Anthracycline-induced cardiovascular toxicity: validation of the Heart Failure Association and International Cardio-Oncology Society risk score.

BACKGROUND AND AIMS: Baseline cardiovascular toxicity risk stratification is critical in cardio-oncology. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score aims to assess this risk but lacks real-life validation. This study validates the HFA-ICOS score for anthracycline-induced cardiovascular toxicity. METHODS: Anthracycline-treated patients in the CARDIOTOX registry (NCT02039622) were stratified by the HFA-ICOS score. The primary endpoint was symptomatic or moderate to severe asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), with all-cause mortality and cardiovascular mortality as secondary endpoints. RESULTS: The analysis included 1066 patients (mean age 54 ± 14 years; 81.9% women; 24.5% ≥65 years). According to the HFA-ICOS criteria, 571 patients (53.6%) were classified as low risk, 333 (31.2%) as moderate risk, 152 (14.3%) as high risk, and 10 (0.9%) as very high risk. Median follow-up was 54.8 months (interquartile range 24.6-81.8). A total of 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD (symptomatic: n = 45; moderate to severe asymptomatic: n = 24; and mild asymptomatic: n = 649). Incidence rates of symptomatic or moderate to severe symptomatic CTRCD and all-cause mortality significantly increased with HFA-ICOS score [hazard ratio 28.74, 95% confidence interval (CI) 9.33-88.5; P < .001, and hazard ratio 7.43, 95% CI 3.21-17.2; P < .001) for very high-risk patients. The predictive model demonstrated good calibration (Brier score 0.04, 95% CI 0.03-0.05) and discrimination (area under the curve 0.78, 95% CI 0.70-0.82; Uno's C-statistic 0.78, 95% CI 0.71-0.84) for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months. CONCLUSIONS: The HFA-ICOS score effectively categorizes patients by cardiovascular toxicity risk and demonstrates strong predictive ability for high-risk anthracycline-related cardiovascular toxicity and all-cause mortality.

Coronary Sinus Reducer Transfemoral Extraction After Intraprocedural Device Migration to the Pulmonary Artery.

Coronary sinus reducer migration during implantation is an unusual complication with no standard bailout strategy and to the best of our knowledge there is no description of migration to the pulmonary artery. A mother-and-child technique during implantation could be the safest way to avoid this complication.

Abordagens de Psicoterapia para Pessoas com Deficiência: Revisão da Literatura / Psychotherapy Approaches for People with Disabilities: Literature Review

RESUMO: Quinze por cento da população mundial apresenta algum tipo de deficiência. Isso pode ser caracterizado por vários tipos de condições, cada uma com sua complexidade específica. Assim sendo, esta revisão da literatura objetiva identificar recentes estudos científicos, no quinquênio 2014-2019, que descrevem cuidados psicoterapêuticos com pessoas com deficiência. Foram consultados: PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) e SciELO. Encontrou-se um total de 1.330 artigos. Após dois processos de seleção, 26 pesquisas corresponderam aos critérios de inclusão. A metodologia de pesquisa predominante foi ensaio clínico randomizado, seguido por estudos de caso e estudos descritivos/qualitativos. Pessoas com deficiência intelectual e/ou física, deficiência visual e/ou auditiva e autismo foram as populações mais estudadas. As técnicas comportamentais prevalecem nos estudos incluídos, com menor incidência de técnicas psicodinâmicas. A psicoterapia favorece inclusive o enfrentamento de situações adversas impostas na vida de qualquer ser humano. Pessoas com deficiência também podem apresentar necessidades psicoterápicas, uma vez que, na realidade de suas vidas, incluem complexidades além de sua deficiência. Existem fortes evidências para o uso da psicoterapia como recurso eficaz para a elaboração terapêutica de problemas relacionados à saúde, à educação e à vida social de pessoas com deficiência, independentemente do tipo de intervenção psicoterápica.

ABSTRACT: Fifteen percent of the world's population has some form of disability. This can be characterized by several types of conditions, each with its specific complexity. Thus, this literature review aims to identify recent scientific studies, in the 2014-2019 five-year period, which describe psychotherapeutic care for people with disabilities. PubMed, EMBASE, Web of Science, PsycINFO (APA), BVS (Bireme/LILACS) and SciELO were consulted. It was found a total of 1,330 articles. After two selection processes, 26 research met the inclusion criteria. The predominant research methodology was the randomized clinical trial, followed by case studies and descriptive/qualitative studies. People with intellectual and/or physical disabilities, visual and/or hearing disabilities and autism were the most studied populations. Behavioral techniques prevail in the studies included, with a lower incidence of psychodynamic techniques. Psychotherapy also favors coping with adverse situations imposed on the life of any human being. People with disabilities may also have psychotherapeutic needs, since, in the reality of their lives, they also include complexities in addition to their disability. There is strong evidence for the use of psychotherapy as an effective resource for the therapeutic elaboration of problems related to health, education and social life of people with disabilities, regardless of the type of psychotherapeutic intervention.