Prevalence of carotid stenosis and incidence of ischemic stroke in patients undergoing non-coronary cardiac surgery

Abstract Introduction: Many publications on coronary surgery and carotid stenosis (CS) can be found, but we do not have enough information about the relationship between ischemic stroke, CS and non-coronary cardiac surgery. Objectives: To evaluate the incidence and risk factors associated with the stroke and CS ≥50% in patients undergoing non-coronary surgeries. Objectives: We assessed 241 patients, aged 40 years or older, between 2009 and 2016, operated in Santa Casa de Misericórdia de Ponta Grossa-PR, Brazil. We perform carotid Doppler in patients 40 years of age or older before any cardiac surgery as a routine. The incidence and possible risk factors for CS ≥50% and perioperative stroke were analyzed by univariate statistical analysis. Results: 11 patients (4.56%) presented perioperative stroke. The risk factor for stroke was CS ≥50%: OR=5.3750 (1.2909-22.3805), P=0.0208. Eighteen patients (7.46%) had CS ≥50% and their risk factors were extracardiac arteriopathy: OR=18.6607 (6.3644-54.7143), P<0.0001; COPD: OR=3.9040 (1.4491-10.5179), P=0.0071; diabetes mellitus: OR=2.9844 (1.0453-8.5204), P=0.0411; recent myocardial infarction: OR=13.8125 (1.8239-104.6052), P=0.0110; EuroSCORE II higher P=0.0056. Conclusion: The incidences of stroke and CS ≥50% were 4.56% and 7.46%, respectively. The risk factor for stroke was CS ≥50% and for CS ≥50% were extracardiac arteriopathy, COPD, diabetes mellitus, recent myocardial infarction and higher EuroSCORE II.

Relações Entre Ações de uma Invervenção Educativa na Adesão ao Tratamento e no RNI de Pacientes em Uso de Antagonistas de Vitamina K / Relationship Between Educative Intervention on Treatment Adherence and INR of Patients on Vitamin K Antagonists

Avaliar se uma intervenção educacional interfere na adesão ao tratamento, meta terapêutica e frequência de eventos hemorrágicos de pacientes em uso de antagonistas de vitamina K e se características socioeconômicas/clínicas possuem efeito sobre os resultados encontrados. Método: Estudo analítico intervencionista não controlado qualitativo. Foram incluídos 49 pacientes e aplicados os questionários de medida de adesão ao tratamento (MAT) e socioeconômico. Posteriormente foram realizadas ligações mensais educativas sobre anticoagulação e foram coletadas informações sobre eventos hemorrágicos e valores de RNI. Ao termino da intervenção foi aplicado mais um questionário MAT. Foram comparados os dados antes e após a intervenção. Resultados: Os pacientes foram considerados mais aderentes após a intervenção (p=0,04) e houve diminuição na frequência de eventos hemorrágicos (p=0,01), existindo nenhuma relação com as variáveis socioeconômicas ou clínicas. Não houve melhora significativa em relação à meta de RNI (p=0,06), porém o estado civil desses pacientes teve associação com a estabilidade terapêutica (p=0,04). Conclusões: A intervenção melhorou a aderência e diminuiu os eventos hemorrágicos dos pacientes, não tendo influência sobre a meta terapêutica. Pacientes com cônjuge apresentaram melhores metas terapêuticas se comparados aos solteiros. Não houve interferência de outras variáveis socioeconômicas ou clínicas sobre os desfechos encontrados

Objectives: To evaluate if an educational intervention interfere in treatment adherence, therapeutic ranges and hemorrhagic.events of patients on vitamin K antagonists; and if social, economic and clinical.characteristics are associated with the ending points. Methods: It's an interventionist analytic study. 49 patients were included.and an adherence.and social/economic questionnaires were applied. Then, monthly educative phone calls.were performed about anticoagulation and information about hemorrhagic,events and INR were collected. When intervention,were done, another adherence questionnaire was applied. Data before and after intervention were compared. Results: Patients had their adherence improved (p=0,04) and there was a fall on the prevalence,of hemorrhagic events (p=0,01) with,no,social/clinical variables association. There were no significant,changes,on the therapeutic ranges (p=0,06), although there was a relationship,between marital state and INR,stability (p=0,04). Conclusions: Educational intervention increased adherence,and decreased hemorrhagic events. Marital state has been associated with better therapeutic,ranges. No other social, economic.or clinical.variable has been associated with the ending points

Anticoagulation quality and complications of using vitamin k antagonists in the cardiac surgery outpatient clinic

ABSTRACT Introduction: In patients with mechanical prosthetic heart valves or atrial fibrillation requiring anticoagulation to prevent thromboembolic events, several factors influence adherence and anticoagulation complications. Objective: To evaluate the factors that interfere with the quality and complications of anticoagulation with vitamin K antagonists. Methods: A retrospective cohort study of 100 patients, in the period from 2011 to 2014, was performed. Anticoagulation conditions in the last year, regarding the presence of complications (embolisms/bleeding) and inadequate treatment were assessed: achievement of less than 8 annual prothrombin times and International Normalized Ratio outside therapeutic target in more than 40% of prothrombin times. Results: There were 31 complications (22 minor bleeding without hospitalization and 9 major complications: 7 bleeding with hospitalization and two emboli); 70 were with International Normalized Ratio outside the target in more than 40% of the tests and 36 with insufficient number of prothrombin times. Socioeconomic factors, anticoagulant type and anticoagulation reason had no relationship with complications or with inadequate treatment. There were more complications in patients with longer duration of anticoagulation (P=0.001). Women had more International Normalized Ratio outside the target range (OR 2.61, CI:1.0-6.5; P=0.04). Patients with lower number of annual prothrombin times had longer times of anticoagulation (P=0.03), less annual consultations (P=0.02) and less dose adjustments (P=0.003). Patients with longer duration of anticoagulation have more complications (P=0.001). Conclusion: There was a high rate of major complications and International Normalized Ratio was outside the goal. Less annual prothrombin times was related to longer duration of anticoagulation, less annual consultations and less dose adjustments. More major complications occurred in patients with longer duration of anticoagulation.

Factors Associated With the Development of Chronic Post-Sternotomy Pain: a Case-Control Study

ABSTRACT OBJECTIVE: The aim of the present study was to investigate the factors associated with chronic post-sternotomy pain in heart surgery patients. METHODS: Between January 2013 and February 2014, we evaluated 453 patients with >6 months post-sternotomy for cardiac surgery at a surgical outpatient clinic. The patients were allocated into a group with chronic post-sternotomy pain (n=178) and a control group without pain (n=275). The groups were compared for potential predictors of chronic post-sternotomy pain. We used Cox proportional hazards regression to determine which independent variables were associated with the development of chronic post-sternotomy pain. RESULTS: In total, 39.29% of the patients had chronic poststernotomy pain. The following factors were significantly associated with chronic post-sternotomy pain: (a) use of the internal thoracic artery in coronary bypass grafting (P =0.009; HR=1.39; 95% CI, 1.08 to 1.80); (b) a history of antidepressant use (P =0.0001; HR=2.40; 95% CI, 1.74 to 3.32); (c) hypothyroidism (P =0.01; HR=1.27; 95% CI, 1.03 to 1.56); (d) surgical wound complication (P =0.01; HR=1.69; 95% CI, 1.08 to 2.63), and (e) patients on disability benefits or scheduled for a consultative medical examination for retirement (P =0.0002; HR=2.05; 95% CI, 1.40 to 3.02). CONCLUSION: The factors associated with chronic poststernotomy pain were: use of the internal thoracic artery; use of antidepressants; hypothyroidism; surgical wound complication, and patients on disability benefits or scheduled for a consultative examination.

Doença de Takotsubo (Síndrome do coração partido): uma doença subdiagnosticada? / Takotsubo disease (Broken heart syndrome): an underdiagnosed disease?

Fundamentos: A cardiomiopatia de Takotsubo, maisconhecida como doença de Takotsubo, é umadisfunção do ventrículo esquerdo (VE) reversível naausência de coronariopatia obstrutiva, frequentemente causada por estresse intenso e que apresenta quadroclínico idêntico ao infarto agudo do miocárdio (IAM).A doença de Takotsubo é muitas vezes erroneamente diagnosticada e confundida com o IAM apesar de ter fisiopatologia e tratamento distintos. Objetivos: Avaliar a incidência da doença de Takotsubona Santa Casa de Misericórdia de Ponta Grossa, PR noperíodo de 2007 a 2012, e analisar os fatores de risco, complicações, condições relacionadas à doença e evolução dos pacientes durante a internação hospitalar. Métodos: Estudo descritivo transversal e revisão bibliográfica com análise de dados coletados dos prontuários do Serviço de Hemodinâmica da SantaCasa de Misericórdia de Ponta Grossa, PR no períodode 2007 a 2012. A partir do diagnóstico retrospectivo de doença de Takotsubo, os dados foram expressos em médias e desvios-padrão ou em valores absolutos e porcentagens. As variáveis foram comparadas através do teste t de Student e qui-quadrado. Adotado o nível de significância p<0,05. Resultados: Encontrados 24 pacientes com doença deTakotsubo. Destes, apenas 5 foram diagnosticados na internação hospitalar. Maioria dos pacientes do sexo feminino (71,0%) e prevalência (75,0%) de hipertensão arterial sistêmica (HAS) no total de pacientes Conclusão: A doença de Takotsubo é subdiagnosticada, sendo o diagnóstico realizado durante a internação em apenas um de cada cinco casos admitidos. Houve forte associação da doença com HAS e maior prevalência em mulheres na pós-menopausa.

Background: Takotsubo cardiomyopathy, more commonly known as Takotsubo disease, is a reversible dysfunction of the left ventricle (LV) in the absence of obstructive coronary disease. Often caused by severe stress, its clinical features are similar to those of acute myocardial infarction (AMI), although with diferente pathophysiology and treatment. Objectives: To assess the rate of Takotsubo disease in the Santa Casa de Misericordia hospital, Ponta Grossa,Paraná State, between 2007 and 2012, analyzing risk factors, complications and conditions related to this disease, together with patient outcomes during hospitalization. Methods: Descriptive cross-sectional study and review of the literature with an analysis of data collected from the medical records of the Hemodynamics Unit, Santa Casa de Misericórdia hospital, Ponta Grossa, Paraná State, between 2007and 2012. Drawn from retrospective diagnoses of Takotsubo disease, the data were expressed as means and standard deviations or as absolute values and percentages. Variables were compared using the Student’s t and chi- squared tests, with significance levels of p<0.05.Results: We found 24 patients with Takotsubo disease,of whom only five were diagnosed during hospitalization. Most (71,0%) patients were female, with a prevalence(75,0%) of systemic arterial hypertension (SAH) among all patients. Conclusion: Takotsubo disease is underdiagnosed,with only one in five cases diagnosed during hospitalization. There was a strong association between this disease and SAH, with a higher prevalence among post-menopausal women.

Benefícios tardios do uso de marcapasso no tratamento da miocardiopatia hipertrófica obstrutiva / Long-term benefits of pacemaker use in obstructive hypertrophic cardiomyopathy treatment

OBJETIVO: Avaliar os resultados tardios do uso de marcapasso (MP) em pacientes portadores de miocardiopatia hipertrófica obstrutiva (MHO), sintomáticos e refratários ao tratamento medicamentoso.MÉTODO: Foram avaliados 10 pacientes portadores de MHO, refratários ao tratamento com betabloqueador e/ou verapamil, submetidos a implante de MP de dupla-câmara (DDD). Os pacientes foram acompanhados por um período médio de 4,5 anos após o implante. Foram comparados os dados clínicos (classe funcional, presença de síncope ou tontura e dor precordial) e os gradientes de pressão máximos na via de saída do VE pelo ecocardiograma, no pré-implante, na consulta entre três e seis meses e na consulta atual. Os dados clínicos foram confirmados por teste ergométrico realizado na última avaliação clínica.RESULTADOS: Não houve mortalidade e sim melhora significativa (p=0,0233) da classe funcional após o implante, que persistiu até a última avaliação, bem como desaparecimento de dor precordial e tontura, estatisticamente significativo para tontura (p=0,0412). O gradiente máximo na via de saída do VE foi 90,6 mmHg no pré-implante, 19 com três e seis meses e 13 no exame atual (p=0,00001). Houve correlação entre a classe funcional avaliada clinicamente e pelo teste ergométrico.CONCLUSÃO: Ocorreu melhora significativa da classe funcional e desaparecimento dos sintomas de dor precordial e tontura, bem como redução significativa do gradiente na via de saída do VE, que persistiu no seguimento tardio, mostrando que o uso de MP DDD foi uma opção terapêutica segura e resolutiva em longo prazo na amostra estudada.