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

Original Article

Cardiometabolic disorders in hypertensive women with abdominal obesity

Tarik de Almeida Isbele; Ana Rosa Cunha; Jenifer d'El-Rei; Michelle Trindade; Marcela Casanova; Wille Oigman; Mario Fritsch Neves

BACKGROUND: Studies show increased waist circumference as a relevant indicator of increased cardiovascular risk (CVR).
OBJECTIVE: To identify structural and functional cardiac abnormalities in nondiabetic hypertensive women with abdominal obesity (AO).
METHODS: Cross-sectional study with 120 hypertensive women, aged 40-65, stratified into: group with no abdominal obesity (NAO, n=42) and with abdominal obesity (QAO, n=78), and waist circumference < or ≥88 cm, respectively. Clinical evaluation, biochemical tests, Doppler echocardiography and carotid ultrasound were conducted.
RESULTS: Average age was 53±1 in the groups. Although the systolic blood pressure (BP) was higher in the WAO group, it did not reach statistical significance (145±2 mmHg vs. 140±2 mmHg, p=0.098). The WAO group had higher diastolic BP (90±1 mmHg vs. 85±1 mmHg, p<0.05), greater number of criteria (3.1±0.1 vs. 1.4±0.1, p<0.001) and prevalence of metabolic syndrome (62.8% vs. 11.9%; p<0.001). Despite normal blood glucose levels, WAO patients had higher HOMA-IR levels (2.62±0.22 vs. 1.61±0.17 p<0.01) and HOMA-beta levels (358±57 vs. 200±22, p<0.05). In the echocardiographic evaluation, systolic function was similar in both groups, but the WAO group presented evidence of diastolic dysfunction by tissue Doppler and higher prevalence of left ventricular hypertrophy (29.2% vs. 2.4%), with no difference between the carotid artery intima-media thickness.
CONCLUSIONS: In this sample of nondiabetic hypertensive women, abdominal obesity was associated with higher levels of diastolic blood pressure, reduced insulin sensitivity and cardiac issues, especially left ventricular hypertrophy and diastolic dysfunction. However, there was no evidence of subclinical carotid atherosclerosis in hypertensive patients with and without abdominal obesity.

Vídeos

Left ventricular noncompaction in adulthood: heart failure clinic experience

Original Article

Mechanical ventilation time and peripheral muscle strength in post-heart surgery

André Luiz Lisboa Cordeiro; Gardênia Oliveira Queiroz; Marcele Martins Souza; André Raimundo Guimarães; Thiago Melo de Araújo; Marco Aurélio de Valois Correia Junior; Sarah Oliveira Carvalho; Max Paulo Peruna

Review Article

Cirrhotic cardiomyopathy

Jessica Bicca; Luiza Porto Jarske; Thamires Oliveira Silva; Ronaldo Gismondi; Luís Otávio Mocarzel; Pedro Gemal Lanzieri

Medical Challenges

EBSY invites you to prepare your appraisal according to the below recommendations

Desafio Médico

Editorial

Education and research - Challenges and opportunities

Ensino e pesquisa - Desafios e oportunidades

Cláudio Tinoco Mesquita

Int J Cardiovasc Sci. 2016;29(2):86-87

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Keywords: Publications; Education; Indicators

Original Article

Cardiometabolic disorders in hypertensive women with abdominal obesity

Alterações cardiometabólicas em mulheres hipertensas com obesidade abdominal

Tarik de Almeida Isbele; Ana Rosa Cunha; Jenifer d'El-Rei; Michelle Trindade; Marcela Casanova; Wille Oigman; Mario Fritsch Neves

Int J Cardiovasc Sci. 2016;29(2):88-96

AbstractPDF PORTPDF ENGLISH

BACKGROUND: Studies show increased waist circumference as a relevant indicator of increased cardiovascular risk (CVR).
OBJECTIVE: To identify structural and functional cardiac abnormalities in nondiabetic hypertensive women with abdominal obesity (AO).
METHODS: Cross-sectional study with 120 hypertensive women, aged 40-65, stratified into: group with no abdominal obesity (NAO, n=42) and with abdominal obesity (QAO, n=78), and waist circumference < or ≥88 cm, respectively. Clinical evaluation, biochemical tests, Doppler echocardiography and carotid ultrasound were conducted.
RESULTS: Average age was 53±1 in the groups. Although the systolic blood pressure (BP) was higher in the WAO group, it did not reach statistical significance (145±2 mmHg vs. 140±2 mmHg, p=0.098). The WAO group had higher diastolic BP (90±1 mmHg vs. 85±1 mmHg, p<0.05), greater number of criteria (3.1±0.1 vs. 1.4±0.1, p<0.001) and prevalence of metabolic syndrome (62.8% vs. 11.9%; p<0.001). Despite normal blood glucose levels, WAO patients had higher HOMA-IR levels (2.62±0.22 vs. 1.61±0.17 p<0.01) and HOMA-beta levels (358±57 vs. 200±22, p<0.05). In the echocardiographic evaluation, systolic function was similar in both groups, but the WAO group presented evidence of diastolic dysfunction by tissue Doppler and higher prevalence of left ventricular hypertrophy (29.2% vs. 2.4%), with no difference between the carotid artery intima-media thickness.
CONCLUSIONS: In this sample of nondiabetic hypertensive women, abdominal obesity was associated with higher levels of diastolic blood pressure, reduced insulin sensitivity and cardiac issues, especially left ventricular hypertrophy and diastolic dysfunction. However, there was no evidence of subclinical carotid atherosclerosis in hypertensive patients with and without abdominal obesity.


Keywords: Hypertension; Abdominal obesity; Insulin resistance; Metabolic X syndrome; Cardiovascular system

Assessing the impact of new guidelines on the use of statins

Avaliação do impacto das novas diretrizes no uso de estatinas

Sulyane Matos de Menezes Alves; Amberson Vieira de Assis; Ozir Miguel Londero Filho; Camila Bussolo Schmitt; Milton Ricardo Poffo; Nilton Rogério Alves Filho

Int J Cardiovasc Sci. 2016;29(2):97-102

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BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in Brazil and has a direct connection with dyslipidemia.
OBJECTIVE: To analyze the pattern of use of statins before and after the publication of the new guidelines on dyslipidemia in patients with a history of atherosclerotic cardiovascular disease.
METHODS: Cross-sectional retrospective study. In this study, 515 consecutive patients with atherosclerotic were randomly evaluated at the outpatient facility of Instituto de Cardiologia de Santa Catarina, SC, Brazil, between 2011 and 2015. Of these, only 76.9% were using statins. Data relating to clinical history, risk factors for cardiovascular disease, laboratory data for cholesterol levels (HDL-c and LDL-c) and triglycerides (TG) were collected, as well as treatment concerning the choice of statins and their doses before and after October 2013, when the new guidelines were published.
RESULTS: After the publication of the new guidelines, 477 patients used statins, representing 92.6% of the study sample (p=0.0001). As to the choice of statin, the use of simvastatin declined to 69.2% (p=0.02), atorvastatin increased to 25.2% (p=0.003) and rosuvastatin was 5.7% (p=ns). Before the release of the new guidelines, the average doses of simvastatin, atorvastatin and rosuvastatin were 33.6±9.4 mg, 32.1±18.9 mg, 13.1±7.9 mg, respectively. After publication, these average doses increased to: simvastatin 36.7±7.9 mg (p=0.0001) and atorvastatin 36.8±16.2 mg (p=0.0001).
CONCLUSIONS: The statin use rates in the study sample increased after the publication of the new ACC/AHA Guidelines and the V Brazilian Guidelines on Dyslipidemia. However, they reached a limited number of patients, associated with doses below the recommended and improper numerical targets of cholesterol, which can generate unfavorable prognostic implications.


Keywords: Hydroxymethylglutaryl-CoA reductase inhibitors; Dyslipidemias; Secondary prevention; Atherosclerosis

Assessment of motor development of children with congenital heart disease

Avaliação do desenvolvimento motor de crianças portadoras de cardiopatia congênita

Lais Sena Leal; Rafael Luiz Morais da Silva; Karla Maria Siqueira Coelho Aita; Rogéria Pimentel de Araújo Monteiro; Tatiana Carvalho de Montalvão

Int J Cardiovasc Sci. 2016;29(2):103-109

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BACKGROUND: Children with congenital heart disease have a higher risk of presenting delay in development. This is why they must attend monitoring and assessment programs to identify such risks and for an early intervention.
OBJECTIVE: To assess the relationship between changes in the development of motor skills and congenital heart defects in children.
METHODS: Cross-sectional study with a quantitative approach involving 30 children of both sexes, with congenital heart disease. The motor development scale was used for the assessment of motor skills.
RESULTS: The motor skills assessed were found to be significantly below the normal average level (p<0.05). Three aspects of motor development revealed significant risk to development: body scheme, spatial organization and temporal organization.
CONCLUSION: There was an association of abnormalities in the development of some motor aspects and the presence of congenital heart disease. It is essential to assess motor development from early childhood, considering the interference of clinical diagnosis and the need to monitor the development and any early intervention that may be required.


Keywords: Heart defects, congenital; Occupational therapy; Child development; Motor skills

Prosthesis-patient mismatch in individuals undergoing aortic valve replacement

Desproporção prótese-paciente em indivíduos submetidos à troca valvar aórtica

Ramsés Miotto; Marcos Venicio Garcia Joaquim

Int J Cardiovasc Sci. 2016;29(2):110-117

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BACKGROUND: Prosthesis-patient mismatch (PPM) in patients undergoing aortic valve replacement surgery is the subject of many research studies and is associated with worse prognosis in the long term.
OBJECTIVES: To evaluate the incidence of PPM after aortic valve replacement surgery and characterize the clinical profile of patients undergoing this surgery.
METHODS: Cross-sectional observational retrospective study of 53 patients hospitalized for surgical treatment of severe aortic valve stenosis from January 2014 to June 2015. Three models of bioprosthesis and a metal prosthesis model were used. Indexed effective orifice area (iEOA) was calculated by dividing the effective orifice area provided by the prosthesis manufacturer by the body surface area of the recipient patient. The presence of PPM was defined when iEOA <0.90 cm2/m2.
RESULTS: The average age of patients was 65,8±9,9. Male sex prevailed. Overall mortality rate was 11.3%. PPM occurred in 32.0% of patients, mostly of which were moderate degree. The prosthesis Biocor showed 70.5% of PPM while the Braile prosthesis showed no case. There was no difference in the reduction of transvalvular aortic gradients in the postoperative period between the groups with and without PPM.
CONCLUSIONS:The patients profile is similar to that described in the literature, the incidence of PPM is high, varying greatly between the prosthesis models. There was no difference in the reduction of postoperative gradients between the groups with or without PPM.


Keywords: Aortic valve stenosis; Heart valve prosthesis implantation; Prosthesis fitting; Prosthesis failure

Reverse left atrial remodeling after treatment with carvedilol in patients with HFREF

Remodelamento reverso do átrio esquerdo após terapia com carvedilol em pacientes com ICFER

Fabiano de Lima Freire; Samuel Moscavitch; Sandra Marina Ribeiro de Miranda; Mario Luiz Ribeiro; Ronaldo Campos Rodrigues; Claudio Tinoco Mesquita

Int J Cardiovasc Sci. 2016;29(2):118-127

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BACKGROUND: Half of the patients with reduced ejection fraction have diastolic dysfunction associated and the data related to the impact of carvedilol therapy in these patients are still conflicting.
OBJECTIVE: To evaluate the behavior of echocardiographic, scintigraphic and left atrial volume (LAV) indexes before and after three months of therapy with carvedilol in patients with HFREF, New York Heart Association (NYHA) functional class (FC) II and III.
METHODS: Nineteen patients with HF, CF II and III, ejection fraction <45% (Simpson method) without previous therapy with carvedilol were selected. For statistical analysis, Wilcoxon and McNemar tests, Spearman coefficient and multiple linear regression were used.
RESULTS: There was significant improvement in the left ventricular (LV) systolic function parameters: DSF, ESV, Simpson EF, EFVI. There was no significant improvement in the diastolic function parameters derived from Doppler: E', E/E', VP, E/VP. Diastolic function behavior through VAE showed significant improvement: LAV (83.2±33.4 mL vs. 73.7±29.8 mL, p=0.009), LAV index (44.8±15.8 mL/m2 vs. 39.7±14.5 mL/m2, p=0.014).
CONCLUSIONS: LAV regression after short-term therapy with carvedilol was not associated with improvement in other diastolic function indexes, but was associated with improved LV systolic function. These findings suggest that LAV reduction is secondary to improvement in systolic performance.


Keywords: Heart failure; Heart atria; Adrenergic beta-antagonists

Original Article

Severity of subvalvular impairment in the results of mitral valvuloplasty with Inoue catheter

Importância do comprometimento subvalvar nos resultados da valvoplastia mitral com cateter de Inoue

Dárcio Gitti de Faria; Adelino Parro Junior; José Luiz Balthazar Jacob

Int J Cardiovasc Sci. 2016;29(2):128-133

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BACKGROUND: Balloon mitral valvuloplasty was introduced in 1984 by Inoue et al and is currently considered the method of choice in the treatment of mitral stenosis.
OBJECTIVE: To compare results of mitral valvuloplasty in patients with mitral stenosis with subvalvular impairment >3 and <3.
METHODS: Retrospective study with 104 patients undergoing mitral valvuloplasty with Inoue balloon. Patients were stratified into two groups: subvalvular impairment (SVI) >3 and SVI <3. The immediate results were compared at 12 months and 24 months or more between the groups with data obtained by echocardiography and hemodynamic study.
RESULTS: The immediate results revealed success in both groups, with statistical significance pre/post-procedure regarding the echocardiographic and hemodynamic parameters and no significant differences between groups. Echocardiographic results at 12 months showed that the mean gradient and the valve area were similar and not statistically significant between the groups, the same occurring in the comparison of echocardiographic results at 24 or more months.
CONCLUSION: The results obtained with mitral valvuloplasty with Inoue balloon did not differ both in patients with subvalvular impairment >3 and <3.


Keywords: Mitral valve stenosis; Balloon valvuloplasty; Mitral valve

Mechanical ventilation time and peripheral muscle strength in post-heart surgery

Tempo de ventilação mecânica e força muscular periférica na pós-cirurgia cardíaca

André Luiz Lisboa Cordeiro; Gardênia Oliveira Queiroz; Marcele Martins Souza; André Raimundo Guimarães; Thiago Melo de Araújo; Marco Aurélio de Valois Correia Junior; Sarah Oliveira Carvalho; Max Paulo Peruna

Int J Cardiovasc Sci. 2016;29(2):134-138

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BACKGROUND: In recent years, there has been an increasing number of heart surgeries (HS). These are accompanied by complex processes that lead to complications. Invasive mechanical ventilation (IMV) can cause severe reduction in respiratory and peripheral muscle strength. Protocols of early weaning and mobilization are currently found, aimed at reducing IMV time.
OBJECTIVE: To correlate IMV time on peripheral muscle strength in patients undergoing heart surgery.
METHODS: Prospective cross-sectional study involving patients from the Intensive Care Unit (ICU) of a reference cardiology hospital in the city of Feira de Santana, BA, Brazil, from April 2014 to August 2015. The patients were evaluated preoperatively regarding their peripheral muscle strength through the Medical Research Council (MRC) scale. IMV time during surgery was noted down. After 12 hours of surgery, peripheral muscle strength was re-evaluated using the MRC scale.
RESULTS: The study included 69 patients (56.5% men) with mean age of 52.5±16.9 years. Significant differences were found between invasive ventilatory assistance time (7.3±2.6 hours) and reduction in final peripheral muscle strength (47.5±3.8) through the MRC scale, with p=0.0001. Initial and final MRC (59.8±0.5 vs. 47.5±3.8; p=0.21) and cardiopulmonary bypass (CPB) time and final MRC (65.1±20.1 minutes vs. 47.5±3.8; p=0.74) were also correlated.
CONCLUSION: It was found that longer IMV time caused a reduction in peripheral muscle strength in patients undergoing heart surgery.


Keywords: Respiration, artificial; Weaning; Physical therapy specialty; Thoracic surgery

Review Article

Cirrhotic cardiomyopathy

Cardiomiopatia cirrótica

Jessica Bicca; Luiza Porto Jarske; Thamires Oliveira Silva; Ronaldo Gismondi; Luís Otávio Mocarzel; Pedro Gemal Lanzieri

Int J Cardiovasc Sci. 2016;29(2):139-148

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Cirrhotic cardiomyopathy (CCM) is a chronic cardiac dysfunction that affects cirrhotic patients without history of heart disease. It is an initially asymptomatic disease that appears in situations of increased metabolic demand due to lower cardiac capacity to increase inotropism. Diagnosis is based on disorders revealed by electrocardiography and echocardiography. There is no specific treatment for CCM. Similar symptomatic medications are established to treat heart failure. This review aims to describe the pathophysiological, clinical and diagnostic aspects of CCM, showing the clinical, laboratory, electrocardiographic and echocardiographic characteristics in assessing cardiac dysfunction in cirrhotic patients.


Keywords: Cardiomyopathies; Liver cirrhosis; Heart failure; Hepatic insufficiency

Case Report

Unusual form of tricuspid stenosis!

Uma forma rara de estenose tricúspide!

Ana Rita Pereira Alves Ferreira; Sofia Lazaro Mendes; Rui Martins; Silvia Monteiro; Mariano Pego

Int J Cardiovasc Sci. 2016;29(2):149-151

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Tricuspid stenosis, in rare cases, can be induced by pacemaker electrodes. We report the case of a 72-year-old patient who, in 1982, underwent surgical ablation procedure for Wolf-Parkinson-White syndrome. The procedure was complicated by complete atrioventricular block, evolving into permanent pacemaker implantation. In 1992, due to pacemaker pocket infection, the generator was removed and extraction of the electrodes was attempted without success. The patient follow-up was lost until November 2014, when he was admitted for several episodes of syncope and right heart failure. Tricuspid stenosis was diagnosed and surgery was chosen as treatment.


Keywords: Tricuspid valve stenosis; Pacemaker, artificial; Heart failure

Point of View

Counseling on sexual activity after acute myocardial infarction: are we overlooking it?

Orientação para a atividade sexual após infarto agudo do miocárdio: estamos negligenciando?

Janaina Rocha Niehues; Ana Inês Gonzáles; Danielle Soares Rocha Vieira

Int J Cardiovasc Sci. 2016;29(2):152-154

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Acute myocardial infarction (AMI) causes significant changes in the life of patients, who face physical and psychological challenges. These include reduction in sexual activity, a factor that influences the quality of life. It is therefore important that health professionals be able to advise patients on the resumption of sexual activity after AMI and how to do that safely. This study is designed to emphasize the neglected need for healthcare professionals to perform such guidance properly, thus contributing to the quality of life of the patient.


Keywords: Sexual behavior; Myocardial infarction; Sexual dysfunction, physiological; Rehabilitation

Erratum

Erratum

Int J Cardiovasc Sci. 2016;29(2):155

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