Achados ao ecocardiograma transtorácico em pacientes hospitalizados com COVID- 19: resultados do registro brasileiro de ecocardiografia durante a pandemia de COVID-19 (ECOVID) / Transthoracic echocardiography findings of hospitalized patients with COVID-19: results from the brazilian echocardiography registry during the COVID-19 Pandemic (ECOVID)

Fundamento: A ecocardiografia transtorácica (ETT) pode desempenhar um papel crucial na avaliação das manifestações cardíacas da COVID-19. Objetivo: Nosso objetivo foi relatar a prevalência das principais anormalidades ecocardiográficas em pacientes hospitalizados com COVID-19. Métodos: Realizou-se estudo observacional multicêntrico prospectivo com pacientes com COVID-19 submetidos a ETT durante a internação. Pacientes com insuficiência cardíaca prévia, doença arterial coronariana ou fibrilação atrial foram classificados como portadores de doença cardiovascular (DCV) prévia. Foram coletados dados clínicos e ecocardiográficos da estrutura e da função cardíaca. Resultados: Avaliamos 310 pacientes com COVID-19, com 62±16 anos de idade, 61% homens, 53% com hipertensão arterial, 33% com diabetes e 23% com DCV prévia. No total, 65% dos pacientes necessitaram de suporte em unidade de terapia intensiva. As alterações ecocardiográficas mais prevalentes foram hipertrofia do ventrículo esquerdo (VE) (29%), hipertensão pulmonar (25%), disfunção sistólida do VE (16,5%), disfunção sistólica do ventrículo direito (VD) (15,9%), disfunção diastólica do VE grau II/III (11%) e alteração da contratilidade regional do VE (11%). Derrame pericárdico foi incomum (7%). Hipertrofia do VE (25 vs. 45%, p=0,001), disfunção sistólica do VE (11 vs. 36%, p<0,001), alterações da contratilidade regional (6 vs. 29%, p<0,001), disfunção diastólica do VE grau II/III (9 vs. 19%, p=0,03) e hipertensão pulmonar (22 vs. 36%, p=0,019) foram menos comuns nos pacientes sem do que com DCV prévia. A disfunção sistólica do VD mostrou-se semelhante em pacientes sem e com DCV prévia (13 vs. 25%, p=0,07). Conclusões: Entre os pacientes hospitalizados com COVID-19, os achados ecocardiográficos anormais foram comuns, porém menos encontrados naqueles sem DCV. A disfunção sistólica do VD pareceu afetar de forma semelhante pacientes com e sem DCV prévia. (AU)

Background: Transthoracic echocardiography (TTE) may play a crucial role in the evaluation of cardiac manifestations of coronavirus disease 2019 (COVID-19). Objective: We aimed to report the prevalence of the main echocardiographic abnormalities of hospitalized COVID-19 patients. Methods: We performed a prospective multicenter observational study in patients with COVID-19 who underwent TTE during hospitalization. Patients with pre-existing heart failure, coronary artery disease, or atrial fibrillation were categorized as having previous cardiovascular disease (CVD). Clinical and echocardiographic data about cardiac structure and function were collected. Results: We evaluated 310 patients with COVID-19 (mean age, 62±16 years; 61% men; 53% with arterial hypertension; 33% with diabetes; and 23% with previous CVD). Overall, 65% of the patients required intensive care unit support. The most prevalent echocardiographic abnormalities were LV hypertrophy (29%), pulmonary hypertension (25%), left ventricular (LV) systolic dysfunction (16.5%), right ventricular (RV) systolic dysfunction (15.9%), grade II/III LV diastolic dysfunction (11%), and LV regional wall motion abnormality (11%). Pericardial effusion was uncommon (7% of cases). LV hypertrophy (25% vs. 45%, p=0.001), LV systolic dysfunction (11% vs. 36%, p<0.001), regional wall motion abnormalities (6% vs. 29%, p<0.001), grade II/III LV diastolic dysfunction (9% vs. 19%, p=0.03), and pulmonary hypertension (22% vs. 36%, p=0.019) were less common in patients without previous CVD. RV systolic dysfunction occurred at similar frequencies in patients with versus without previous CVD (13% vs. 25%, p=0.07). Conclusions: Among patients hospitalized with COVID-19, abnormal echocardiographic findings were common, but less so among those without previous CVD. RV systolic dysfunction appeared to affect similar proportions of patients with versus without previous CVD. (AU)

Autofagia en el sistema cardiovascular: pasado, presente y futuro / Cardiovascular autophagy: past, present and future

La enfermedad cardiovascular se mantiene como la principal causa de morbimortalidad a nivel mundial a pesar de los avances científicos y tecnológicos recientes, por esto existe la necesidad de búsqueda de nuevas dianas terapéuticas. La autofagia es un mecanismo de degradación de proteínas y organelos disfuncionales que ocurre en vacuolas especializadas de doble membrana denominadas autofagosomas y que requiere la participación de los lisosomas. Este proceso permite el auto abastecimiento celular de energía a través del reciclaje de diversos substratos energéticos. Se activa en respuesta a diversas formas de estrés, principalmente debido a la ausencia de nutrientes y su presencia ha sido caracterizada en todos los tipos celulares que componen el sistema cardiovascular. Existe una ventana de actividad de autofagia óptima la que se relaciona con la mantención de la homeostasis cardiovascular y su desregulación participa en la patogénesis de diversas patologías cardiovasculares. En este artículo se revisa el curso temporal que llevó el descubrimiento de la autofagia, la contribución al área del Dr. Ohsumi, reciente Premio Nobel de Medicina, los principales conceptos, mecanismos celulares y moleculares de la formación del auto-fagosoma, nodos de regulación y sintetizamos su participación en la homeostasis del corazón y en la patogénesis de las enfermedades cardiovasculares y sus perspectivas futuras.

Cardiovascular disease continues to be the leading cause of morbi-mortality worldwide despite the recent scientific and technological advances. Therefore, more research is needed to discover novel therapeutic targets. Autophagy mediates the removal of dysfunctional proteins and organelles. This process takes place in double-membrane vesicles, named autophagosomes, which later fuse with lysosomes. The mechanism allows self-renewal energy repletion through diverse energy substrate recycling. Diverse forms of cellular stress, mainly nutrient deprivation, activate this process. Autophagy has been widely characterized within the cells of the cardiovascular system. There is a window of optimal autophagy activity implicated in maintaining cardiovascular homeostasis and its dysregulation participates in the pathogenesis of different cardiovascular diseases. In this article, we review the time course of auto-phagy discovery, the Nobel Prize winner Dr. Ohsumi contribution, main concepts, mechanisms involved in autophagosome formation and its regulatory no-des. Additionally, we summarized the role of auto-phagy in cardiovascular homeostasis and pathogenesis and future perspectives.

Nobel Prizes: Contributions to Cardiology / Prêmios Nobel: Contribuições para a Cardiologia

The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

O Prêmio Nobel foi criado por Alfred Nobel. Os primeiros prêmios foram entregues em 1901, e o primeiro ganhador na área da medicina foi Emil Adolf von Behring, por seus trabalhos com soro antidiftérico. Na cardiologia, o conhecimento da história do Prêmio Nobel ajuda a entender a importância dos avanços fisiopatológicos, diagnósticos e terapêuticos realizados ao longo dos últimos 120 anos. O objetivo do presente estudo foi revisar as principais descobertas científicas contempladas pelo Prêmio Nobel, que contribuíram para avanços no estudo da cardiologia. Além disso, apresentamos a hipótese pela qual Carlos Chagas, um dos nossos mais importantes cientistas, não recebeu o Prêmio Nobel em duas ocasiões. A partir de uma revisão não sistemática sobre os Prêmios Nobel, foram selecionados, entre os laureados, os principais estudos com relevância para as doenças cardíacas. No período entre 1901 e 2013, 204 pesquisadores, em 104 prêmios, foram premiados na categoria Medicina ou Fisiologia, dos quais 16 estudos (15%) tiveram importância na área da cardiologia. Foram 33 (16%) premiados, sendo apenas duas (6%) mulheres. Em relação ao local de nascimento, 14 (42%) eram norte-americanos, 15 (45%) europeus e quatro (13%) de outros países. Apenas um laureado nasceu no Brasil: Peter Medawar, cuja carreira se deu toda na Inglaterra. A revisão da história do Prêmio Nobel na área de medicina ou fisiologia possibilitou identificar pesquisadores e estudos que contribuíram para avanços no diagnóstico, prevenção e tratamento das doenças cardiovasculares. A maioria dos laureados eram norte‑americanos e europeus, e do sexo masculino.

Initial approach to hypertension in the hemodynamics unit: review article / Abordagem inicial da hipertensao arterial sistemica em unidade de hemodinamica: artigo de revisao

Correct identification and early management of hypertensive disorders should be a part of the therapeutic repertoire of every professional working in hemodynamics units. Based on recent publications, this study aims to propose a practical approach to the identification and early management of these disorders in this type of service.

O reconhecimento correto e manejo inicial das síndromes hipertensivas devem fazer parte do arsenal terapêutico de todo profissional que trabalhe em unidade de hemodinâmica. Este trabalho tem por objetivo, baseado em publicações recentes, propor uma abordagem prática para identificação e manejo inicial destes agravos nessa unidade.

ABO blood groups distribution and cardiovascular major risk factors in healthy population

This study was designed to investigate whether there was an association between ABO blood groups and cardiovascular risk factors in healthy population. In this cross-sectional study, risk factors screening for cardiovascular disease [CVD] on 5000 healthy persons of Golestan Province, northern Iran, in 2005 was estimated by a questionnaire that included age, sex, physical activity, smoking status, blood group type [if they had blood laboratory tests], weight, height, blood pressure and family history of coronary artery disease [CAD]. Data were analyzed with SPSS version 11.5 and by using Chi Square and ANOVA tests. A p-value less than 0.05 were considered as statistically significant. Amongst 5000 subjects, 2920 had blood laboratory tests and their types of blood group were known. Of the total of 2920, 57.4% were male, 70% were inactive, 14% were smoker, 25% were hypertensive, 23% obese, 21% had family history of CAD and mean age was 41.52 +/- 12.317. Blood group O[32.9%], A[30.1%], B[23.3%] and AB [13.7%], respectively had most frequency. Amongst cardiac risk factors, only frequency of family history of CAD in individual with different blood groups was different [P<0.01] and individual with A blood group reported more family history of CVD versus other blood groups. Amongst cardiovascular risk factors, only family history of CAD had significant relation with ABO

Breve historia de la relación entre el colesterol y las enfermedades cardiovasculares / Brief history of the relationship between cholesterol and cardiovascular diseases

The association of plasma levels of cholesterol and atherogenesis was not an easy task. During the 18th century the first evidences about the discovery of cholesterol appeared. However, in the 19th century, from the work of Anichkov, was possible to establish that atheromas originate from cholesterol deposition. The discovery and the isolation of lipoproteins by John Goffman was another landmark in cholesterol history. The observation of Laurence Kinsell that diets rich in polyunsaturated fatty acids produce a reduction of plasma cholesterol was another important landmark. The discovery of the LDL-receptor by Goldstein and Brown was one of the most important discoveries about the relationship of cholesterol with cardiovascular diseases. This work reviews the main events of the history of cholesterol.

No fue fácil asociar lo niveles plasmáticos de colesterol con la aterogénesis. En el siglo XVIII se produjeron las primeras evidencias del descubrimiento del colesterol, pero fue en el siglo XIX, con los trabajos de Anichkov, cuando fue posible establecer que los depósitos de colesterol originan los ateromas. El descubrimiento y el aislamiento de las lipoproteínas por John Gofman fue otro hito importante en la historia del colesterol. También lo fue la observación de Laurence Kinsell, quien describió que las dietas ricas en ácidos grasos poliinsaturados producen disminución del colesterol plasmático. El descubrimiento de Goldstein y Brown del receptor de LDL, ha sido quizás uno de los descubrimientos más importantes sobre la relación del colesterol y las enfermedades cardiovasculares. Este trabajo revisa los principales acontecimientos de la historia del colesterol.

Endotélio e hipertensão arterial sistêmica: mecanismos de lesão/novo alvo terapêutico? / Endothelium and essential hypertension: mechanisms of lesion/new therapeutic target?

A hipertensão arterial é uma doença multifatorial decorrente da interação de aspectos ambientais e genéticos. Sabemos, também, que a hipertensão arterial é poligênica e sua apresentação fenotípica dependerá do gene ou do grupo de genes envolvidos em cada caso.Dentre a multifatoriedade da hipertensão arterial, o endotélio surge como um dos fatores mais importantes no controle do tônus vasomotor.O endotélio tem a capacidade de produzir substâncias vasodilatadoras e vasoconstritoras. É o equilíbrio entre essas substâncias que determinará o tônus vasomotor. Quando existe disfunção endotelial há maior aumento da produção de vasoconstritores ou menor produção da quantidade de substâncias vasodilatadoras. Isso acarreta aumento do tônus vasomotor e conseqüente aumento da pressão arterial.Vários são os medicamentos disponíveis no controle da pressão arterial.Neste artigo serão discutidos os mecanismos envolvidos no aumento da pressão arterial decorrentes de disfunção endotelial. Também serão abordados alguns aspectos relacionados com o efeito dos medicamentos anti-hipertensivos sobre a função endotelial...

A importância da fase de aquecimento em programas ambulatoriais de exercícios físicos para pacientes cardíacos / The importance of the warm-up phase in ambulatory program of physical exercises for cardiac patients

Um bom programa de exercícios físicos deve possuir três fases: aquecimento, resistência e relaxa-mento. O aquecimento deve ser realizado com o objetivo de produzir alterações metabólicas e fisiológicas, as quais permitirão melhor adaptação ao esforço que será desenvolvido na fase de resistência, além de evitar lesões potenciais dos sistemas musculoesquelético e cardiorrespiratório. Em cardiopatas, o aquecimento proporciona poderoso estímulo para a dilatação das artérias periféricas e coronárias; por outro lado, a realização de uma atividade física de forma brusca e intensa, sem aquecimento prévio, pode induzir angina ou alterações eletrocardiográficas. Dada a importância da fase de aquecimento em um programa de exercícios físicos para indivíduos com disfunções do sistema cardiovascular, pretendemos, neste trabalho, abordar alguns aspectos relacionados ao aquecimento e descrever como é realizada essa fase no programa ambulatorial para pacientes cardíacos desenvolvido no Setor de Fisioterapia Cardiovascular da FCT/UNESP

1896-1996: cien años de cirugía cardíaca: Ludwig Rehn y la primera operación al corazón / 1896-1996: one hundred of cardiac surgery: Ludwig Rehn and the first heart surgery

In 1896 Stephen Paget published his book "Surgery of the Chest", where he affirmed that heart surgery had probably reached the limits of nature for any kind of surgery. This statement followed Billroth's who, few years earlier, sustained that the surgeon who attempted a suture of a wound in the heart was sure to loose forever the consideration of his colleagues. However, that very year of 1896 in Frankfurt, Ludwig Rehn succeded in suturing a stab wound of a man's heart. By accomplishing this, he not proved his colleagues wrong, but he made the heart, center of life and site of the soul, accesible to the surgeon, opening the way to what is today cardiovascular surgery

Cardiología de ayer, hoy y mañana / Cardiology of yesterday, today and tomorrow

The subject of this lecture has been chosen in relation to the contribution that professor H. Alessandri made in the first half of this century, as an outstanding clinician in the professional, humanistic and ethical development of generations of physicians in this country. This lecture is divided in 3 sections: the first reviews the practice in cardiology in the 50's, a period of initiation of the present advances in the specialty, still dominated at that time by semiologic and clinical approach. The second part presents examples of the significant contributions made by newer technologies in the fields of echocardiography, nuclear medicine, electrophysiology and therapeutic procedures. Finally, an assessment is made of the needed balance between technology and clinical judgement, coupled with humanistic and ethical considerations in the management of patients