Arquivos brasileiros de cardiologia最新文献

{"title":"Systematic Review of the Effectiveness of Intensive Antihypertensive Treatment Goals: Brazilian Society of Cardiology (SBC) Recommendation.","authors":"Andréa Araujo Brandão, Cibele Isaac Saad Rodrigues, Luiz Aparecido Bortolotto, Leonardo Castro Luna, Bruno Monteiro Barros, Mario Fritsch Toros Neves, Ana Flávia de Souza Moura, Frida Liane Plavnik, Luciano Ferreira Drager, Osni Moreira Filho, Weimar Kunz Sebba Barroso de Souza, Wilson Nadruz","doi":"10.36660/abc.20240761","DOIUrl":"https://doi.org/10.36660/abc.20240761","url":null,"abstract":"<p><strong>Background: </strong>Strict blood pressure control has been investigated as a strategy to reduce severe cardiovascular events in patients with hypertension. However, there are still doubts about the impact of intensive antihypertensive treatment goals (< 130/80 mmHg) compared to conventional goals (≥ 130/80 mmHg) in preventing myocardial infarction, stroke, mortality, and possible treatment-related adverse effects.</p><p><strong>Objective: </strong>To evaluate the effectiveness of intensive antihypertensive treatment goals in reducing critical cardiovascular events compared to usual goals.</p><p><strong>Methods: </strong>This systematic review included randomized controlled trials (RCTs) that compared intensive blood pressure control goals with conventional goals in adults aged 18 years or older. Studies with at least one of the following outcomes were included: mortality, myocardial infarction, stroke, progression to stage 4 or 5 chronic kidney disease, need for dialysis, or kidney transplantation. Medline, Embase, and Cochrane Library databases were searched up to May 2024. Risk of bias assessment was performed by two independent reviewers using the Cochrane Collaboration's Risk of Bias 2 (RoB 2) tool. Synthesis of results was conducted through meta-analysis for the composite outcome of myocardial infarction, stroke, and all-cause mortality. The certainty of scientific evidence and strength of recommendation followed the methods proposed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool.</p><p><strong>Results: </strong>Nine RCTs with more than 34,000 participants were included. Intensive treatment was associated with a 13% reduction in cardiovascular events. In the studies with low risk of bias, the reduction was 17%, with high certainty of evidence. Separately, a significant reduction was observed in the outcomes of myocardial infarction and stroke, but not in all-cause mortality. Limited data were found on the progression of kidney disease and the need for dialysis or kidney transplantation.</p><p><strong>Conclusion: </strong>High-quality evidence suggests that more intensive antihypertensive treatment goals significantly reduce cardiovascular events. However, the choice of treatment goals should be individualized, considering factors such as age, frailty, individual cardiovascular risk, and the possibility of adverse events. Adherence to treatment is essential to therapeutic success.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240761"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Protection Strategies for Ablation of Atrial Fibrillation: Comparative Results of Consecutive Endoscopic Evaluation.","authors":"Alberto Pereira Ferraz, Cristiano Faria Pisani, Esteban Wisnivesky Rocca Rivarola, Tan Chen Wu, Francisco Carlos da Costa Darrieux, Rafael Alvarenga Scanavacca, Muhieddine Omar Chokr, Carina Abigail Hardy, Sissy Lara de Melo, Denise Tessariol Hachul, Beatriz Hachul de Campos, Mauricio Ibrahim Scanavacca","doi":"10.36660/abc.20230913","DOIUrl":"https://doi.org/10.36660/abc.20230913","url":null,"abstract":"<p><strong>Background: </strong>Atrial-esophageal fistula following AF ablation remains a concern. There is no standardized approach to minimize its risk and morbidity.</p><p><strong>Objective: </strong>To present the seven-year experience of a systematic endoscopic surveillance of esophageal injury after AF catheter ablation.</p><p><strong>Methods: </strong>This is a retrospective single center registry of systematic endoscopic evaluation after AF ablation in consecutive procedures performed from 2016 to 2022. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>823 AF ablation with controlled esophagogastroduodenoscopy (EGD) were analyzed. Most patients (n=588, 71.4%) were male, 575 (69.9%) had paroxysmal AF. Esophageal temperature monitoring was performed using a single sensor in 310 patients (40.3%) and a multi-sensor probe in 306 (39.8%). Lesions were presented in 217 EGD (26.5%): hematoma-ecchymosis in 27 (3.3%), erythema in 14 (1.7%), erosion in 78 (9.5%) and ulcer in 67 (8.2%) patients. No esophageal protective strategy was associated with more ulcers, except the use of 8mm tip-catheter (14.7% of ulcers with 8mm tip catheter vs 6.7% with other catheters, p = 0.001). Thermal lesions were early detected and treated. Most lesions were considered healed at endoscopy, but one patient who underwent pulmonary vein isolation with an 8m tip catheter had esophageal fistula, treated successfully with endoscopic metal clip and endoloop technique.</p><p><strong>Conclusion: </strong>The incidence of esophageal lesions at routine EGD following AF ablation is high, although in most of the cases they heal spontaneously. Patients who underwent ablation with the 8mm tip catheter had more severe thermal lesions. Early esophagus endoscopy may help the diagnosis of early-stage lesions and the prevention of fistula formation after AF ablation.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20230913"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Predictors of Heart Failure after STEMI: Data from a Middle-Income Country with Limited Access to Percutaneous Coronary Intervention.","authors":"Vinícius C Fiusa, Andrea D Stephanus, Victor F Couto, Gustavo A Alexim, Thaiene M M Severino, Ana Claudia C Nogueira, Adriana J B A Guimarães, Alexandre Anderson S M Soares, Elizabeth Bilevicius, Vivian Batista, Alessandra Staffico, Andrei C Sposito, Luiz Sérgio F de Carvalho","doi":"10.36660/abc.20240447","DOIUrl":"10.36660/abc.20240447","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a common complication of ST-elevation myocardial infarction (STEMI) in low- and middle-income countries (LMICs), where cardiovascular mortality is disproportionately high. Primary percutaneous coronary intervention (PCI) has reduced post-STEMI HF incidence in high-income countries. However, access to this standard of care is poor in LMICs, and data in these settings remain scarce.</p><p><strong>Objective: </strong>To identify predictors of HF following STEMI in a LMIC with limited access to PCI, aiming at better management and outcomes.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed 2,467 STEMI patients admitted to two Brazilian public hospitals between January/2015 and February/2020. All participants received pharmacological thrombolysis and underwent coronarography within 48h post-admission. The primary outcome was symptomatic HF, defined as dyspnea with chest X-ray evidence of congestion, from 48h post-admission until discharge. Stepwise binary logistic regression was used to identify HF predictors. Significance was defined as p-values<0.05.</p><p><strong>Results: </strong>The population was 61.9% male, mean age was 58.3±12.6 years, and 39.9% developed post-STEMI HF. HF was more common among older men with cardiovascular-kidney-metabolic (CKM) disease, larger infarcts, and left anterior descending artery involvement. Medications were often underprescribed at discharge, especially aldosterone antagonists (11.0%). HF was notably more frequent among individuals with failed thrombolysis (47.0%).</p><p><strong>Conclusions: </strong>This regionally representative cohort from a LMIC with limited access to PCI showed that older men with CKM disease are particularly vulnerable to post-STEMI HF, and that HF pharmacotherapy at discharge needs optimization. The high HF incidence among patients with failed thrombolysis highlights the need to expand PCI availability.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240447"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143804972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Gender Disparities in Cardiovascular Care: Guideline-Oriented PCI for Women and the Hua-Mulan Conundrum.","authors":"Pedro Guimarães Silva, Henrique Barbosa Ribeiro","doi":"10.36660/abc.20240824","DOIUrl":"10.36660/abc.20240824","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240824"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Valve Prosthesis and Pregnancy: Challenges and Strategies.","authors":"Marcelo Luis Nomura","doi":"10.36660/abc.20240602","DOIUrl":"10.36660/abc.20240602","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240602"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choosing a Valve Prosthesis for a Successful Pregnancy. The \"Tip of the Iceberg\" for a Disease of Complex Evolution.","authors":"Walkiria Samuel Avila, Daniel Vinicius Rodrigues Pinto, Jessica Sol Brugnara, Marilia Moro, Talita Carla Stratti Moreira, Isabelle Borges, Nana Miura, Flávio Tarasoutchi","doi":"10.36660/abc.20240163","DOIUrl":"10.36660/abc.20240163","url":null,"abstract":"<p><strong>Background: </strong>The choice of valve prosthesis in women planning a pregnancy is still controversial. The durability of biological prostheses and the characteristic thrombogenic of mechanical prostheses are limitations to the pregnancy's successful Objectives: To study the pregnancy success rate after valve prosthesis implantation, and identify the variables related to maternal outcomes.</p><p><strong>Methods: </strong>Prospective study with 78 pregnant women with bovine pericardial prosthesis (Group BP) and 50 with a mechanical prosthesis (Group MP), who received prior guidance on the risks of pregnancy. The pregnancy success rate was considered in the absence of complications cardiac, obstetric and/or fetal complications.</p><p><strong>Results: </strong>Successful pregnancy was achieved in 64 (50.0%) patients, not differing between groups (BP 56.4% vs MP 40.0% - p=0.103). The BP group had a higher cardiac events rate and prosthesis dysfunction (43.6% vs 16.0% p<0.001; 26.9% vs 2.0% p<0.001). The frequency of fetal losses (14.1% vs 24.0% p=0.165) and obstetric complications (28.2% vs 42% p=0.127) were not different between the BP and MP groups. The pre-existence of heart failure (odds ratio 8.5; 95% CI [1.4; 50.7]; p=0.019), atrial fibrillation (odds ratio 16.7; 95% CI [5.7; 49 .1]; p<0.001) and dysfunction of the biological prosthesis (odds ratio 12.6; 95% CI [3.0; 52.7]; p=0.001) were the variables predicting complications and/or deaths.</p><p><strong>Conclusions: </strong>Patients with valve prostheses had low maternal-fetal success due to the complicating factors of valve disease, the limited structural survival of biological prostheses and the lack of anticoagulants to guarantee pregnancy. The choice of a prosthesis, whether biological or mechanical, should not be considered an isolated decision, but rather a consequence of a complex outcome of the heart disease.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240163"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Importance of Electrovectorcardiographic Assessment of Intraventricular Blocks and their Relationship with the Cardiac Cycle.","authors":"Carlos Alberto Pastore","doi":"10.36660/abc.20240767","DOIUrl":"10.36660/abc.20240767","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 12","pages":"e20240767"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Posterior Wall Isolation in Catheter Ablation of Persistent Atrial Fibrillation Change Clinical Outcomes?","authors":"Luiz Eduardo Montenegro Camanho","doi":"10.36660/abc.20240815","DOIUrl":"10.36660/abc.20240815","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240815"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11870122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acupuncture for Essential Hypertension and Endothelial Dysfunction: A Randomized Clinical Trial.","authors":"Amanda Rodrigues Bitencourt, Ana Luiza Lima Sousa, Priscila Valverde de Oliveira Vitorino, Mikaelle Costa Correia, Alexandre Massao Yoshizumi, Weimar Kunz Sebba Barroso","doi":"10.36660/abc.20240596","DOIUrl":"10.36660/abc.20240596","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 1","pages":"e20240596"},"PeriodicalIF":0.0,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-power, Short-duration Radiofrequency Ablation of Atrial Fibrillation: Point-by-Point or Catheter Dragging Technique?","authors":"Guilherme Fenelon","doi":"10.36660/abc.20240771","DOIUrl":"https://doi.org/10.36660/abc.20240771","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 12","pages":"e20240771"},"PeriodicalIF":0.0,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}