Arquivos brasileiros de cardiologia最新文献

{"title":"Uncontrolled Cholesterol in Individuals with Severe Hypercholesterolemia in a Health Evaluation Program in Brazil.","authors":"Raul D Santos, Nea Miwa Kashiwagi, Fernando Yue Cesena, Silvia Regina Lamas Assis, Josué Nieri, Carlos Andre Minanni, Marcelo Franken, Otavio Berwanger","doi":"10.36660/abc.20240116","DOIUrl":"10.36660/abc.20240116","url":null,"abstract":"<p><strong>Background: </strong>Individuals with severe hypercholesterolemia (SH) are considered at high atherosclerosis risk and should be intensively treated with lipid-lowering drugs aiming for an LDL-C reduction of≥50% and a goal of <70 mg/dL.</p><p><strong>Objectives: </strong>This study aimed to evaluate cholesterol control in individuals with SH (LDL-C ≥ 190 mg/dL or 160-189 mg/dL using lipid-lowering drugs) followed in a health evaluation program.</p><p><strong>Methods: </strong>55,000 individuals were evaluated, of which 2,214 (4%) had SH, and 1,016 (45.8%) had repeated assessments. Achievement of recommended LDL-C goals was the primary study endpoint. A p-value < 0.05 was considered significant.</p><p><strong>Results: </strong>Mean age (± SD) was 44.9±8.8 years, 84.2% were men, and 0.5% reported previous myocardial infarction. Mean LDL-C was 203.0±22.0 mg/dL, and although 62.5% referred dyslipidemia, only 19% were using lipid-lowering drugs (5.9% in cases with LDL-C ≥ 190 mg/dL). During a 4.1±2.8-year follow-up, use of lipid-lowering drugs increased from 18.1% to 48.4% (p<0.00001), 5.9% to 45.4% in those with LDL-C ≥ 190 mg/dL (p< 0.00001) though 31% of cases with LDL-C 160-189 mg/dL stopped taking medications. Overall, there was a mean 26.7% reduction in LDL-C (p<0.0001), and LDL-C reductions ≥50% were attained in 19.2%, 19.1%, and 19.7 % of all individuals, and in those with LDL-C > 190 mg/dL and 160-189 mg/dL respectively. Only 3.1% reached LDL-C < 70 mg/dL (2.7% in those with LDL-C ≥ 190 and 5.3% in those with 160-189 mg/dL).</p><p><strong>Conclusions: </strong>A serious gap was found between treatment recommendations and reality in individuals at high atherosclerosis risk due to SH.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 11","pages":"e20240116"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741160","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":"Sleep Duration, Genetics, and Atherosclerosis: Challenges and Opportunities.","authors":"Ana Vitoria Vitoreti Martins, Larissa T Krul, Luciano F Drager","doi":"10.36660/abc.20240593","DOIUrl":"10.36660/abc.20240593","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 9","pages":"e20240593"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741582","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":"Primary Percutaneous Coronary Intervention during Off-Hours: One-Decade Experience from a High-Volume Cardiovascular Center.","authors":"Filipe Cirne, Marcia Moura Schmidt, Cristiano Oliveira Cardoso, Darryl P Leong, Alexandre Schaan de Quadros","doi":"10.36660/abc.20240396","DOIUrl":"10.36660/abc.20240396","url":null,"abstract":"<p><strong>Background: </strong>The impact of performing a primary percutaneous coronary intervention (pPCI) off-hours on clinical outcomes is not well established.</p><p><strong>Objective: </strong>Compare characteristics and major adverse cardiovascular events (MACE) of pPCI off-hours versus on-hours in a high-volume cardiology center.</p><p><strong>Methods: </strong>Prospective cohort of patients who underwent pPCI for ST elevation myocardial infarction (STEMI) from 2009 to 2019. We defined off-hours pPCI as workdays from 8pm to 7:59 am as well as weekends and holidays. We compared patients treated on- and off-hours as to baseline characteristics and 1-year events.</p><p><strong>Results: </strong>A total of 2,560 patients were treated off-hours and 1,876 patients treated on-hours. The groups were similar for most of the baseline characteristics. A higher thrombus burden was seen in patients treated off-hours (50% x 45%; p < 0.01), and in this group the radial access was more frequently used (62% x 58%; p = 0.01). Procedural success was not statistically different between the groups (95.7% x 96.4%; p = 0.21). MACE rates were higher in patients treated off-hours at 30 days (10.2% x 8.5%; p = 0.04) and at one year of follow-up (15.4% x 13.1%; p = 0.03), driven by higher death rates at 30 days (7.8% x 6.1%; p = 0.03) and at 1 year follow-up (11.1% x 9.0%; p = 0.02).</p><p><strong>Conclusion: </strong>In a high-volume cardiology center, clinical characteristics, door-to-balloon times, procedural pPCI success and complication rates of STEMI patients treated on and off-hours were similar. However, patients treated off-hours presented higher MACE and mortality rates, in spite of similar MI and stroke rates.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 11","pages":"e20240396"},"PeriodicalIF":0.0,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741023","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":"Lyme Carditis: An Infectious Cause of Atrioventricular Block - A Case Report.","authors":"Eduardo Dan Itaya, Danilo Hantschick Fernandes Monteiro, Gabriela Coelho Itaya, Nathan Kong, Andre d'Avila","doi":"10.36660/abc.20240301","DOIUrl":"10.36660/abc.20240301","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 10","pages":"e20240301"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683856","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":"Is This a Causal Relationship? Mendelian Randomization as a Statistical Method for Unraveling Connections.","authors":"Lucas Vieira Lacerda Pires","doi":"10.36660/abc.20240606","DOIUrl":"10.36660/abc.20240606","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 10","pages":"e20240606"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683855","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":"Impact of Pulsed Field Ablation on Atrial Fibrillation.","authors":"Mauricio Scanavacca, Cristiano Pisani","doi":"10.36660/abc.20240565","DOIUrl":"10.36660/abc.20240565","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 10","pages":"e20240565"},"PeriodicalIF":0.0,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683853","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":"Potentially Inappropriate Cardioverter Defibrillator Implants in Secondary Prevention of Death.","authors":"William Neves de Carvalho, Tainá Teixeira Viana, Clara Salles Figueiredo, Fernanda Martins, Luiz Carlos Santana Passos","doi":"10.36660/abc.20220899","DOIUrl":"10.36660/abc.20220899","url":null,"abstract":"<p><strong>Background: </strong>Implantable cardioverter defibrillators (ICDs) are recommended for patients experiencing malignant tachyarrhythmias due to irreversible causes, who are clinically stable, and have a life expectancy exceeding one year. However, adverse socioeconomic and psychosocial conditions can adversely affect short-term survival and may render implantation inappropriate.</p><p><strong>Objective: </strong>To assess whether economic and psychosocial markers (EPSM) are associated with higher mortality in the first year (indicating potentially inappropriate implants) following ICD implantation.</p><p><strong>Methods: </strong>A prospective cohort study conducted between 2017 and 2021 included patients with heart failure and left ventricular ejection fraction (LVEF) < 50% who underwent ICD implantation for secondary prophylaxis. Prior to the procedure, patients were evaluated by an MDT, which examined four EPSM variables, namely socioeconomic vulnerability, self-care capacity, pharmacological adherence, and mood disorders. The participants were monitored for at least 12 months. Statistical significance was considered to be p-values < 0.05.</p><p><strong>Results: </strong>A total of 208 individuals were included, with 144 (68.9%) being male. The mean LVEF was 32% ±9 and 107 (51%) had Chagas disease etiology. The mortality rate in the first year was 54/208 (25.8%). All patients who died had at least one of the EPSM and there no deaths were reported among the 73 (35.4%) who did not have EPSM. In multivariate analysis, having EPSM and LVEF were the only independent predictors of mortality under 1 year: RR 20.48 (2.75 - 52.29); p=0.003 and RR 0.97 (0.93 - 0.99); p=0.047, respectively.</p><p><strong>Conclusion: </strong>Socioeconomic and psychosocial conditions should be identified and, where possible, resolved before implantation, as they may make device implantation a potentially inappropriate procedure.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 10","pages":"e20220899"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634308","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":"Atrial Cardiomyopathy and Hypertension: Connections between Arterial Stiffness and Subclinical Atrial Arrhythmias.","authors":"Ronaldo Altenburg Gismondi, Mario Fritsch Neves","doi":"10.36660/abc.20240598","DOIUrl":"10.36660/abc.20240598","url":null,"abstract":"","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 10","pages":"e20240598"},"PeriodicalIF":0.0,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634294","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 Atrial Fibrillation Ablation: Long-Term Predictors of Success and Recurrence - A Multivariate Analysis.","authors":"Fabricio Vassallo, Christiano Cunha, Lucas Corsino, Eduardo Serpa, Aloyr Simões, Dalton Hespanhol, Carlos Volponi Lovatto, Dalbian Gasparini, Luiz Fernando Barbosa, Andre Schmidt","doi":"10.36660/abc.20230837","DOIUrl":"10.36660/abc.20230837","url":null,"abstract":"<p><strong>Background: </strong>Point-by-point ablation with a high-power short-duration (HPSD) technique in atrial fibrillation (AF) ablation is used worldwide. Little data is available with the HPSD and dragging technique (DT).</p><p><strong>Objective: </strong>To perform a multivariate analysis of clinical and procedural predictors of success and recurrence in HPSD with DT.</p><p><strong>Methods: </strong>214 patients in the first AF ablation in sinus rhythm were prospectively enrolled. DT with radiofrequency power of 50 W and contact force (CF) of 10-20 g and 5-10 g at a flow rate of 40 mL/min were applied on the anterior and posterior walls, respectively. Statistical significance was defined as p < 0.05.</p><p><strong>Results: </strong>143 (66.8%) males, paroxysmal AF (PAF) in 124 (57.9%), with 61.1±12.3 years and followed for 32.8±13.2 months. After 90 days, AF occurred in 43 (20.1%) patients, 19 (15.3%) from PAF, and 24 (26.7%) in persistent AF (PersAF). Multivariate analysis indicated as clinical predictors of recurrence: age ≥ 65 years (p=0.006); obesity [body mass index > 30 (p=0.009)]; CHA2DS2VASC score ≥ 3 (p=0.003); and PersAF (p=0.045). The procedural predictor of recurrence was a heart rate increase < 10% (p=0.006). Predictors of success were an increase in heart rate ≥ 30% (p=0.04) and < 60 min in left atrium time (LAT) (p=0.007).</p><p><strong>Conclusion: </strong>AF ablation with DT and HPSD clinical and procedural predictors of recurrence were ≥ 65 years, obesity, a CHA2DS2VASC ≥ 3, PersAF, and a heart rate increase of < 10% after ablation. Success predictors were an increase of ≥ 30% in heart rate and low LAT (< 60 min).</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 12","pages":"e20230837"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857251","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":"Impact of 3D Printing on Cardiac Surgery in Congenital Heart Diseases: A Systematic Review and Meta-Analysis.","authors":"Davi Shunji Yahiro, Mariana de Paula Cruz, Brenda Ficheira Coelho Ribeiro, Luiza Meireles Teixeira, Maria Fernanda Ribeiro Mendes de Oliveira, Aurea Lúcia Alves de Azevedo Grippa de Souza, Ana Flávia Malheiros Torbey, Juliana Serafim da Silveira, Claudio Tinoco Mesquita","doi":"10.36660/abc.20240430","DOIUrl":"10.36660/abc.20240430","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart disease (CHD) poses significant challenges in surgical management due to the complexity of cardiac anatomy. Three-dimensional (3D) printing has emerged as a promising tool in preoperative planning, intraoperative guidance, and medical education for CHD surgeries.</p><p><strong>Objectives: </strong>We aimed to systematically review the literature on the utilization and benefits of 3D printing technology in CHD surgical interventions.</p><p><strong>Methods: </strong>A systematic search was conducted across PubMed and EMBASE for studies published up to February of 2024. We included controlled and uncontrolled studies investigating the surgical role of 3D printing in CHD patients. We conducted a single-arm meta-analysis estimating the proportion of change in treatment planning due to the use of 3D printed-models. Moreover, studies that compared 3D printing to conventional care were included into the meta-analysis. A p-value < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>A total of 21 studies met the inclusion criteria, comprising 444 patients undergoing CHD surgeries with 3D printing assistance. Preoperative planning aided by 3D models led to changing surgical decisions in 35 of 75 cases (51.8%; 95% CI 26.6-77.0%, I2=80.68%, p=0.001) and reduced total operative time in 22.25 minutes in favor of the 3D printing group (95%CI 49.95; 5.80 min, I2=0%, p=0.817) but without statistical significance. Albeit in a smaller sample, other endpoints (mechanical ventilation and ICU time) demonstrated some benefit from the technology but without statistical significance.</p><p><strong>Conclusions: </strong>By providing personalized anatomical models, 3D printing may facilitate surgical planning and execution. More studies are needed to investigate the effects of 3D printing on reducing intervention, hospitalization, and mechanical ventilation times.</p>","PeriodicalId":93887,"journal":{"name":"Arquivos brasileiros de cardiologia","volume":"121 12","pages":"e20240430"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451293","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}