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

Edição: 25.6 - 11 Article(s)


Balanço de 2012
Gláucia Maria Moraes de Oliveira
Rev Bras Cardiol. 2012;25(6):444-445


Survival rate for hemodialysis patients and association with angiotensinogen and ACE gene polymorphisms
Sobrevida de hemodialisados e sua associação com os polimorfismos dos genes da ECA e do angiotensinogênio

Mauro Alves; Nelson Albuquerque de Souza e Silva; Lucia Helena Alvares Salis; Basílio de Bragança Pereira; Paulo Henrique Godoy; Emilia Matos do Nascimento; José Mario Franco de Oliveira
Rev Bras Cardiol. 2012;25(6):447-455

+   Abstract  
BACKGROUND: The lethality rate for hemodialysis (HD) patients is high, which cannot be explained by traditional cardiovascular risk factors alone.
OBJECTIVE: To assess the survival rate and its association with the polymorphism of reninangiotensin system genes: ACE insertion/deletion and angiotensinogen M235T in HD patients.
METHODS: The initial analysis encompassed 473 chronic patients treated at four dialysis units in Rio de Janeiro State. The survival curves were calculated by the Kaplan-Meier method, with the differences between them evaluated by the Tarone-Ware and Peto-Prentice Tests.
RESULTS: For the population of 82 patients with up to 1 year of HD in Hardy-Weinberg equilibrium, the mean age was 53±15 years, of whom 55% were men. The overall survival rates were 74% and 44% at 5 and 11 years respectively. The major causes of death were circulatory system diseases (41%), infections (15%) and diabetes mellitus (15%). The logistic regression models presented a trend (p=0.0844) towards a shorter survival time for the TT polymorphism with an odds ratio of 3.931 (95% CI: 0.128 to 1.231).
CONCLUSIONS: The data indicate a possibility that the lethality risk of HD patients may be influenced not only by well-known cardiovascular risk factors such as age and diabetes mellitus, but also by angiotensinogen TT polymorphism.

Keywords: Renal dialysis; Survivorship (Public Health); Renal insufficiency, chronic; Polymorphism, genetic; Angiotensinogen


Evaluation of A1166C polymorphism of the AT1R receptor in chronic heart failure patients
Avaliação do polimorfismo A1166C no receptor AT1R em portadores de insuficiência cardíaca crônica

Silene Jacinto da Silva; Salvador Rassi; Cláudio Carlos da Silva
Rev Bras Cardiol. 2012;25(6):456-463

+   Abstract  
BACKGROUND: Heart failure is a common outcome of several cardiovascular diseases. Genetic evaluation promises individualized treatment based on the interaction between genetics and drugs. A1166C polymorphism of the angiotensin II AT1R receptor is associated with vasoconstriction and cardiac remodeling.
OBJECTIVE: To identify A1166C polymorphism in a longitudinal cohort consisting of 90 patients and evaluate the interaction of genotypes with different clinical variables.
METHODS: After genomic DNA extraction, Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR - RFLP) techniques were used in 30 patients with chronic heart failure with EF <40%, function class II - IV, and 60 control patients with cardiopathies, except heart failure.
RESULTS: The case/control genotype distribution was: 60/65% AA; 33.3/35% AC; 6.6/0% CC. The case/control genotype distribution was: 60/65% AA; 33.3/35% AC; 6.6/0% CC. There were no statistically significant differences between the groups (p=0.12). There was no evidence of interaction of A1166C polymorphism in terms of function class, etiology, ejection fraction, left atrium, left ventricular diastolic and systolic volume, and systolic and diastolic blood pressure. For the 12-month follow-up of the case group, the ejection fraction values were assessed (p=0.17).
CONCLUSION: There was no evidence that A1166C polymorphism interacts with heart failure.

Keywords: Angiotensin II; Heart failure; Genetic polymorphism


Profile and theoretical knowledge of cardiopulmonary arrest among physicians and nurses in the Rio Branco municipality, Acre state
Perfil e conhecimento teórico de médicos e enfermeiros em parada cardiorrespiratória, município de Rio Branco, AC

José Vitor Benevides Ferreira; Silvana Margarida Benevides Ferreira; Giovanni Bady Casseb
Rev Bras Cardiol. 2012;25(6):464-470

+   Abstract  
BACKGROUND: Cardiopulmonary arrest (CPA) is a serious and life-threatening occurrence.
OBJECTIVE: To analyze the profile and theoretical knowledge of CPA among physicians and nurses.
METHODS: Observational cross-sectional study conducted on the basis of information on CPA obtained from a population of physicians and nurses working in the Urgency and Emergency Hospital, Rio Branco Municipality, Acre State, in 2011.
RESULTS: Of the 31 participants, 74.2% were physicians and 25.8% were nurses, with a mean age of 33 years old. There was a larger proportion (70.6% vs. 35.7%; p=0.052) with less than five years experience among those who had not completed a basic life support course, with more females (65.2% vs. 12.5%; p = 0.013) who had not completed an advanced life support course, with more non-specialist nurses (85.7% vs. 8.3%; p=0.000). There was a prevalence (62.5% vs. 14.3%; p=0.032) of specialists who stated they do not check the urgency and emergency cart, and a higher proportion (70.6% vs. 35.7%, p=0.052) of non-specialists with less experience in CPA care.
CONCLUSION: The length of experience in CPA care, together with knowledge acquired during the basic and advanced life support courses suggest an influence on related care actions that could prevent premature deaths and ensure longer patient survival times. Heavier investments in training for the CPA care practitioners are recommended, especially for non-specialists and those with less experience, in order to enhance the efficacy of cardiopulmonary resuscitation.

Keywords: Heart Arrest/nursing; Heart arrest/ prevention & control; Nurses, Male/education; Epidemiology


Determinants of mortality for acute coronary syndrome with ST segment depression
Determinantes da mortalidade da síndrome coronariana aguda sem supradesnivelamento do segmento ST

Luiz José Martins Romêo Neto; Luiz José Martins Romêo Filho; José Geraldo de Castro Amino
Rev Bras Cardiol. 2012;25(6):471-478

+   Abstract  
BACKGROUND: Different papers highlight differences in mortality rates in terms of gender, age, risk factors, and variables obtained on admission and during the hospitalization of acute coronary syndrome (ACS) patients without ST segment elevation.
OBJECTIVES: To analyze mortality rates by gender, age groups, risk factors and the admission and progression variables resulting in mortality among ACS patients.
METHODS: Two year prospective study involving 389 patients, using the following data: medical history, clinical examinations, electrocardiograms, echocardiograms and hemodynamic studies. Univariate and multivariate analyses with logistic regression were conducted.
RESULTS: The population studied included 215 men, with most patients between 55 and 74 years old (n=207). There was no statistical correlation among gender, age, risk factors and mortality. In the univariate analysis, the main mortality predictors were: on admission, ST segment depression with T wave inversion and ST segment depression over 0.5mV; for progression, high TIMI score, worsening of ST segment alteration, unstable clinical progression, surgical indication and treatment, segmental, moderate and severe global dysfunction of the left ventricle, weakening of anterior wall and combinations, AMI recurrence, left ventricle failure and shock (p<0.0001). In the multivariate analysis, reinfarction, left ventricle failure and shock (p<0.0001) and surgical treatment (p=0.0140) were correlated with mortality.
CONCLUSIONS: The mortality rates were equivalent for men and women, age groups and risk factors. Reinfarction, left ventricle failure, shock and surgical treatment were predictors for mortality in the multivariate analysis.

Keywords: Acute coronary syndrome/mortality; Myocardial infarction; Electrocardiography; Ventricular dysfunction, left; Shock


Echocardiographic predictors of in-hospital mortality for decompensated heart failure: added value for ADHERE score
Preditores ecocardiográficos de mortalidade hospitalar na insuficiência cardíaca descompensada: valor adicional ao escore ADHERE

Eliza de Almeida Gripp; Andréa Silvestre de Sousa; Fernanda de Souza Nogueira Sardinha Mendes; Tatiana Abelin Saldanha Marinho; Marcelo Iorio Garcia; Luiz Augusto Feijó; Sérgio Salles Xavier
Rev Bras Cardiol. 2012;25(6):479-488

+   Abstract  
BACKGROUND: Heart failure (HF) is a major public health problem with high costs, frequent hospitalizations and high mortality rates. An awareness of clinical aspects and the laboratory and echocardiography findings of decompensated HF patients is crucial for clinicians. Through the ADHERE registry, a score was constructed to evaluate the risk of in-hospital death, with limited accuracy for the derivation cohort (ROC area under the curve - AUC 0.76).
OBJECTIVES: To evaluate the ADHERE score performance in a university hospital population in Rio de Janeiro, testing echocardiography parameters that, in association with the ADHERE score, would improve its accuracy.
METHODS: Retrospective observational study of 634 cases hospitalized for decompensated HF in the Clementino Fraga Filho University Hospital between January 1, 2006 and February 28, 2011, of whom 413 included echoDopplercardiogram data, constituting the study population.
RESULTS: The median age was 64 years old, with male predominance (55.0%) and systolic dysfunction of the left ventricle (82.1%). The ADHERE score area under the ROC curve for the general population and patients with echoDopplercardiograms differed from the ADHERE study values (0.63 vs. 0.62 vs 0.76 respectively). Associating the pulmonary artery systolic pressure with the predictive in-hospital mortality model resulted in an increase to 0.70 (CI 95% 0.59-0.80)
CONCLUSIONS: In this cohort of decompensated HF patients, the in-hospital death risk estimate using only the ADHERE score was limited. The pulmonary artery systolic pressure parameter added independent prognostic data, allowing a modest increase in the accuracy of this score.

Keywords: Heart failure/mortality; Echocardiography, Doppler; Hospitalization



Pre-excited tachycardia in a patient with mitral stenosis
Taquicardia pré-excitada em paciente com estenose mitral

Renato Côrtes de Lacerda; Júlio Constant Lohmann; Ana Luisa Rocha Mallet; Claudio Munhoz da Fontoura Tavares
Rev Bras Cardiol. 2012;25(6):489-493

+   Abstract  
A 52-year-old male patient with moderate mitral stenosis developed a sustained wide QRS tachycardia of 120 bpm, diagnosed as ventricular tachycardia through the Brugada algorithm. A subsequent ECG revealed an atypical flutter with variable atrioventricular conduction at different pre-excitation levels through the left lateral accessory pathway. In sinus rhythm, it was possible to note ventricular pre-excitation, which led to a diagnosis of atrial arrhythmia associated with the presence of an accessory pathway. In cases of pre-excited tachycardia, the Brugada algorithm can be misdiagnosed.

Keywords: Tachycardia, ventricular; Mitral valve stenosis; Atrial flutter; Wolff-Parkinson-White Syndrome



Electrical storm and cardiogenic shock after acute myocardial infarction
Tempestade elétrica e choque cardiogênico após infarto agudo do miocárdio

Neusa Perina de Jesus Jessen; Régina Limongi Figueiredo; Júlia Paulo Silva; Paola Martins Presta; Ricardo Mourilhe-Rocha

+   Abstract  
Acute myocardial infarction (AMI) is the main cause of cardiogenic shock, due to cardiac dysfunction and the resulting inadequate tissue perfusion, with severe clinical consequences. Electrical storms are another possible complication for AMI. The simultaneous occurrence of these complications is reported in a patient with AMI. Mechanical, pharmacological and hemodynamic support associated with primary percutaneous angioplasty, several cardioversions, combined anti-arrythmics and a biventricular cardio-defibrillator implant all contributed to a satisfactory outcome.

Keywords: Point sources storm; Shock, cardiogenic; Myocardial infarction; Tachycardia, ventricular


Embolization of AmplatzerTM occluder after transcatheter closure of atrial septal defect
Embolização da prótese de Amplatzer® após fechamento percutâneo de comunicação interatrial

Gerez Fernandes Martins; Barbara Jessen; Claudio Roberto Assunção Cavalcanti; João de Deus Brito; Serafim Borges; Kleiber Marciano Lima Bonfim
Rev Bras Cardiol. 2012;25(6):498-500

+   Abstract  
This is a case report on a young male patient with no history of heart disease. During his admission to a soccer club, a clinical examination and echocardiographic analysis detected the presence of an atrial septal defect, ostium secundum type. This was closed percutaneously, placing an AmplatzerTM prosthesis with no adverse occurrences. On the third day after the procedure, the patient complained of palpitations, and contacted the State Cardiology Institute. The embolization of the prosthesis into the right ventricle was detected. This was treated through surgery to remove the prosthesis, using a bovine pericardium to close the atrial septal defect.

Keywords: Interatrial communication; AmplatzerTM; Embolization


Acutely decompensated heart failure and treatment with non-invasive ventilation
Insuficiência cardíaca agudamente descompensada e o tratamento com ventilação mecânica não invasiva

Silvia dos Santos Rocha; Laíne Caroline Vicenzi; Ilmar Kolher; Luis Cláudio Danzmann
Rev Bras Cardiol. 2012;25(6):501-503

+   Abstract  
Heart failure (HF) is the common pathway of most heart diseases. Oxygen therapy for mechanical non-invasive ventilation (MNIV) is based on evidence. This case report describes a case of HF and application of the MNIV technique for its treatment. A patient with severe dyspnea, tachypnea and alteration of vital signs presented acute edema of the lung secondary to decompensated HF. After drug therapy and MNIV, the patient was discharged after 36 hours. The studies reviewed concluded that MNIV is good option for the treatment of decompensated HF.

Keywords: Heart failure; Respiration, artificial/methods; Pulmonary edema; Dyspnea


Transcutaneous electrical diaphragmatic stimulation in diaphragmatic paralysis after cardiac surgery
Estimulação diafragmática elétrica transcutânea na paralisia diafragmática após cirurgia cardíaca

Letícia Baltieri; Laisa Antonela dos Santos; Elisane Pessotti; Eli Maria Pazzianotto Forti
Rev Bras Cardiol. 2012;25(6):504-506

+   Abstract  
The case study reports on a woman, 37, with diaphragmatic paralysis (DP) after cardiac surgery (CS) who underwent physiotherapy after discharge because of dyspnea and received transcutaneous electrical diaphragmatic stimulation (TEDS). The following were evaluated: tidal volume (TV), minute volume (MV), respiratory rate (RR), maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP) and chest radiography (CR). There was an increase in the TV, MIP and MEP, with a decrease in the RR and MV. The CR showed partial resolution of the DP, which confirms the efficacy of TEDS for restoring lung strength and volumes when DP is present after CS.

Keywords: Myocardial revascularization; Respiratory insufficiency; Postoperative care; Physical therapy modalities


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