Discriminative value of pulse wave velocity for arterial stiffness and cardiac injury in prediabetic patients / Valor discriminativo da velocidade da onda de pulso para rigidez arterial e lesão cardíaca em pacientes pré-diabéticos

Abstract Background Prediabetes (PD) is defined as impaired fasting glucose and/or impaired glucose tolerance (IGT) and may be associated with high risk of cardiovascular injury. It is recommended that PD patients be screened for signs of arterial stiffness and cardiovascular injury to reinforce therapeutic strategies. Objectives To identify pulse wave velocity values discriminative for arterial stiffness and cardiovascular injury in PD patients. Methods A cross-sectional study was conducted with PD (N=43) and normoglycemic (N=37) patients who underwent clinical evaluation, arterial stiffness assessment by carotid-femoral pulse wave velocity (cfPWV) using SphygmoCor, laboratory blood analysis, investigation of morphological and functional cardiac variables by transthoracic echocardiogram, and assessment of carotid intima-media-thickness (CIMT) by carotid ultrasonography. A statistical analysis was performed using SPSS software and values of p<0.05 were considered significant. Results A cfPWV cut-off value of 6.9 m/s was identified for IGT (Sensitivity [SE]: 74% and Specificity [SP]: 51%). Comparison of general data and risk factors between subsets with values above and below this cutoff value revealed higher rates of fasting glucose (p=0.02), obesity (p=0.03), dyslipidemia (p=0.004), early signs of left ventricle (p=0.017) and right ventricle (p=0.03) impaired diastolic function, and elevated CIMT in subjects with cfPWV ≥ 6.9m/s (p=0.04). Conclusions In PD patients, a cfPWV cutoff of 6.9 m/s was considered a discriminative value for arterial stiffness. These findings highlight the value of early investigation of cardiovascular injury and aggressive therapy strategies with good control of risk factors in PD.

Resumo Contexto O pré-diabetes (PD) é definido como glicemia de jejum alterada e/ou tolerância à glicose alterada (TGA) e pode estar associado a alto risco de lesão cardiovascular. Recomenda-se discriminar quais pacientes com PD podem apresentar sinais de rigidez arterial e lesão cardiovascular para reforçar as estratégias terapêuticas. Objetivos Identificar os valores discriminativos da velocidade de onda de pulso determinantes de rigidez arterial e lesão cardiovascular em pacientes com PD. Métodos Estudo transversal em pacientes com PD (N=43) e normoglicêmicos (N=37) submetidos a avaliação clínica, avaliação da rigidez arterial pela velocidade da onda de pulso carótido-femoral (cfPWV) utilizando SphygmoCor, análise laboratorial de sangue, investigação de alterações morfológicas e variáveis cardíacas funcionais por ecocardiograma transtorácico e avaliação da espessura íntima-média carotídea (EIMC) pela ultrassonografia da carótida. A análise estatística foi realizada no software SPSS, e valores de p<0,05 foram considerados significativos. Resultados Foi identificado um valor de corte cfPWV de 6,9 m/s para TGA (sensibilidade 74% e especificidade 51%). A comparação dos dados e fatores de risco entre valores acima e abaixo do valor de corte estabelecido revelou glicemia de jejum elevada (p=0,02), obesidade (p=0,03), dislipidemia (p=0,004), sinais precoces de função diastólica prejudicada do ventrículo esquerdo (p=0,017) e ventrículo direito (p=0,03) e maior EIMC em cfPWV ≥6,9m/s (p=0,04). Conclusões Em pacientes com PD, o cfPWV de 6,9 m/s foi considerado um valor discriminativo de rigidez arterial. Esses achados reforçam que a investigação precoce da lesão cardiovascular e uma estratégia com terapia agressiva são valiosas no controle dos fatores de risco na PD.

Effects of Physical Exercise on Left Ventricular Function in Type 2 Diabetes Mellitus: A Systematic Review

Abstract Background The incidence of diabetes mellitus in younger adults is rising over the years. The diabetic population has an increased risk of developing heart failure, and diabetic individuals with heart failure have four times greater mortality rate. Studies results about exercise effect on left ventricular function in type 2 diabetes mellitus are heterogenous. Objective This review aimed to analyze the effects of physical exercise on left ventricular dysfunction in type 2 diabetes mellitus (T2DM). Methods Only randomized clinical trials with humans published in English were included. Inclusion criteria were studies with type 2 diabetes patients, physical exercise, control group and left ventricular function. Exclusion criteria were studies with animals, children, teenagers, elderly individuals and athletes, presence of diet intervention, and patients with type 1 diabetes, cancer, cardiac, pulmonary, or neurological diseases. Electronic databases PubMed, Web of Science, Cochrane, and Scopus were last searched in September 2021. Risk of bias was assessed by the Physiotherapy Evidence Database (PEDro) scale. Results Five studies were included, representing 314 diabetic individuals submitted to resistance and aerobic exercise training. Of the variables analyzed, physical exercise improved peak torsion (PTo), global longitudinal strain, global strain rate (GSR), time to peak untwist rate (PUTR), early diastolic filling rate (EDFR) and peak early diastolic strain rate (PEDSR). Conclusion To our knowledge, this is the first systematic review on the effects of exercise on left ventricular function in T2DM including only randomized clinical trials with humans. Physical exercise seems to improve systolic and diastolic strain, twist, and torsion. High intensity exercise was reported to be superior to moderate intensity exercise in one study. This review was limited by the small number of studies and their heterogeneity regarding exercise protocols, follow-up period, exercise supervision and left ventricular function variables analyzed. This review was registered in PROSPERO (CRD42021234964).

Smartphone-Based Screening for Cardiovascular Diseases: A Trend?

Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.

Comparing cardiac function and structure and their relationship with exercise capacity between patients with stable COPD and recent acute exacerbation: a cross-sectional study / Comparação da função e estrutura cardíaca e sua relação com a capacidade de exercício entre pacientes com DPOC estável e exacerbação aguda recente: estudo transversal

ABSTRACT Objective: Patients with COPD are prone to cardiac remodeling; however, little is known about cardiac function in patients recovering from an acute exacerbation of COPD (AECOPD) and its association with exercise capacity. The aim of this study was to evaluate the cardiac function and structure and to compare their relationship with exercise capacity in patients with a recent AECOPD and patients with clinically stable COPD. Methods: This was a cross-sectional study including 40 COPD patients equally divided into two groups: recent AECOPD group (AEG) and clinically stable COPD group (STG). Echocardiography was performed to assess cardiac function and chamber structure. The six-minute walk distance (6MWD) and the Duke Activity Status Index (estimated Vo2) were used in order to assess exercise capacity. Results: No significant differences in cardiac function and structure were found between the groups. The 6MWD was associated with early/late diastolic mitral filling velocity ratio (r = 0.50; p < 0.01), left ventricular posterior wall thickness (r = −0.33; p = 0.03), and right atrium volume index (r = −0.34; p = 0.04), whereas Vo2 was associated with right atrium volume index (r = −0.40; p = 0.02). Conclusions: Regardless of the clinical condition (recent AECOPD vs. stable COPD), the cardiac function and structure were similar between the groups, and exercise capacity (determined by the 6MWD and Vo2) was associated with cardiac features.

RESUMO Objetivo: Pacientes com DPOC são propensos a remodelamento cardíaco; no entanto, pouco se sabe sobre a função cardíaca em pacientes em recuperação de exacerbação aguda da DPOC (EADPOC) e sua associação com a capacidade de exercício. O objetivo deste estudo foi avaliar a função e estrutura cardíaca e comparar sua relação com a capacidade de exercício em pacientes com EADPOC recente e pacientes com DPOC clinicamente estável. Métodos: Estudo transversal com 40 pacientes com DPOC divididos igualmente em dois grupos: grupo EADPOC recente (GEA) e grupo DPOC clinicamente estável (GCE). Realizou-se ecocardiografia para avaliar a função cardíaca e a estrutura das câmaras. A distância percorrida no teste de caminhada de seis minutos (DTC6) e o Duke Activity Status Index (Vo2 estimado) foram utilizados para avaliar a capacidade de exercício. Resultados: Não foram encontradas diferenças significativas na função e estrutura cardíaca entre os grupos. A DTC6 apresentou associação com a razão entre as velocidades de enchimento diastólico mitral precoce e tardia (r = 0,50; p < 0,01), a espessura da parede posterior do ventrículo esquerdo (r = −0,33; p = 0,03) e o índice de volume do átrio direito (r = −0,34; p = 0,04), enquanto o Vo2 apresentou associação com o índice de volume do átrio direito (r = −0,40; p = 0,02). Conclusões: Independentemente da condição clínica (EADPOC recente vs. DPOC estável), a função e estrutura cardíaca eram semelhantes entre os grupos, e a capacidade de exercício (determinada pela DTC6 e pelo Vo2) apresentou associação com as características cardíacas.

Age is the main factor related to expiratory flow limitation during constant load exercise

OBJECTIVE: The objective of this study was to investigate the interaction among the determinants of expiratory flow limitation (EFL), peak oxygen uptake (VO2peak), dysanapsis ratio (DR) and age during cycling at different intensities in young and middle-aged men. METHODS: Twenty-two (11 young and 11 middle-aged) men were assessed. Pulmonary function tests (DR), cardiopulmonary exercise tests (VO2peak) and two constant load tests (CLTs) at 75% (moderate intensity) and 125% (high intensity) of the gas exchange threshold were performed to assess EFL. EFL was classified using the percentage of EFL determined from both CLTs (mild: 5%-30%, moderate: 30%-50%, severe: >50%). RESULTS: Only the middle-aged group displayed EFL at both exercise intensities (p<0.05). However, the number of participants with EFL and the percentage of EFL were only associated with age during high-intensity exercise. CONCLUSIONS: There was no interaction between the determinants. However, age was the only factor that was related to the presence of EFL during exercise in the age groups studied.

Vitamin D role in smoking women and cardiac remodeling

Background: The objective of the study is to evaluate the influence of serum vitamin D concentrations and smoking status in cardiac structure and function. Methods: The participants of this study were healthy women smokers (n = 18, mean age 52.8 years), ex-smokers ( n = 18, mean age 51.7 years), and never smokers ( n = 19, mean age 44.4 years). All participants underwent assessment of body composition, dietary intake, sun exposure frequency, vitamin D serum determination, and echocardiographic assessment. All data underwent statistical analysis. Results: The three groups were classified as overweight. The group of ex-smokers showed significantly higher vitamin D serum concentrations. Smoker group showed a higher posterior wall thickness (PW), left ventricular mass, and left ventricular mass index (LVMI). We identified positive correlations between LVMI and smoking history, PW and vitamin D serum, and body mass index and time of smoking history. Multiple linear regressions showed positive association of smoking history and LVMI and PW, also that serum vitamin D has a positive association with PW. PW was associated with smoking history and serum vitamin D, showing a deleterious effect on the heart of both variables. Conclusions: Smoking habit in adult women was associated with cardiac remodeling, and excess of vitamin Dis associated with the action of smoking on cardiac variables. Thus, higher serum vitamin D values have a deleterious effect on the heart in this model.

Diastolic function and functional capacity after a single session of continuous positive airway pressure in patients with compensated heart failure

OBJECTIVE: The effects of acute continuous positive airway pressure therapy on left ventricular diastolic function and functional capacity in patients with compensated systolic heart failure remain unclear. METHODS: This randomized, double-blind, placebo-controlled clinical trial included 43 patients with heart failure and a left ventricular ejection fraction <0.50 who were in functional classes I-III according to the New York Heart Association criteria. Twenty-three patients were assigned to continuous positive airway pressure therapy (10 cmH2O), while 20 patients received placebo with null pressure for 30 minutes. All patients underwent a 6-minute walk test (6MWT) and Doppler echocardiography before and immediately after intervention. Clinicaltrials.gov: NCT01088854. RESULTS: The groups had similar clinical and echocardiographic baseline variables. Variation in the diastolic function index (e′) after intervention was associated with differences in the distance walked in both groups. However, in the continuous positive airway pressure group, this difference was greater (continuous positive airway pressure group: Δ6MWT = 9.44+16.05×Δe′, p = 0.002; sham group: Δ6MWT = 7.49+5.38×Δe′; p = 0.015). There was a statistically significant interaction between e′ index variation and continuous positive airway pressure for the improvement of functional capacity (p = 0.020). CONCLUSIONS: Continuous positive airway pressure does not acurately change the echocardiographic indexes of left ventricle systolic or diastolic function in patients with compensated systolic heart failure. However, 30-minute continuous positive airway pressure therapy appears to have an effect on left ventricular diastolic function by increasing functional capacity. .

Anemia, insuficiência cardíaca e manejo clínico baseado em evidências / Anemia, heart failure and evidence-based clinical management

A anemia é uma comorbidade prevalente e marcadora de pior prognóstico em pacientes com insuficiência cardíaca (IC). Sua relevância clínica, bem como a fisiopatologia e abordagem terapêutica nesses pacientes são temas de destaque na literatura especializada. Nessa revisão são descritos os conceitos atuais sobre a fisiopatologia da anemia na IC, os critérios diagnósticos e as indicações da suplementação de ferro, ao mesmo tempo em que são analisados criticamente os principais estudos que ofereceram evidências sobre os benefícios dessa suplementação. São abordados os quatro componentes principais da anemia: doença crônica, dilucional, "renal" e disabsortiva. Nos pacientes com IC, os critérios para o diagnóstico são os mesmos utilizados na população geral: níveis de ferritina sérica inferiores a 30 mcg/L em pacientes não nefropatas e menores que 100 mcg/L ou ferritina sérica entre 100-299 mcg/L com saturação de transferrina menor que 20% em pacientes com doença renal crônica. Finalmente, são discutidas as possibilidades terapêuticas da anemia nessa população específica de pacientes.

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, "renal" and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

Insuficiência cardíaca / Hearth failure

Insuficiência cardíaca (IC) é conhecida como uma síndrome clínica complexa e multifatorial, caracterizada pelo prejuízo da ejeção ou enchimento do ventrículo esquerdo. Trata-se de importante problema em saúde pública, sendo a causa mais prevalente de internações por doença cardiovascular e está associada a prognóstico desfavorável em mais de 40% dos casos. O diagnóstico dessa síndrome envolve tanto a história, exame físico e exames complementares como o ecocardiograma e a dosagem do BNP. O tratamento se baseia tanto em terapia não farmacológica quanto farmacológica e tem mostrado grandes benefícios na evolução natural da doença. O objetivo central desta revisão é proporcionar para o profissional clínico uma abordagem aprofundada tanto do diagnóstico quanto do tratamento da insuficiência cardíaca.

Impacto da hipertensão arterial no remodelamento ventricular, em pacientes com estenose aórtica / Impact of hypertension on ventricular remodeling in patients with aortic stenosis

FUNDAMENTO: A hipertrofia ventricular esquerda (HVE) é comum em pacientes com hipertensão arterial sistêmica (HAS) e estenose aórtica (EAo) e, com certa frequência, encontramos associação entre estas patologias. Mas, em tal situação, não está clara a importância de cada uma na HVE. OBJETIVO: 1 - Avaliar em pacientes portadores de EAo, submetidos previamente a estudo ecocardiográfico, a magnitude da HVE, nos casos de EAo isolada e associada à HAS; 2 - Avaliar o padrão de remodelamento geométrico nas duas situações. MÉTODOS: Estudo retrospectivo, observacional e transversal, incluindo 298 pacientes consecutivos, com EAo ao ecocardiograma. HVE foi considerada para massa miocárdica > 224g em homens e > 162g em mulheres. Os pacientes foram classificados como portadores de EAo leve (gradiente máximo < 30,0 mmHg), moderada (entre 30 e 50,0 mmHg) e grave (> 50,0 mmHg), além disso, foram separados em dois subgrupos: com e sem HAS. RESULTADOS: Nos três níveis de lesão aórtica, a massa ventricular esquerda foi maior na EAo associada à HAS do que na EAo isolada (EAo leve: 172 ± 45 vs 223 ± 73g, p < 0,0001; EAo moderada: 189 ± 77 vs 245 ± 81g, p = 0,0313; EAo grave: 200 ± 62 vs 252 ± 88g, p = 0,0372). Presença de HAS esteve associada a maior risco de HVE (OR = 2,1,IC95 por cento:1,2-3,6; p = 0,012). Pacientes com EAo grave e HAS apresentaram predomínio de hipertrofia concêntrica, quando comparados com aqueles normotensos (p = 0,013). CONCLUSÃO: Em pacientes com EAo, a presença de HAS foi um fator adicional de aumento da massa ventricular esquerda, interferindo também na geometria ventricular.

BACKGROUND: Left ventricular hypertrophy (LVH) is a marker of increased cardiovascular risk and is frequently associated with both arterial hypertension (AH) and aortic stenosis (AoS). Also, these two maladies may co-exit in a same patient. However, in these cases, it is not clear the impact of each one in LVH. OBJECTIVE: To evaluate LVH and ventricular geometry in patients with AS associated or not with arterial hypertension. METHODS: This was a retrospective, observational and transversal study, including 298 consecutive patients with echocardiographic diagnosis of AoS. LVH was defined as myocardial mass > 224g for men and > 162g for women. Patients were classified as having mild (peak gradient < 30 mmHg), moderate (between 30 and 50 mmHg) or severe (> 50 mmHg) AoS and separated into two subgroups: with and without hypertension. RESULTS: AH was associated with increased ventricular mass in all three levels of aortic stenosis (mild AS: 172 ± 45g vs 223 ± 73g, p < 0.0001 moderate AoS: 189 ± 77 g vs 245 ± 81g, p = 0.0313 severe AoS: 200 ± 62g vs 252 ± 88g, p = 0.0372), and increased risk of LVH (OR = 2.1 CI95 percent:1.2-3.6 p = 0.012). Regarding to geometric remodeling, hypertensive patients with severe AS presented a significant increase in frequency of concentric hypertrophy, when compared with those without hypertension (p = 0.013). CONCLUSION: Hypertension is an additional factor of increased left ventricular mass in patients with AS. Also, hypertension was influential in ventricular geometry.

Evolução das modificações morfo-funcionais cardíacas no processo de adaptação crônica à insuficiência aórtica aguda experimental em ratos / Evolution of morphological and functional cardiac changes in the process of adaptation to chronic aortic insufficienty acute in mice

A adaptação cardíaca à insuficiência aórtica resulta em hipertrofia excêntrica seguida de disfunção ventricular e insuficiência cardíaca. A evolução desse processo ainda não é bem compreendida. Avaliar a adaptação cardíaca à insuficiência aórtica aguda experimental por meio de ecocardiografia, identificar os marcadores anatâmicos de transição da hipertrofia excêntrica compensada para a fase descompensada e verificar se existe associação entre marcadores anatâmicos e de disfunção ventricular e fibrose miocárdica. Estudo experimental com 35 ratos Wistar machos, 23 animais submetidos à insuficiência aórtica aguda (grupo IAO) e 12 animais a procedimento simulado (Grupo Controle). Todos os animais foram seguidos com ecocardiogramas seriados com 1, 4, 8 e 16 semanas. No término do protocolo, foi realizada mortometria do tecido cardíaco. A análise estatística foi efetuada por meio do teste "t" de Student, Mann-Whitney, ANOVA de medidas repetidas, Modelo de Regressão Longitudinal (GEE) e Modelo de Regressão Linear simples e múltipla. Em todos os casos, o nível de significância adotado foi p

To evaluate the cardiac adaptation to experimental acute aortic regurgitation by echocardiography, to identify the anatomical markers of the transition from compensated eccentric hypertrophy to decompensated stage and to investigate the association between anatomical markers of ventricular dysfunction and myocardial flbrosis. Thirty flve Male Wistar rats underwent surgical procedure for inducing acute aorta regurgitation (AR group, n= 23) or sham operation (SH group, n= 12). Transthoracic echocardiograms were performed at 1, 4, 8 and 16 weeks after procedure. At the end of the protocol, morphometry of the heart tissue was performed. Statistical analyses used t test, Mann-Whitney, repeated measures ANOVA, GEE model (General Estimative Equation, STATA 10.0), linear regression model and multiple linear regression. In ali cases, the levei of significance was p <0.05. There were interactions between time and AR for increasing left ventricle diastolic diameter (LVDD, p<0.0011), normalized left atrium area (LAA, p=0.0011) and sphericity index (SI, p<0.0011), and for decreasing relative wall thickness (RWT, p=0.002) and fractional shortening (F5, p<0.001). Compared to week 1, the increased SI at week 4 (0.72±0.10 vs. 0.65±0.60; p<0.001) preceded the LVDD enlargement (9.00±1.30mm vs. 7.60±0.63mm; p<0.05) and LAA increasing (1.59±0.35 vs. 1.45±0.20; p<0.05) observed at week 8 and RWT decreasing observed at week 16 (O.18±0.04 vs. 0.20±0.02; p=0.003). There was an interaction between time and SI for reducing F5 (p<0.001). LV systolic dysfunction was detected at week 8 and preceded LAA enlargement at week 16. This suggested increased LV diastolic pressure and it was coincident with the decreased RWT indicating LV dilation.(...)

Qualidade de vida em pacientes com doença ateroclerótica coronariana grave e estável / Quality of life in patients with severe and stable coronary atherosclerotic disease / Calidad de vida en pacientes con enfermedad aterosclerótica coronaria severa y estable

FUNDAMENTO: Existem poucas informações sobre fatores agravantes da qualidade de vida em pacientes com doença arterial coronariana (DAC), antes da intervenção coronária percutânea (ICP). OBJETIVO: Associar variáveis clínicas com escores de qualidade de vida (EQV) em pacientes com DAC estável, antes da ICP e com desfechos desfavoráveis, 12 meses após o procedimento. MÉTODOS: Trata-se de estudo longitudinal incluindo 78 pacientes (43 homens e 35 mulheres), antes da ICP eletiva. As associações entre EQV (questionário SF-36) e idade, sexo, peso, índice de massa corpórea, diabete melito (DM), hipertensão arterial, dislipidemia, tabagismo atual, evento cardiovascular ou ICP prévios, controle da glicemia e da pressão arterial foram analisadas por meio de regressão logística multivariada. Também se analisaram as associações entre esses atributos clínicos e os desfechos desfavoráveis (morte por qualquer causa, insuficiência cardíaca ou infarto não fatal). O nível de significância foi p < 0,05. RESULTADOS: As medianas dos EQV estiveram abaixo de 70 percentuais em todos os domínios. Sexo feminino, idade < 60 anos, evento cardiovascular ou ICP prévios, IMC > 25 kg/m², DM e pressão arterial elevada foram associados a maior prejuízo de, pelo menos, um dos EQV. Sexo feminino (OR: 7,19; IC95 por cento: 1,55 - 33,36; p = 0,012), evento cardiovascular prévio (OR: 3,97; IC95 por cento: 1,01 - 15,66; p = 0,049) e insucesso na ICP (OR: 10,60; IC95 por cento: 1,83 - 61,46; p = 0,008) foram associados com risco aumentado de desfecho combinado. CONCLUSÃO: Na presença de DAC, mulheres e pacientes com comorbidades têm maior prejuízo da qualidade de vida. Os desfechos desfavoráveis após 12 meses da ICP estão associados com o sexo feminino, evento prévio ou insucesso do procedimento.

BACKGROUND: There are few data on the factors decreasing quality of life (QoL) in patients with coronary artery disease (CAD) before a percutaneous coronary intervention (PCI). OBJECTIVE: To associate clinical variables with QoL scores in patients with stable CAD before the PCI and with unfavorable outcomes, 12 months after the procedure. METHODS: The present is a longitudinal study of 78 patients (43 men and 35 women), before an elective PCI. The associations between the QoL scores (SF-36 questionnaire) and age, sex, weight, body mass index, diabetes mellitus (DM), arterial hypertension, dyslipidemia, current smoking, previous cardiovascular event or PCI, glycemia control and blood pressure (BP) were analyzed by multivariate logistic regression. We also analyzed the associations between the clinical features and the unfavorable outcomes (death due to any cause, heart failure or nonfatal infarction). The level of significance was set at p < 0.05. RESULTS: The medians of the QoL scores were < 70 percentage in all domains. Female sex, age < 60 years, previous cardiovascular event or PCI, BMI > 25 kg/m², DM and high BP were associated with a higher degree of impairment of at least one QoL score. Female sex (OR: 7.19; 95 percentCI: 1.55 - 33.36; p = 0.012), previous cardiovascular event (OR: 3.97; 95 percentCI: 1.01 - 15.66; p = 0.049) and PCI failure (OR: 10.60; 95 percentCI: 1.83 - 61.46; p = 0.008) were associated with increased risk of combined outcome. CONCLUSION: In the presence of CAD, women and patients with comorbidities present a higher degree of QoL impairment. The unfavorable outcomes 12 months after the PCI are associated with the female sex, previous event or procedure failure.

FUNDAMENTO: Hay pocas informaciones sobre factores agravantes de la calidad de vida en pacientes con enfermedad arterial coronaria (EAC), antes de la intervención coronaria percutánea (ICP). OBJETIVOS: Asociar variables clínicas con scores de calidad de vida (ECV) en pacientes con CAC estable, antes de la ICP y con desenlaces desfavorables, 12 meses tras el procedimiento. MÉTODOS: Se trata de estudio longitudinal incluyendo a 78 pacientes (43 varones y 35 mujeres), antes de la ICP electiva. Las asociaciones entre ECV (cuestionario SF-36) y edad, sexo, peso, índice de masa corpórea, diabetes melito (DM), hipertensión arterial, dislipidemia, tabaquismo actual, evento cardiovascular o ICP previos, control de glucemia y de la presión arterial se analizaron por medio de regresión logística multivariada. También se analizaron las asociaciones entre estos atributos clínicos y los desenlaces desfavorables (muerte por cualquier causa, insuficiencia cardiaca o infarto no fatal). El nivel de significancia fue p < 0,05. RESULTADOS: Las medianas de los ECV estuvieran abajo de 70 en todos los dominios. Sexo femenino, edad < 60 años, evento cardiovascular o ICP previos, IMC > 25 kg/m², DM y presión arterial elevada se asociaron a mayor perjuicio de, al menos uno de los ECV. Sexo femenino (OR: 7,19; IC95 por ciento: 1,55 - 33,36; p = 0,012), evento cardiovascular previo (OR: 3,97; IC95 por ciento: 1,01 - 15,66; p = 0,049) y sin éxito en la ICP (OR: 10,60; IC95 por ciento: 1,83 - 61,46; p = 0,008) se asociaron con riesgo aumentado de desenlace combinado. CONCLUSIÓN: En la presencia de EAC, mujeres y pacientes con comorbidades tiene mayor perjuicio de la calidad de vida. Los desenlaces desfavorables tras 12 meses de la ICP están asociados con el sexo femenino, evento previo o sin éxito del procedimiento.

Insuficiência cardíaca com fração de ejeção normal / Heart failure with normal ejection fraction

A insuficiência cardíaca com fração de ejeção normal (ICFEN) é uma síndrome complexa que vem sendo largamente estudada, desde a última década. É causada por disfunção ventricular diastólica evidenciada por métodos complementares, como estudo hemodinâmico ou ecocardiograma, na presença de fração de ejeção preservada. Acomete preferencialmente indivíduos mais idosos e com comorbidades, como hipertensão arterial sistêmica, insuficiência coronariana e obesidade. Os mecanismos fisiopatológicos são complexos e multifatoriais, envolvendo a rigidez passiva do miocárdio, a geometria ventricular, a força de contenção do pericárdio e a interação entre os ventrículos. Os objetivos principais do tratamento são reduzir a congestão venosa pulmonar, a frequência cardíaca e controlar as comorbidades. Ainda não há evidências fortes de que o uso de medicações específicas, como inibidores de enzima de conversão ou betabloqueadores, interfiram na mortalidade. Os fatores de pior prognóstico incluem a idade avançada, presença de disfunção renal, diabete, classe funcional III e IV (NYHA) e estágio avançado de disfunção diastólica, com padrão restritivo ao enchimento ventricular. Outro aspecto que vem ganhando espaço na literatura é o questionamento do papel da disfunção sistólica nos quadros de ICFEN. Todos esses aspectos são abordados detalhadamente na presente revisão.

Heart failure with normal ejection fraction (HFNEF) is a complex syndrome that has been broadly studied since the last decade. It is caused by diastolic ventricular dysfunction demonstrated by complementary methods, such as hemodynamic study or echocardiogram, in the presence of a normal ejection fraction (EF). It affects primarily elderly individuals with comorbidities, such as systemic arterial hypertension, coronary failure and obesity. The physiopathological mechanisms are complex and multifactorial, involving the myocardial passive stiffness, the ventricular geometry, the pericardial restraint and the interaction between the ventricles. The main objectives of the treatment were to decrease the pulmonary venous congestion and the heart rate and control the comorbidities. There is no strong evidence that the use of specific medications, such as the angiotensin-converting enzyme inhibitors or beta-blockers can influence mortality. The poorer prognostic factors include advanced age, presence of kidney dysfunction, diabetes, functional class III and IV (NYHA) and advanced-stage diastolic dysfunction, with a restrictive pattern of ventricular filling. Another aspect that has been increasingly cited in the literature is the analysis of the role of the systolic function in HFNEF cases. All these aspects are analyzed in detail in the present review.

Cardiomiopatia periparto / Peripartum cardiomyopathy

A cardiomiopatia periparto é rara e se caracteriza por disfunção ventricular esquerda e sintomas de insuficiência cardíaca, que se manifestam no período periparto em mulheres previamente saudáveis. A incidência de cardiomiopatia periparto varia de 1 em 1.300 a 1 em 1.500 gestações. A etiologia da cardiomiopatia periparto ainda é desconhecida, mas foram propostas várias causas, como viral, autoimune e idiopática. Os critérios diagnósticos consistem no desenvolvimento da síndrome de insuficiência cardíaca no último mês de gestão ou nos primeiros cinco meses pós-parto, ausência de um causa determinável de insuficiência cardíaca, e ausência de doença cardíaca reconhecível anterior ao último mês de gestação. Também fazem parte dos critérios diagnósticos os seguintes achados ecocardiográficos: fração de ejeção < 45 por cento e/ou fração de encurtamento < 30 por cento ou dimensão diastólica final do ventrículo esquerdo...