboratoriais, eletrocardiograma e ecocardiograma com Doppler tecidual (EDT). A diferença entre as categorias foi testada com Kruskall-Wallis com testes post hoc, uma vez que todas as variáveis estudadas não são normalmente distribuídas e o qui-quadrado de Pearson (variáveis categóricas). As ORs brutas e ajustadas foram estimadas por regressão logística. O nível de significância foi de 5% para todos os testes. Os indivíduos tinham RVE caracterizada como: geometria normal (GN), remodelamento concêntrico (RC), hipertrofia concêntrica (HC) e hipertrofia excêntrica (HE). Resultados: A prevalência de padrões alterados foi de 33%. Os sujeitos apresentaram GN (n = 423; 67%); HE (n = 186; 29%); HC (n = 14; 2%); e RC (n = 13; 2%). As variáveis sexo, idade, escolaridade e razão albumina/creatinina (A/C) mostraram relação com a chance de HE, mesmo após o ajuste. Conclusão: Aproximadamente um terço dos indivíduos estudados apresentavam RVE e corriam risco de desenvolver insuficiência cardíaca. A/C alterada na urina foi associada à HE, indicando uma relação precoce entre disfunção cardíaca e renal.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Ventricular Remodeling/physiology , Heart Failure/physiopathology , Primary Health Care , Socioeconomic Factors , Echocardiography , Prevalence , Risk Factors
11.
Arch. cardiol. Méx ; 90(supl.1): 26-32, may. 2020. tab
Article in Spanish | LILACS | ID: biblio-1152839

ABSTRACT

Resumen La pandemia por COVID-19 decretada por la Organización Mundial de la Salud (OMS) desde el 12 de marzo de 2020 está produciendo estragos a nivel mundial y es un verdadero reto económico, social y sanitario. Aunque las manifestaciones clínicas del COVID-19 son síntomas respiratorios, algunos pacientes también tienen síntomas cardiológicos. Dentro de los pacientes con afecciones cardiológicas2 suponen un grupo de mayor riesgo y que de hecho son un grupo especialmente vulnerable, por su mayor riesgo de contagio y mayor gravedad en caso de adquirir la enfermedad1 aquellos con insuficiencia cardiaca (IC), incluyendo al trasplante cardiaco (TC) y las asistencias ventriculares, así como los pacientes con hipertensión arterial pulmonar (HAP). La IC es la principal patología cardiovascular crónica y los pacientes en este grupo son los más vulnerables para el desarrollo de cuadros clínicos más graves tras sufrir la infección, y en mayor medida los casos con IC avanzada3. De hecho, la IC es unas de las complicaciones más frecuentes en los pacientes con COVID-194. De igual forma, los pacientes trasplantados que requieren de los inmunosupresores para evitar el rechazo del injerto, constituyen una población especialmente susceptible a la infección y a desarrollar procesos más graves. Esta situación ha hecho que la Asociación Nacional de Cardiólogos de México (ANCAM) y la Sociedad Mexicana de Cardiología (SMC) junto con sus respectivos capítulos, hayan elaborado las siguientes recomendaciones para el personal médico, que participa en la atención de este grupo especial de pacientes en los diferentes escenarios clínicos, que padezcan o no, COVID-19.


Abstract The COVID-19 pandemic decreed by the World Health Organization (WHO) since March 12, 2020 is wreaking havoc globally and it is a true economic, social and health challenge. Although the clinical manifestations of COVID-19 are respiratory symptoms, some patients also have cardiological symptoms. Among patients with cardiological conditions2 they represent a group of higher risk and, in fact, they are a particularly vulnerable group, due to their higher risk of contagion and greater severity in case of acquiring the disease1 those with heart failure (HF), including heart transplant (CT) and ventricular assists, as well as patients with pulmonary arterial hypertension (PAH). HF is the main chronic cardiovascular disease and patients in this group are the most vulnerable for the development of more serious clinical symptoms after suffering the infection, and to a greater extent cases with advanced HF3. In fact, HF is one of the most frequent complications in patients with COVID-194. Likewise, transplant patients who require immunosuppressants to avoid graft rejection, constitute a population especially susceptible to infection and to develop more serious processes. This situation has made the National Association of Cardiologists of Mexico (ANCAM) and the Mexican Society of Cardiology (SMC) together with their respective chapters, have prepared the following recommendations for medical personnel, who participate in the care of this special group of patients in the different clinical settings, who suffer or not, of COVID-19.


Subject(s)
Humans , Pneumonia, Viral/complications , Cardiovascular Diseases/virology , Coronavirus Infections/complications , Heart Failure/virology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Severity of Illness Index , Cardiovascular Diseases/physiopathology , Cardiovascular Diseases/therapy , Risk Factors , Coronavirus Infections/epidemiology , Pandemics , COVID-19 , Heart Failure/physiopathology , Heart Failure/therapy , Mexico
13.
Rev. gaúch. enferm ; 41(spe): e20190095, 2020. graf
Article in English | LILACS, BDENF | ID: biblio-1093864

ABSTRACT

ABSTRACT Aim: To analyze the behavior of B-type natriuretic peptide (BNP) in the presence of defining characteristics (DCs) of the nursing diagnosis Excess fluid volume (00026) in patients hospitalized for acute decompensated heart failure. Methods: Cohort study of patients admitted with acute decompensated heart failure (September 2015 to September 2016) defined by Boston Criteria. Patients hospitalized for up to 36 h with BNP values ≥ 100 pg/ml were included; BNP values at baseline-final assessment were compared by Wilcoxon test, the number of DCs at baseline-final assessment was compared by paired t-test. Results: Sixty-four patients were included; there was a significant positive correlation between delta of BNP and the number of DCs present at initial clinical assessment. Conclusions: The behavior of BNP was correlated to the DCs indicating congestion. With clinical compensation, DCs and BNP decreased. The use of this biomarker may provide additional precision to the nursing assessment.


RESUMEN Objetivo: Analizar el comportamiento del péptido natriurético tipo B (BNP) en presencia de características definitorias (CD) del diagnóstico de enfermería Exceso de volumen de líquidos (00026) en pacientes hospitalizados por insuficiencia cardíaca aguda descompensada (ICAD). Métodos: Estudio de cohorte de pacientes ingresados ​​con ICAD (septiembre/2015 a septiembre/2016).Se incluyeron pacientes hospitalizados hasta 36 h con valores de BNP ≥ 100 pg / ml; Los valores de BNP en la evaluación inicial basal se compararon mediante la prueba de Wilcoxon, el número de CD en la evaluación inicial basal se comparó mediante el Test-T apareado. Resultados: Se incluyeron 64 pacientes; hubo una correlación positiva significativa entre el delta del BNP y las CD presentes en la evaluación clínica inicial. Conclusiones: El comportamiento del BNP se correlacionó con las CD que indican congestión. Con compensación clínica, las CD y el BNP disminuyeron. El uso del BNP puede proporcionar precisión adicional a la evaluación de enfermería.


RESUMO Objetivo: Analisar o comportamento do peptídeo natriurético tipo B (BNP) na presença de características definidoras (CDs) do diagnóstico de enfermagem Excesso de volume de líquidos (00026) em pacientes hospitalizados por insuficiência cardíaca descompensada. Métodos: Estudo de coorte com pacientes internados com insuficiência cardíaca descompensada (setembro-2015 a setembro-2016), definida pelos Critérios de Boston. Pacientes hospitalizados por mais de 36 horas, valor de BNP ≥ 100 pg/ml foram incluídos; valores de BNP basal-final foram comparados pelo teste Wilcoxon; as CDs no basal-final foram comparadas pelo teste t pareado. Resultados: Sessenta e quatro pacientes foram incluídos; houve correlação positiva significativa entre o delta de BNP com o número de CDs presentes na avaliação clínica inicial. Conclusões: O comportamento do BNP foi correlacionado com as CDs, indicando congestão. Com a compensação clínica, as CDs e a concentração de BNP diminuíram. O uso deste biomarcador pode fornecer precisão adicional à avaliação de enfermagem.


Subject(s)
Humans , Male , Female , Aged , Water-Electrolyte Imbalance/diagnosis , Nursing Diagnosis , Natriuretic Peptide, Brain/blood , Heart Failure/blood , Stroke Volume , Water-Electrolyte Imbalance/blood , Biomarkers/blood , Cohort Studies , Sample Size , Emergency Medical Services , Heart Failure/nursing , Heart Failure/physiopathology
14.
Rev. Soc. Bras. Med. Trop ; 53: e20200100, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136806

ABSTRACT

Abstract Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.


Subject(s)
Humans , Chagas Cardiomyopathy/physiopathology , Ventricular Function, Left/physiology , Ventricular Function, Right/physiology , Exercise Tolerance/physiology , Exercise Test/methods , Heart Failure/physiopathology , Prognosis , Echocardiography
15.
Rev. Soc. Bras. Med. Trop ; 53: e20190488, 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136799

ABSTRACT

Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.


Subject(s)
Humans , Male , Female , Adult , Polymorphism, Genetic/genetics , Chagas Disease/genetics , Peptidyl-Dipeptidase A/genetics , Heart Failure/physiopathology , Brazil , Angiotensin-Converting Enzyme Inhibitors , Case-Control Studies , Cohort Studies , Chagas Disease/physiopathology , Disease Progression , Genotype , Heart Failure/genetics , Middle Aged
16.
Braz. j. med. biol. res ; 53(7): e9646, 2020. graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1132528

ABSTRACT

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have symptoms and signs of HF with normal or near-normal left ventricular ejection fraction (LVEF ≥50%). Roughly half of all patients with HF worldwide have an LVEF ≥50% and nearly half have an LVEF <50%. Thanks to the increased scientific attention about the condition and improved characterization and diagnostic tools, the incidence of HF with reduced ejection fraction (HFrEF) dropped while that of HFpEF has increased by 45%. HFpEF has no single guideline for diagnosis or treatment, the patient population is heterogeneously and inconsistently described, and longitudinal studies are lacking. To better understand and overcome the disease, in this review, we updated the latest knowledge of HFpEF pathophysiology, introduced the existing promising diagnostic methods and treatments, and summarized its prognosis by reviewing the most recent cohort studies.


Subject(s)
Humans , Stroke Volume/physiology , Ventricular Function, Left/physiology , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Failure/therapy , Prognosis
17.
Arch. cardiol. Méx ; 89(4): 360-368, Oct.-Dec. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1149094

ABSTRACT

Resumen La insuficiencia cardíaca (IC) es un problema de salud pública global con más de 37 millones de individuos afectados en el mundo. La insuficiencia cardíaca con fracción de expulsión preservada (ICFEp) representa una categoría cada vez más frecuente en la práctica clínica, constituye hasta el 60% de los casos y presenta diferencias importantes en el diagnóstico y tratamiento en comparación con la insuficiencia cardíaca y la fracción de expulsión reducida. Esta revisión de ICFEp expone la epidemiología, delimita los principales factores de riesgo y mecanismos fisiopatológicos, identifica las características clínicas/paraclínicas y los criterios diagnósticos, y finaliza con un llamado para realizar investigación en este país.


Abstract Heart failure is a global public health problem, with more than 37 million patients living with heart failure around the world. Heart failure with preserved ejection fraction is an increasingly common category (approximately 60% of the cases) and shows remarkable differences in diagnosis and treatment when compared with heart failure with reduced ejection fraction. The current review covers epidemiology, risk factors, pathophysiologic mechanisms, clinical and paraclinical characteristics and diagnostic criteria of heart failure with preserved ejection fraction and concludes with a plea for original research in our country.


Subject(s)
Humans , Stroke Volume/physiology , Heart Failure/physiopathology , Public Health , Global Health , Risk Factors , Heart Failure/diagnosis , Heart Failure/epidemiology
18.
Arch. cardiol. Méx ; 89(4): 339-347, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1149092

ABSTRACT

Abstract Heart failure (HF) is a syndrome characterized basically by a circulatory deficit to cover the metabolic and energetic demands of the body. This condition has a broad spectrum in its clinical presentation, affects the quality of life significantly, impacts the family/social environment, and generates a great demand for health services. The purpose of this research is to report the situational diagnose of patients with HF in Mexico. We evaluated 292 patients, 70.2% were men. Average age was 56.7 +- 14.3 years. Ischemic heart disease is the main etiology (98 patients, 33.9%) followed by hypertensive (22.6%) and idiopathic (23.3%) heart disease. The associated clinical background was obesity (31.1%), systemic hypertension (36.7%), myocardial infarction (26.4%), and dyslipidemia (15.1%). The most common symptom was stress dyspnea (41.4%) and jugular vein engorgement at physical examination (32.5%). Anemia was observed in 1% of patients. The average left ventricular ejection fraction was 29.2 +- 10.6%. Sinus rhythm was the most frequently detected in 84.9%. 19.9% of patients had an implantable cardioverter-defibrillator or cardiac resynchronization therapy. 13.7% of patients with QRS > 130 ms. In our population, the meta-analysis global group in chronic heart failure risk score calculated was 16.8 +- 5.7 and for EMPHASIS 3.3 +- 1.5. We observed that age at presentation in HF in this analysis is at least 10 years younger than in other reports. The grade of obesity takes relevance in our group. The association of anemia and HF in Mexico is rare.


Resumen La insuficiencia cardiaca es un síndrome caracterizado fundamentalmente por un déficit circulatorio para cubrir las demandas metabólicas y energéticas del organismo. Esta entidad tiene un amplio espectro en su presentación clínica, afecta de manera significativa la calidad de vida, impacta en el entorno familiar/social y genera una gran demanda de los servicios de salud. El propósito de esta investigación es reportar el diagnóstico situacional de pacientes con insuficiencia cardiaca (IC) en México. Evaluamos 292 enfermos, 70.2% eran hombres. Con edad promedio 56.7 +- 14.3 años. La principal etiología es la cardiopatía isquémica (33.9%), seguida de la hipertensiva (22.6%) e idiopática (23.3%). Los antecedentes clínicos asociados fueron: obesidad (31.1%), hipertensión arterial sistémica (36.7%), infarto al miocardio (26.4%) y dislipidemia (15.1%). El síntoma con mayor presentación fue la disnea de esfuerzos (41.4%) y a la exploración física la ingurgitación yugular (32.5%). Se observó anemia en 1% de los enfermos. La fracción de expulsión del ventrículo izquierdo (FEVI) promedio fue de 29.2 + 10.6%. El ritmo sinusal fue el más frecuentemente detectado en 84.9%. El 19.9% de los pacientes tenían instalado un desfibrilador automático implantable (DAI) o tratamiento de resincronización cardiaca (TRC). El 13.7% de los enfermos con QRS mayor de 130 ms. El riesgo (MAGGIC) calculado en nuestro grupo poblacional fue de 16.8 +- 5.7 y para EMPHASIS 3.3 +- 1.5. Observamos que la edad de presentación de la IC en el presente análisis es menor por 10 años en comparación con otros reportes. El grado de obesidad toma relevancia en nuestro grupo. La asociación de anemia e IC en México es poco frecuente.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Quality of Life , Heart Failure/epidemiology , Stroke Volume , Defibrillators, Implantable/statistics & numerical data , Cardiac Resynchronization Therapy/statistics & numerical data , Heart Failure/physiopathology , Heart Failure/therapy , Anemia/epidemiology , Mexico/epidemiology , Obesity/epidemiology
19.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 17(3): 82-96, dic.2019. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1048069

ABSTRACT

La insuficiencia cardiaca aguda (ICA) se define como la aparición rápida o el empeoramiento de los síntomas o signos de IC. Es una entidad potencialmente mortal que requiere evaluación y tratamiento urgentes y típicamente conlleva la hospitalización urgente. La descompensación de la insuficiencia cardiaca crónica puede ocurrir sin que existan factores desencadenantes conocidos. Se produce una disfunción endotelial que puede deberse a un desequilibrio en el medio neuro-hormonal, inflamatorio, y oxidativo en la circulación y en las células endoteliales. Se produce clínicamente hipoperfusión miocárdica, reducción del flujo coronario, disfunción isquémica, aumento de la rigidez vascular y deterioro de la distensibilidad arterial que agravan en mayor medida la lesión miocárdica. La evaluación inicial y la monitorización no invasiva continua de las funciones vitales cardiorrespiratorias son esenciales. Los diuréticos son la piedra angular del tratamiento de los pacientes con ICA y signos de sobrecarga de fluidos y congestión. La terapia de reemplazo renal se debe reservar para pacientes que no responden al tratamiento con diuréticos. Los vasodilatadores intravenosos son los segundos fármacos más utilizados en la ICA para el alivio de los síntomas; sin embargo, no existen pruebas definitivas que confirmen su efecto beneficioso. El uso de inotrópicos debería estar reservado a los pacientes con disfunción sistólica que afecta a la perfusión de órganos vitales. Los dispositivos de asistencia ventricular y otras formas de asistencia mecánica circulatoria pueden emplearse como tratamiento puente en pacientes seleccionados(AU)


Acute heart failure (AHF) is defined as the rapid onset or worsening of the symptoms or signs of heart failure. It is a potentially fatal entity that requires urgent evaluation and treatment and typically involves urgent hospitalization. Decompensation of chronic heart failure can occur without known triggers. An endothelial dysfunction occurs that may be due to an imbalance in the neuro-hormonal, inflammatory, and oxidative environment in the circulation and in the endothelial cells. Myocardial hypoperfusion is clinically produced, coronary flow reduction, ischemic dysfunction, increased vascular rigidity and deterioration of arterial compliance that aggravate myocardial injury to a greater extent. Initial evaluation and continuous non-invasive monitoring of vital cardiorespiratory functions are essential. Diuretics are the cornerstone of the treatment of patients with AHF and signs of fluid overload and congestion. Renal replacement therapy should be reserved for patients who do not respond to treatment with diuretics. Intravenous vasodilators are the second most used drugs in the AHF for the relief of symptoms; however, there is no definitive evidence to confirm its beneficial effect. The use of inotropics should be reserved for patients with systolic dysfunction that affects the perfusion of vital organs. Ventricular assist devices and other forms of mechanical circulatory assistance can be used as a bridge treatment in selected patients(AU)


Subject(s)
Heart Failure , Heart Failure/physiopathology , Therapeutics
20.
Int. braz. j. urol ; 45(6): 1204-1208, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1056338

ABSTRACT

ABSTRACT Purpose: This study aims to assess the association between CHA2DS2-VASc score and erectile dysfunction in patients who were admitted to cardiology outpatient clinics. Materials and methods: One hundred and two male patients who were admitted to the cardiology outpatient clinic were included to the study. Erectile dysfunction was evaluated in the urology outpatient clinic in the same hospital and scored using Turkish Version of The International Index of Erectile Function. CHA2DS2-VASc score was calculated for every patient using the current associated guidelines. Results: There was a negative correlation between The International Index of Erectile Function score and CHA2DS2-VASc score, age, hypertension, heart failure, diabetes mellitus, stroke respectively. Smoking and dislipidemia were not correlated with The International Index of Erectile Function score (p>0.05). Conclusion: CHA2DS2-VASc score can be used to detect Erectile dysfunction in patients who are admitted to the cardiology outpatient clinics.


Subject(s)
Humans , Male , Adult , Aged , Risk Assessment/methods , Erectile Dysfunction/diagnosis , Erectile Dysfunction/physiopathology , Reference Values , Anthropometry , Cross-Sectional Studies , Reproducibility of Results , Risk Factors , Age Factors , Statistics, Nonparametric , Stroke/physiopathology , Diabetes Mellitus/physiopathology , Heart Failure/physiopathology , Hypertension/physiopathology , Middle Aged
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