Arquivos brasileiros de cardiologia最新文献

{"title":"Clinical and Echocardiographic Particularities of Hypertrophic Cardiomyopathy in a Brazilian Population and its Prognostic Impact.","authors":"Georgina Del Cisne Jadán Luzuriaga, Edmundo Arteaga-Fernandez, Viviane Tiemi Hotta, Barbara Ianni, Luciano Nastari, Felix Ramires, Guilherme Wesley Peixoto da Fonseca, Charles Mady, Fábio Fernandes, Juliano Novaes Cardoso","doi":"10.36660/abc.20240640","DOIUrl":"https://doi.org/10.36660/abc.20240640","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) presents echocardiographic abnormalities that are important for diagnosis and prognosis. Data are scarce in the Brazilian literature.</p><p><strong>Objective: </strong>To assess clinical and echocardiographic characteristics and disease progression in a Brazilian cohort of patients with HCM.</p><p><strong>Methods: </strong>This retrospective cohort included patients with HCM aged ≥ 18 years. Patients with moderate or severe aortic stenosis and those undergoing septal reduction were excluded. The significance level adopted in the statistical analysis was 5%.</p><p><strong>Results: </strong>The study included 1244 patients, between 2010 and 2022, with a mean follow-up time of 7.7 ± 4.5 years; 53.6% of patients were men. Mean age was 54.6 ± 16.5 years, and mean left ventricular ejection fraction (LVEF) was 65.8% ± 7.6. We observed LVEF ≤ 50% in 5.8% of patients, asymmetric form in 88.7%, and septal hypertrophy in 85.4%. We found systolic anterior motion of the mitral valve in 30.1% of patients, left ventricular outflow tract obstruction in 30.7%, and septum ≥ 28 mm in 7.2%. Only 1 patient had ventricular aneurysm. Atrial fibrillation/flutter occurred in 9.6% of patients. Overall mortality occurred in 232 patients (1.3%/year). Patients with B-type natriuretic peptide (BNP) > 200 pg/ml, left atrium ≥ 45 mm, and LVEF ≤ 50% had higher mortality (p < 0.001). Age and atrial fibrillation/flutter were also associated with mortality.</p><p><strong>Conclusions: </strong>The majority of patients had LVEF > 50%, asymmetric hypertrophy, and septal predominance. BNP, LA diameter, LVEF ≤ 50%, age, and atrial fibrillation/flutter were associated with worse prognosis.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240640"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082511","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":"Diagnostic Test Accuracy of Exercise Testing in Detecting High-Risk Accessory Pathways in WPW: A Systematic Review and Meta-Analysis.","authors":"José Nunes de Alencar, Fabio Mahamad Rassi, Raquel Pereira Rios, Matheus Kiszka Scheffer, Guilherme Dagostin de Carvalho","doi":"10.36660/abc.20240663","DOIUrl":"https://doi.org/10.36660/abc.20240663","url":null,"abstract":"<p><strong>Background: </strong>Wolff-Parkinson-White (WPW) syndrome is characterized by ventricular pre-excitation, which can lead to severe arrhythmic events such as supraventricular tachycardia and pre-excited atrial fibrillation. The diagnostic value of non-invasive exercise tests in detecting high-risk accessory pathways remains inconsistent in the literature.</p><p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of non-invasive exercise tests compared to invasive electrophysiological studies (EPS) for identifying high-risk accessory pathways in WPW syndrome.</p><p><strong>Methods: </strong>Following PRISMA-DTA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science databases. Eligible studies assessed the sensitivity, specificity, and likelihood ratios of non-invasive exercise tests in WPW patients, using EPS as the reference standard. A bivariate random-effects model was applied for meta-analysis.</p><p><strong>Results: </strong>Six studies, comprising a total of 765 patients, met the inclusion criteria. The pooled sensitivity was 92.7% (95% CI: 88.0% - 94.0%), while the pooled specificity was 28.1% (95% CI: 23% - 35.1%). A negative likelihood ratio (LR-) of 0.260 (95% CI: 0.174 - 0.387) indicated that the presence of a high-risk accessory pathway is about four times less likely after a negative test result. Sensitivity analysis restricted to pediatric patients showed consistent results.</p><p><strong>Conclusion: </strong>Non-invasive exercise tests demonstrate a reasonable diagnostic utility for ruling out high-risk pathways in WPW syndrome. However, caution is advised when using these tests as standalone criteria for risk stratification.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240663"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082581","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":"Non-Invasive Central Blood Pressure and Intracranial Waveform Assessment in Hypertensive Patients: A Cross-Sectional Study.","authors":"Sayuri Inuzuka, Mikaelle Costa Correia, Matheus Martins da Costa, Thiago Oliveira Costa, Priscila Valverde de Oliveria Vitorino, Polyana Vulcano de Toledo Piza, Gustavo Frigieri, Ana Luiza Lima Sousa, Antonio Coca, Weimar Kunz Sebba Barroso","doi":"10.36660/abc.20240778","DOIUrl":"https://doi.org/10.36660/abc.20240778","url":null,"abstract":"<p><strong>Background: </strong>There is a strong association between hypertension and cerebrovascular disease, mainly with stroke and cognitive impairment. However, but the mechanistic of this relationship are not completely understood.</p><p><strong>Objective: </strong>To analyze the relationship of central, peripheral blood pressure (BP) and arterial stiffness, with intracranial pressure (ICP) in long-term chronic hypertensive patients.</p><p><strong>Methods: </strong>Adult individuals were consecutively included in the study from November 2022 to August 2023. The cut-off point identified to define intracranial hypertension (ICHT) by the wave peak (P2/P1) ratio was > 1.2, and the cut-off for time to peak (TTP) was > 0.25. The level of significance adopted in the statistical analysis was 5%.</p><p><strong>Results: </strong>A total of 145 patients (32 male, 113 female) with long-term hypertension (average of time since diagnoses 20 ± 12 years) were evaluated over a period of 10 months. The median age was 69.0 (61.8 - 75.7) years and median body mass index 29.0 (25.4 - 33.1) kg/m2. Median value of P2/P1 ratio for all cohort was 1.4 (1.2 - 1.5) and TTP 0.24 (0.21 - 0.29). The analysis was performed considering presence or not of ICHT, and parameters of central BP and pulse wave velocity. There was higher central systolic (SBP), diastolic blood pressure (DBP), and peripheral DBP among patients with ICHT based on the P2/P1 ratio.</p><p><strong>Conclusions: </strong>Central SBP levels are more linked to ICHT than office peripheral SBP measurements, while DBP measurements are similar, raising questions about the most suitable BP assessment method for hypertensive patients with cerebrovascular damage.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 5","pages":"e20240778"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082721","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":"Seven Deadly Sins in Hypertension Management: In-Depth Analysis of the Errors on a Journey from Riva-Rocci to Myocardial Fibrosis.","authors":"Claudio Pinho, Heitor Moreno, José Francisco Kerr Saraiva, Fernanda Marciano Consolim-Colombo","doi":"10.36660/abc.20240811","DOIUrl":"https://doi.org/10.36660/abc.20240811","url":null,"abstract":"<p><p>Medicine is perhaps the only science that values knowledge of the most recent scientific publications more than its history over time. Medical epistemology shows that some mistakes and successes are so close that we often do not readily differentiate between them. The production of medical knowledge makes us understand that knowledge is transitory and theories need to be revalidated, rectified, or polished, if not destroyed and built again on other bases; paradigms that are renewed move science. With this critical view, it was necessary to access how much knowledge about arterial hypertension has been built over the last 130 years, since the measurement of blood pressure began to be widespread and become routine in medical practice until the present day. This critical review was focused on errors in the interpretation of acquired knowledge, seven of which have been identified, deeply discussed, and condemned as sins due to the delay in being recognized, thus allowing the lives of people with this cardiovascular pathology to be shortened.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240811"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000091","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":"Unveiling the Genetic Puzzle: Asymmetric Hypertrophy in a Heart Transplant Recipient Linked to Birt-Hogg-Dubé Syndrome.","authors":"Silas Ramos Furquim, Lucas Vieira Lacerda Pires, Nara Alves Buriti, Mariana Lombardi Peres de Carvalho, Emanuelle Leonilia Marques, Bianca Domit Werner Linnenkamp, Luciana Sacilotto, Fabiana G Marcondes-Braga, Iascara Wozniak de Campos, Luis Fernando Bernal da Costa Seguro, Sandrigo Mangini, Monica S Avila, Fernando Bacal, José Eduardo Krieger","doi":"10.36660/abc.20240444","DOIUrl":"https://doi.org/10.36660/abc.20240444","url":null,"abstract":"<p><p>A case of a 54-year-old man who underwent a heart transplant with early asymmetric hypertrophy unrelated to rejection. Donor's genetic analysis revealed a variant in folliculin gene, associated with Birt-Hogg-Dubé Syndrome. Screening of the donor's family uncovered a similar hypertrophy and same genetic variant in the donor's father. Although genetic evaluation of donors' tissues is not routine, it can be crucial for understanding changes unrelated to the transplant procedure and identifying carriers of pathogenic variants.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 3","pages":"e20240444"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060302","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":"Mean Platelet Volume to Platelet Distribution Width Ratio: The Most Effective Platelet Parameter in the Closer of Ductus Arteriosus.","authors":"Ufuk Cakir, Cuneyt Tayman","doi":"10.36660/abc.20240635","DOIUrl":"https://doi.org/10.36660/abc.20240635","url":null,"abstract":"<p><strong>Background: </strong>The role of platelets and platelet indices in the closure of the ductus arteriosus in premature infants is still controversial. We aimed to determine whether the platelet count and all platelet-related indices are effective on the closer of patent ductus arteriosus (PDA).</p><p><strong>Objectives: </strong>Demographic characteristics, prematurity morbidities, and platelet indices were compared between groups with and without hemodynamically significant PDA (hsPDA).</p><p><strong>Methods: </strong>Data of premature infants with a gestational age of <30 weeks were evaluated retrospectively. All platelet-related data were recorded from the complete blood count in the first 24 hours of all patients. The statistical analysis was performed on the obtained data. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 1151 patients were included in the study, including 426 patients in the hsPDA group and 725 patients in the non-hsPDA group. Platelet parameters mean platelet volume (MPV), MPV/ plateletcrit (PCT), MPV/ platelet distribution width (PDW), platelet mass (PM), red cell distribution width (RDW) values were found to be significantly lower in the hsPDA group compared to the non-hsPDA group (p<0.001, p<0.001, p<0.001, p=0.015, and p<0.001, respectively). MPV/PDW ratio with the highest AUC value (0.748) was found to be the most valuable parameter in estimating the closer of PDA.</p><p><strong>Conclusions: </strong>The MPV/PDW ratio was found to be the most valuable parameter for the prediction of hsPDA among all platelet indices.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 5","pages":"e20240635"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082718","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 and Microbiology Predictors for Therapeutic Failure in Sternal Surgical Site Infections - A Retrospective Cohort Study.","authors":"Jaqueline Fabiano Palazzo, Diego Augusto Medeiros Santos, Bruno Adler Maccagnan Pinheiro Besen, Caio Sambo, Gabriel Fialkovitz da Costa Leite, Samuel Terra Gallafrio, Danielle Menosi Gualandro, Lani Paola Bonilla Cuello, Marcus Vinicius Barbosa Santos, Tania Mara Varejão Strabelli, Pablo Maria Alberto Pomerantzeff, Fabio Biscegli Jatene, Rinaldo Siciliano","doi":"10.36660/abc.20240464","DOIUrl":"10.36660/abc.20240464","url":null,"abstract":"<p><strong>Background: </strong>Although sternal surgical site infections (SSI) are an important complication after cardiac surgeries, predictors of treatment failure are poorly studied.</p><p><strong>Objectives: </strong>The aim of this study is to assess the clinical and microbiology predictors of a sternal SSI therapeutic failure.</p><p><strong>Methods: </strong>Patients who presented a sternal SSI were retrospectively analyzed. Data regarding demographic characteristics, clinical findings, initial laboratory and radiologic findings and treatment of index sternal SSI were evaluated. Primary outcome was treatment failure, comprising infection relapse (clinical sternal SSI after complete treatment) or infection persistence (outpatient antimicrobial treatment failure). The microbiology was assessed at the index infection and in the outcome. P-values < 0.05 were considered statistically significant.</p><p><strong>Results: </strong>Among 489 included patients, mean age was 58 years, 265 (55%) were female, 185 (38%) had diabetes mellitus. The overall prevalence of therapeutic failure was 14% (67), occurring in a median of 174 days (±41) after index cardiac surgery. Most frequent etiologies were cocci Gram-positive and Klebsiella pneumoniae. None of laboratory or thoracic tomographic findings presented during the index sternal SSI was related to outcome. After multivariate analysis, Staphylococcus aureus, carbapenem-resistant Gram-negative bacilli (GNB), fungi, diabetes mellitus and presence of mediastinitis/osteomyelitis were positive predictors of therapeutic failure.</p><p><strong>Conclusions: </strong>Emerging carbapenem-resistant GNB, fungi and S. aureus were etiologies associated with higher risk of therapeutic failure in sternal SSI. DM and deep sternal wound infections were also contributing factors. Its clinical implications and the exact role of multi-resistant microorganism itself are subject for more studies.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240464"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144113001","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":"Elements for Implementing Perioperative Optimization in Cardiac Surgery Based on Enhanced Recovery after Surgery.","authors":"Marcelo Jamus Rodrigues, Andréa de Fátima Cristino Bastos Crespo, Gabrielle Barbosa Borgomoni, Fábio Antônio Serra de Lima Júnior, Paola Keese Montanhesi, Luiz Fernando Falcão, Valter Furlan, Omar Asdrúbal Vilca Mejia","doi":"10.36660/abc.20240599","DOIUrl":"https://doi.org/10.36660/abc.20240599","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240599"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082582","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":"Use of Artificial Intelligence Applied to Electrocardiogram for Diagnosis of Left Ventricular Systolic Dysfunction.","authors":"Wilton Batista de Santana Júnior, Marcelo M Pinto Filho, Sandhi Maria Barreto, Murilo Foppa, Luana Giatti, Rohan Khera, Antonio Luiz Pinho Ribeiro","doi":"10.36660/abc.20240740","DOIUrl":"10.36660/abc.20240740","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a disease associated with an important type of morbidity and mortality. The electrocardiogram (ECG), one of the tests used to evaluate HF, is low-cost and widely available.</p><p><strong>Objective: </strong>To evaluate the performance of an artificial intelligence (AI) algorithm applied to ECG to detect HF and compare it with the predictive power of major electrocardiographic alterations (MEA).</p><p><strong>Methods: </strong>This work is a diagnostic accuracy cross-sectional study. All participants were from the Longitudinal Study of Adult Health (Estudo Longitudinal da Saúde do Adulto - ELSA-Brasil) and presented a valid ECG and echocardiogram (ECHO). The algorithm estimated probability values for left ventricular systolic dysfunction (LVSD). The assessed endpoint was left ventricular ejection fraction (LVEF) <40% in the ECHO. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were determined for both the algorithm and the MEA. The area under the ROC curve (AUC-ROC) for the algorithm was calculated.</p><p><strong>Results: </strong>In the analytical sample of 2,567 individuals, the prevalence of LVEF <40% was 1.13% (29 individuals). The values obtained for sensitivity, specificity, PPV, NPV, LR+, LR-, and DOR for the algorithm were 0.690, 0.976, 0.244, 0.996, 27.6, 0.32, and 88.74, respectively. For the MEA, the values were 0.172, 0.837, 0.012, 0.989, 1.09, 0.990, and 1.07, respectively. The AUC-ROC of the algorithm to predict the LVEF <40% was 0.947 (95% CI: 0.913 - 0.981).</p><p><strong>Conclusion: </strong>The AI algorithm performed well in detecting LVSD and can be used as a screening tool for LVSD.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240740"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112976","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":"Treating Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) and Atrial Fibrillation: We Need to Talk About the Fifth Pillar.","authors":"Mauricio Pimentel, Lucas Simonetto Faganello, Ana Paula Arbo Magalhães, Eduardo Caberlon, Leandro Ioschpe Zimerman","doi":"10.36660/abc.20240585","DOIUrl":"10.36660/abc.20240585","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"122 4","pages":"e20240585"},"PeriodicalIF":0.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766071","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}