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ISSN (Print): 2359-4802 | ISSN (Online): 2359-5647

Original Article

High-sensitivity C-reactive protein in patients undergoing contrast studies

José Carlos Carraro-Eduardo; Luis Guillermo Coca Velarde; Mariana Franco Ferraz Santino; Diego Cerqueira Alexandre; Danielle Calil de Sousa; Iuna Almeida Deveza

BACKGROUND: The use of iodinated agents in radiological studies can cause contrast-induced nephropathy (CIN) in the presence of classic risk factors such as previous renal disease and diabetes. High serum levels of high-sensitivity C-reactive protein (CRP) have been described as indicators of increased risk of CIN. Regardless of the occurrence of CIN, hs-CRP may rise after contrast studies.
OBJECTIVE: To investigate the behavior of hs-CRP in patients undergoing parenteral administration of iodinated contrast agent.
METHODS: Observational cross-sectional prospective study held at Hospital Universitário Antônio Pedro from 2007 to 2014 involving 51 patients, 30 men and 21 women, mean age 60.19±20.0, undergoing tests with low-osmolality contrast (Iopamidol 612 mg/ml).
RESULTS: CIN occurred in 15 patients (29.4%). There was no correlation between increased hs-CRP and occurrence of CIN. The percentage increase in hs-CRP was significantly higher among patients undergoing cardiac catheterization (p=0.0044). The mean increase in hs-CRP in patients undergoing cardiac catheterization and in those submitted to administration of iodinated contrast by peripheral vein was 100.3% and 13.8%, respectively.
CONCLUSION: The findings suggest that increased hs-CRP after cardiac catheterization cannot be attributed to iodinated contrast agent.

Vídeos

Left ventricular noncompaction in adulthood: heart failure clinic experience

Original Article

Prevalence of anemia in patients with heart failure

Worens Luiz Pereira Cavalini; Nico Ceulemans; Ramon Bedenko Correa; Patrick Willian Padoani; Edson Felipe Grudinski Delfrate; Eliane Mara Cesário Pereira Maluf

Original Article

Echocardiographic findings in patients with secondary hyperparathyreoidism

André Falcão Pedrosa Costa; Paulo Regis Távora Diniz Júnior; Vitorino Modesto dos Santos

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Original Article

High-sensitivity C-reactive protein in patients undergoing contrast studies

Proteína C-reativa ultrassensível em pacientes submetidos a exames contrastados

José Carlos Carraro-Eduardo; Luis Guillermo Coca Velarde; Mariana Franco Ferraz Santino; Diego Cerqueira Alexandre; Danielle Calil de Sousa; Iuna Almeida Deveza

Int J Cardiovasc Sci. 2016;29(1):1-5

AbstractPDF PORTPDF ENGLISH

BACKGROUND: The use of iodinated agents in radiological studies can cause contrast-induced nephropathy (CIN) in the presence of classic risk factors such as previous renal disease and diabetes. High serum levels of high-sensitivity C-reactive protein (CRP) have been described as indicators of increased risk of CIN. Regardless of the occurrence of CIN, hs-CRP may rise after contrast studies.
OBJECTIVE: To investigate the behavior of hs-CRP in patients undergoing parenteral administration of iodinated contrast agent.
METHODS: Observational cross-sectional prospective study held at Hospital Universitário Antônio Pedro from 2007 to 2014 involving 51 patients, 30 men and 21 women, mean age 60.19±20.0, undergoing tests with low-osmolality contrast (Iopamidol 612 mg/ml).
RESULTS: CIN occurred in 15 patients (29.4%). There was no correlation between increased hs-CRP and occurrence of CIN. The percentage increase in hs-CRP was significantly higher among patients undergoing cardiac catheterization (p=0.0044). The mean increase in hs-CRP in patients undergoing cardiac catheterization and in those submitted to administration of iodinated contrast by peripheral vein was 100.3% and 13.8%, respectively.
CONCLUSION: The findings suggest that increased hs-CRP after cardiac catheterization cannot be attributed to iodinated contrast agent.


Keywords: Contrast media; Inflammation; Cardiac catheterization; Acute kidney injury; Multidetector computed tomography

Prevalence of anemia in patients with heart failure

Prevalência de anemia em pacientes com insuficiência cardíaca

Worens Luiz Pereira Cavalini; Nico Ceulemans; Ramon Bedenko Correa; Patrick Willian Padoani; Edson Felipe Grudinski Delfrate; Eliane Mara Cesário Pereira Maluf

Int J Cardiovasc Sci. 2016;29(1):6-12

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BACKGROUND: The prevalence of anemia and the morphology of red blood cells in patients hospitalized with heart failure (HF) are not totally known.
OBJECTIVE: To check the prevalence of anemia in patients diagnosed with HF, characterize the morphology and check its association with NYHA functional class.
METHODS: Cross-sectional retrospective study with 144 patients from the Brazilian Public Health System hospitalized for HF at Hospital da Cruz Vermelha, Curitiba, PR, January 2010 to July 2014. Sociodemographic data and admission blood count information were taken from the patients' medical records. The blood count analysis included: hemoglobin levels, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and anisocytosis index (RDW). The reference values to characterize anemia followed the World Health Organization's guidelines.
RESULTS: Population studied with similar distribution of sex (52.8% men), mean age 67.8±13.8 years and nearly all of them (95.8%) self-reported white ethnicity. Anemia prevalence in this population was 41.0%, the majority (38.2%) corresponding to mild to moderate degrees. Functional class III (FC III) was the most prevalent one (63.2%), followed by FC IV (31.3%). The main morphological characteristic found was normocytic and hypochromic with 49.1%. Correlation of anemia with increasing age (>60 years) was found with p=0.008.
CONCLUSIONS: Prevalence of anemia in patients with HF was higher in older age groups, in FC III and IV, and the main morphological characteristic was normocytic and hypochromic.


Keywords: Anemia; Heart failure; Epidemiology; Comorbidity

Echocardiographic findings in patients with secondary hyperparathyreoidism

Achados ecocardiográficos em pacientes com hiperparatireoidismo secundário

André Falcão Pedrosa Costa; Paulo Regis Távora Diniz Júnior; Vitorino Modesto dos Santos

Int J Cardiovasc Sci. 2016;29(1):13-18

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BACKGROUND: Cardiovascular diseases are frequent in the course of chronic kidney disease, are an important cause of death, and cause 1/3 of hospitalizations of patients on dialysis. Secondary hyperparathyroidism is the most common metabolic disorder in kidney failure. Its pathophysiology involves changes in the balance of calcium, phosphorus, calcitriol and parathyroid hormone.
OBJECTIVE: To assess the prevalence of echocardiographic abnormalities in chronic kidney disease patients with secondary hyperparathyroidism, according to plasma levels of parathyroid hormone.
METHODS: Retrospective study conducted based on data recorded in medical records between 2005 and 2007, including 52 individuals of both sexes with chronic kidney disease on a regular dialysis program, stratified based on plasma levels of parathyroid hormone into three groups: Group I < 299 pg/mL (n=10); Group II between 300-499 pg/mL (n=21); and Group III >500 pg/mL (n=21).We evaluated the following echocardiographic parameters: aortic root diameter, left atrial and ventricular diameter; septal and posterior wall thickness; ejection fraction; and end diastolic and systolic volumes.
RESULTS: The comparative analysis of the echocardiographic findings in the three groups revealed that the only variable presenting statistical significance (p 0.009) was diastolic posterior wall thickness.
CONCLUSION: Patients with chronic kidney disease with secondary hyperparathyroidism may present echocardiographic changes, some of which correlate with circulating levels of parathyroid hormone.


Keywords: Renal insufficiency, chronic; Hyperparathyroidism, secondary; Echocardiography

Sensitivity and specificity of ischemia modified albumin in Wistar rats

Sensibilidade e especificidade da albumina modificada pela isquemia em ratos Wistar

Jordana Colombo; Elvis Wisniewski; Michelle Faggion; Simone Hubner da Silva; Luiz Carlos Chicota; Miriam Salete Wilk Wisniewski; Silvane Souza Roman; Patrícia Severo do Nascimento

Int J Cardiovasc Sci. 2016;29(1):19-23

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BACKGROUND: Acute myocardial infarction (AMI) is a condition determined by an acute ischemic process resulting in myocardial necrosis. Cardiac markers in reversible ischemia currently have limited sensitivity.
OBJECTIVE: To check the sensitivity of ischemia modified albumin (IMA) as a cardiac marker.
METHODS: Experimental study held at the Animal Experimentation Laboratory of Universidade Regional Integrada (URI), Erechim, RS, from 2011 to 2013. After myocardial ischemic induction in Wistar-Tecpar rats aged about 60-90 days through administration of isoproterenol hydrochloride, the IMA content was evaluated at different times.
RESULTS: The IMA values remained reduced during the three first hours after ischemic induction by isoproterenol hydrochloride.
CONCLUSION: In this study, ischemia modified albumin was considered a sensitive marker, particularly in the first three hours of ischemia.


Keywords: Albumins; Myocardial ischemia; Myocardial infarction

Impact of pulmonary hypertension on surgical mortality and 3-year survival after aortic valve replacement

Impacto da hipertensão pulmonar na mortalidade cirúrgica e na sobrevida em três anos pós-cirurgia de troca valvar aórtica

Rafael Lessa da Costa; Cristiane da Cruz Lamas; Vitor Manuel Pereira Azevedo; Eulina Maria dos Santos Chaves Cardoso; Luciano Pereira Duarte; Clara Weksler

Int J Cardiovasc Sci. 2016;29(1):24-30

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BACKGROUND: Severe pulmonary hypertension (PH) contributes to significant morbidity and mortality and may increase the number of complications and death in heart surgery.
OBJECTIVE: To evaluate the impact of PH on surgical mortality and three-year survival after aortic valve replacement surgery.
METHODS: Retrospective cohort study of patients undergoing aortic valve replacement surgery from May 2011 to December 2012 at Instituto Nacional de Cardiologia, RJ. The study population was stratified into two groups according to the systolic pulmonary artery pressure (SPAP): <45 mmHg and >45 mmHg. The chi-square test was used for comparison between groups; surgical mortality was studied by logistic regression and survival by Kaplan-Meier method and log-rank test; the hazard ratio was examined using the Cox method.
RESULTS: The study included 182 patients, 57.0% were males aged 61.0±13.0 years, with systemic arterial hypertension (72.0%), diabetes mellitus (22.0%), functional class by the New York Heart Association III/IV (61.1%), SPAP >45 mmHg (14.3%). Overall mortality rate was 12.0%. Survival rate was higher in the group with SPAP <45 mmHg - 89.0% at one year and 86.0% at three year compared with the group with SPAP >45 mmHg - 68.8% at one year and 58.1% (35.1% to 75.4%) at three years (p=0.0004).
CONCLUSION: Patients with SPAP >45 mmHg had higher surgical mortality and worse survival at three years after aortic valve replacement surgery.


Keywords: Aortic valve; Cardiac surgical procedures; Hypertension, pulmonary; Mortality; Survival rate

Importance of academic quality in the treatment of chronic venous insufficiency

Importância da qualidade da formação acadêmica no tratamento da insuficiência venosa crônica

Jefferson Petto; Vinícius Afonso Gomes; Francisco Tiago Oliveira de Oliveira; Marcos Paulo Alves dos Santos; Paulo Ricardo Pinto Barbosa; Alan Carlos Nery dos Santos

Int J Cardiovasc Sci. 2016;29(1):31-36

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BACKGROUND: Studies have shown limitations in the knowledge of academics and health professionals on a variety of clinical conditions. However, there is little research in the field of cardiovascular sciences.
OBJECTIVE: To identify and describe the level of knowledge of Physiotherapy graduates on chronic venous insufficiency (CVI).
METHODS: Descriptive cross-sectional observational study with graduates in the last year of physiotherapy undergraduate studies randomly selected from six higher education institutions. Data were collected through a self-administered structured questionnaire addressing academic education, clinical aspects and physiotherapy interventions on CVI. The students were grouped into: FSDA - universities where Angiology is not taught; FPNE - universities where a non-specialist professor teaches Angiology; and FPE - universities where a specialist professor teaches Angiology.
RESULTS: The evaluation covered 101 graduates. Of these, only 4.9% were familiar with of all the techniques and methods to diagnose CVI and 44.0% did not mention clinical examination as diagnostic evaluation. Of the 35 FPNE students, 18 (51.0%) did not mention clinical examination and 31.0% mentioned incorrect CVI diagnosing methods. Of the 19 FSDA students, 74.0% did not choose elastic compression as a means of treatment.
CONCLUSION: It was concluded that the evaluated graduates presented little knowledge on the main physiotherapy treatments and diagnostic methods for chronic venous insufficiency.


Keywords: Education, medical; Physical therapy specialty; Venous insufficiency; Rehabilitation

Original Article

Effects of different types of flaxseed flour in appetite and satiety sensations among overweight and obese women

Efeitos de diferentes tipos de linhaça nas sensações de apetite e saciedade no sobrepeso e na obesidade

Wânia Lúcia Araujo Monteiro; Glorimar Rosa; Ronir Raggio Luiz; José Firmino Nogueira Neto; Gláucia Maria Moraes de Oliveira

Int J Cardiovasc Sci. 2016;29(1):37-46

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BACKGROUND: Flaxseed is rich in fibers and is a nutritional strategy for the treatment of obesity.
OBJECTIVE: To compare the effects of three types of flaxseed flours in the appetite and satiety sensations in overweight and obese women.
METHODS: Five types of test meals were randomly consumed: 400 g of low-fat yogurt with 30 g of the following types of flaxseed flour: whole brown flaxseed flour (WBFF), brown defatted flaxseed flour (BDFF), golden flaxseed flour (GFF) or 14 g of soluble fiber (guar gum) or yogurt (control). Evaluation of the appetite and satiety sensation was held 0 (fasting), 15, 45, 75 and 105 minutes after the test meal using an adapted visual analogue scale. Variation on the rate between times T0-T15 and T15-T105 was calculated and the volunteers were ranked into four quadrants according to the average and variation rates.
RESULTS: The groups supplemented with flaxseed showed similar behavior in the sensation of appetite and satiety; with BDFF, there was a weaker sensation of appetite and greater satiety, and greater frequency of the overweight group (47.0%) and grade 1 obesity group (47.6%) in the "Loses slowly and gains slowly" quadrant. The overweight group appeared more frequently (41.2%) in the "Loses quickly and gains quickly" quadrant. The grade 1 obesity group appeared more frequently (31.8%) in the "Loses slowly and gains quickly" quadrant.
CONCLUSION: Intake of BDFF led to reduced appetite and increased satiety probably due to the higher viscosity and greater amount of protein found in flaxseed.


Keywords: Women; Dietary fiber; Obesity; Flax

Pharmacological therapy adherence: a poorly explored benefit of cardiac rehabilitation

Benefício pouco explorado da reabilitação cardíaca: alta aderência à terapêutica farmacológica

Fabio Akio Nishijuka; Claudio Gil Soares de Araújo

Int J Cardiovasc Sci. 2016;29(1):47-55

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BACKGROUND: Participation in cardiac rehabilitation programs (CRP) or supervised exercise programs (SEP) is strongly recommended in the secondary prevention of coronary artery disease (CAD). To optimize the therapy outcome there should be high adherence to drug therapy (ADT).
OBJECTIVE: To analyze adherence to drug therapy in supervised exercise program participants.
METHODS: Data from 191 patients (74% men) aged between 35 and 92 years (mean age 71±10.0) regularly attending SEP in a private clinic in Rio de Janeiro, RJ. Information on ADT was sourced from structured interviews conducted by the doctors responsible for the SEP sessions. Demographic and clinical data, as well as information about SEP attendance, were extracted from electronic medical records.
RESULTS: 92% of patients reported correct use of medications/dosages prescribed by their doctors in the week preceding the interview, while 8% admitted having partially failed; 66% knew their medications/dosage by heart. There were no differences between patients adhering and partially adhering to the drug therapy regarding sex - women 96% and men 91% (p= 0.25) - or age -> 65, 92% and <65 years, 92% (p=0.96). Patients with a medical background were able to list more accurately the medications/dosage compared to those without a medical background (86% vs. 61%; p<0.01).
CONCLUSION: Regular participants of SEP conducted in a private clinic showed a high rate of ADT. This may be related to medical assessment completed just before starting the exercise sessions. Whatever the reason, the high ADT appears to be an additional and important benefit of regularly attending the SEP, which had not have its clinical and epidemiological potential properly explored.


Keywords: Exercise; Cardiovascular diseases; Drug utilization

Review Article

Cardiovascular continuum 25 years - The evolution of an etiopathophysiology model

Continuum cardiovascular 25 anos - Evolução de um modelo etiofisiopatológico

Evandro Tinoco Mesquita; Amanda Vanessa Demarchi; Dezirrê dos Santos Bitencourt; Patricia Elaine de Azevedo Machado; Paula Meneguini Badran; Renata Gudergues Pereira de Almeida; Antonio José Lagoeiro Jorge

Int J Cardiovasc Sci. 2016;29(1):56-64

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The concept of cardiovascular continuum was devised by Dzau and Braunwald and spread among cardiologists as an etiopathophysiology model that directs the development of interventionist measures in the prevention of cardiovascular diseases. After a workshop held in 1989, it was possible to gather resolved and unresolved issues about factors related to cardiovascular therapy and protection, resulting in the first publication by Dzau and Braunwald, in 1991. Progress in the studies of molecular and cellular biology allowed understanding the role of endothelial dysfunction in oxidative stress and nitric oxide in coronary artery atherosclerosis (CAA), awarding Nobel Prize to authors Ferid Murad, Robert Furchgott and Louis Ignarro. In 2006, a second publication, also led by Dzau, consolidated the classic model of cardiovascular continuum, in which risk factors for CAA are associated and trigger a progressive cascade of events leading to the final stages of cardiovascular disease. By observing the existence of ischemic myocardial diseases in populations with low incidence of coronary artery atherosclerosis, studies have shown that ischemic heart disease is not only associated with atherosclerosis, but also to vascular aging. This finding led to the publication of O'Rourke's third manuscript in 2010, which presented an additional model: vascular aging continuum. The evolution of this model allowed focusing on preventive treatments for the risk factors of CAA and the search for therapies capable of preventing endothelial damage caused by vascular aging and modulating oxidative stress. This review aims to bring together the leading studies that support the evolution of the cardiovascular continuum model over 25 years.


Keywords: Primary prevention; Secondary prevention; Coronary artery disease; Atherosclerosis

Psychiatric disorders and cardiovascular system: heart-brain interaction

Doenças psiquiátricas e o sistema cardiovascular: interação cérebro e coração

Fernando José Nasser; Marcos Merula de Almeida; Lucas Saraiva da Silva; Renata Gudergues Pereira de Almeida; Gustavo Borges Barbirato; Mauro Vitor Mendlowicz; Cláudio Tinoco Mesquita

Int J Cardiovasc Sci. 2016;29(1):65-75

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Depression and anxiety are psychiatric disorders that often coexist with coronary artery disease (CAD) and other cardiovascular diseases (CVD). Both depressive symptoms and anxiety are currently recognized as risk factors for CAD and CVD, and present complex pathophysiological processes that seem to adversely influence the prognosis of patients with these comorbidities. These symptoms include hypercortisolism, sympathetic hyperactivity, complex platelet abnormalities, immune activation leading to inflammatory response, common genetic factors and association with behaviors that predispose to cardiovascular disease. Strategies for treating depression such as using selective serotonin reuptake inhibitors (SSRI), have the potential to contribute to reducing the risk of acute coronary events. From a clinical perspective, instruments and protocols for screening and evaluating depression and anxiety are intended to counteract the negative effects of these disorders on the quality of life and cardiovascular health.


Keywords: Cardiovascular diseases; Mental disorders; Coronary disease

Case Report

Primary percutaneous coronary intervention of anomalous circumflex artery after mitral valve replacement

Angioplastia primária de artéria circunflexa anômala após cirurgia de troca valvar mitral

Rafael Alexandre Meneguz-Moreno; Antônio de Castro Filho; Mário Barbosa Guedes Nunes; Emerson Gonçalo Pereira Filho; Ricardo Alves da Costa; Alexandre Abizaid

Int J Cardiovasc Sci. 2016;29(1):76-79

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Anomalous origin of the circumflex coronary artery from the right sinus of Valsalva is the most frequent coronary anomaly. We report the case of a patient with anomalous circumflex artery originating from the right coronary artery, who underwent mitral valve replacement surgery evolving with cardiogenic shock and acute occlusion of the circumflex artery. Emergency percutaneous coronary intervention and bare-metal stent implantation were required. The patient improved clinically without any further cardiac complications.


Keywords: Percutaneous coronary intervention; Mitral valve; Thoracic surgery

Preliminary Communication

Healthcare social networks for patients with cardiovascular diseases and recommendation systems

Rede social de saúde para pacientes com problemas cardiovasculares e sistemas de recomendação

Edhelmira Lima Medina; Cláudio Tinoco Mesquita; Orlando Loques Filho

Int J Cardiovasc Sci. 2016;29(1):80-85

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BACKGROUND: The theme of Online Social Networks Health - OHSN is becoming increasingly important in the lives of patients. According to the literature, these environments provide an opportunity for them to express their views and share experiences of health situations, allowing them to forge relationships to give or receive emotional support.
OBJECTIVE: To evaluate the impact of OHSN Minha Saúde in the lives of patients with heart problems.
METHODS: Descriptive study conducted with patients in the cardiology clinic of Hospital Universitário Antônio Pedro (HUAP/UFF) in the first half of 2013. The study included interviews with 91 outpatients with cardiovascular problems. Of these, 45 (49.45%) patients with a mean age of 56.0±12.0 met the inclusion criteria for the study and agreed to participate. A questionnaire was applied to determine the user profile. Usability and accessibility tests were conducted following the Web Content Accessibility Guidelines 2.0. A network called Minha Saúde (My Health) focused on patients with cardiovascular problems was developed. In this environment, the following modules were available: Social management, a Health Care Plan (HCP) and a Friendship Recommender module (FRS). The participants agreed to participate in this network. Once the study period was finished, new questionnaires to assess the satisfaction, characteristics and benefits of the social network were applied.
RESULTS: The results indicate the presence of barriers and lack of familiarity with the participants' social networks. The content generated reveals interesting aspects from a psycho-emotional point of view, including: providing emotional support, better adherence to treatment, sharing information on diseases and getting life experiences.
CONCLUSION: The impact of the network was positive, allowing the participants to connect with people with similar health conditions, despite the lack of familiarity with the virtual environment.


Keywords: Social networking; Cardiovascular diseases; Discussion forums; Social support

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