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

Edition: 29.5 - 11 Articles


Coronary Computed Tomography Angiography and C-Reactive Protein in the Evaluation of Coronary Artery Disease
Angiotomografia de Coronárias e Proteína C Reativa na Avaliação da Doença Arterial Coronariana

Fabíola Santos Gabriel, Marcos Antonio Almeida-Santos, Thiago Domingues Crespo Hirata, Mario Hiroyuke Hirata, Ibraim Masciarelli Francisco Pinto, Antônio Carlos Sobral Sousa, Flavia Bianca Suica Mota, Daniel Pio de Oliveira, Joselina Luzia Menezes Oliveira
Int J Cardiovasc Sci. 2016;29(5):338-347

+   Abstract  
BACKGROUND: Coronary artery disease (CAD) is the leading cause of death in developed countries. In Brazil, approximately 1.74% of the gross domestic product is spent on cardiovascular diseases. Ischemia tests have a low diagnostic accuracy for patients with intermediate CAD risk, and multidetector computed tomography angiography (MDCTA) may help establish the diagnosis of these patients, despite the cost of this procedure, which is still high for our standards. C-reactive protein (CRP) is increased in cases of systemic inflammation and has been used as a CAD marker.
OBJECTIVE: To evaluate the correlation of CRP with the presence of atherosclerotic plaques identified on CT angiography.
METHODS: Cross-sectional study including 118 patients with intermediate risk of CAD, who underwent coronary MDCTA and CRP measurement from September 2011 to January 2013 in a referral ardiology hospital.
RESULTS: Males comprised about 55% of the sample. CAD, hypertension, and obesity were identified in 68.6%, 76.3%, and 31.8% of the subjects, respectively. We observed that patients with increased CRP levels had a 2.9-fold higher chance of presenting CAD on MDCTA (p = 0.016).
CONCLUSION: Individuals with altered CRP are more likely to present CAD diagnosed by MDCTA and have higher CRP values than patients without CAD. CRP, along with other risk factors, may represent a relevant predictive element in the diagnosis of CAD in MDCTA, or in situations in which MDCTA is not feasible. (Int J Cardiovasc Sci. 2016;29(5):338-347) :

KEYWORDS: Coronary Artery Disease / mortality; Multidetector Computed Tomography / methods; Atherosclerosis; Thrombosis, C-Reactive Protein.


Low-Density Lipoprotein Values Estimated by Friedewald Equation are Affected by Diabetes Control
Valores de LDL-Colesterol Estimados pela Equação de Friedewald são Afetados pelo Controle do Diabetes

Pedro Lima Vieira, Gustavo Neves Araújo, Guilherme Heyden Telo, Luis Felipe Silva Smidt, Mariana Ferreira Jost, Mariana Vargas Furtado, Emilio Hideyuki Moriguchi, Carisi Anne Polanczyk
Int J Cardiovasc Sci. 2016;29(5):348-354

+   Abstract  
BACKGROUND: Friedewald equation (FE) is widely used to estimate the LDL-c without the use of ultra-centrifugation. However, the equation has limitations in some clinical settings.
OBJECTIVE:Our goal was to investigate the potential importance of differences between FE and direct measurement of LDL-c in patients with diabetes.
METHODS: We conducted a cross-sectional study among 466 patients with stable coronary disease. Total cholesterol, triglycerides, HDL-c and LDL-c were collected, and FE was calculated. Accuracy was calculated as the percentage of estimates within 30% (P30) of measured LDL. Bias was calculated as the mean difference between measured and estimated LDL-c. Agreement between methods was evaluated using Bland-Altman plots.
RESULTS: Bias was 3.7 (p=0.005) and 1.1 mg/dl (p=0.248), and accuracy was 86% and 93% in diabetic and non-diabetic patients, respectively. Among patients with diabetes, bias was 5mg/dl (p=0.016) and 1.93 mg/dl (p=0.179), and accuracy was 83% and 88% in subjects with Hemoglobin A1C above 8mg/dl versus below cutoff point, respectively. Bias was similar in patients without diabetes compared to patients with diabetes and HbA1C < 8 (1.1 and 1.93 mg/dl).
CONCLUSION: FE is inaccurate among overall individuals with diabetes. However, when stratifying patients with diabetes into good and poor disease control, the first group behaves as if it does not have diabetes, with a good correlation between calculated and measured LDL-c. It is important to know when is it reasonable to use FE because an inaccurate estimation of LDL-c levels could result in undertreatment of dyslipidemia and predispose these patients to acute events. (Int J Cardiovasc Sci. 2016;29(5):348-354) :

KEYWORDS: Hypercholesterolemy; Cholesterol, LDL/blood; Cholesterol,VLDL/blood; Mathematics; Diabetes Mellitus.


Zinc Status of and its Association to Cardiovascular Risk Biomarkers
Status do Zinco e sua Relação com Biomarcadores de Risco Cardiovascular

Camila Maria Simplicio Revoredo, Heila Dias de Sousa Pinho Aguiar, Sueli Maria Teixeira Lima, Elise Sousa Saffnauer, Kaluce Gonçalves de Sousa Almondes, Aldenora Oliveira do Nascimento Holanda, Camila Guedes Borges de Araújo, Nadir do Nascimento Nogueira, Dilina do Nascimento Marreiro
Int J Cardiovasc Sci. 2016;29(5):355-361

+   Abstract  
BACKGROUND: The antioxidant action of some nutrients is important in vascular protection. Zinc, particularly, has been associated with reduced risk of atherosclerosis, stroke and thrombosis.
OBJECTIVE:The study evaluated zinc status and its association to cardiovascular risk biomarkers in healthy adults.
METHODS: Cross-sectional study with 186 university students of both genders, aged between 20 and 30 years, selected using the convenience sampling method. The cardiovascular risk biomarker measurements included the lipid profile, Castelli index I and II, and waist circumference. Zinc analysis was performed by a three-days food record using NutWin program version Plasma and erythrocyte mineral concentrations were determined by flame atomic absorption spectrophotometry. The lipid profile was determined by enzymatic colorimetric methods.
RESULTS: The mean values of zinc intake were higher than the EAR in both genders. Participants had mean plasma and erythrocyte zinc concentrations lower than the cutoff points. The mean values of the lipid profile, Castelli index I and II, and waist circumference were adequate. There was a negative correlation between dietary zinc and total cholesterol and triglycerides.
CONCLUSION: The participants have a high dietary zinc intake and reduced plasma and erythrocyte concentrations of this mineral. Additionally, this study showed a negative association between zinc dietary intake and total cholesterol and triglycerides, biomarkers of cardiovascular risk, suggesting the importance of zinc in protecting against cardiovascular disease. (Int J Cardiovasc Sci. 2016;29(5):355-361) :

KEYWORDS: Cardiovascular Diseases / mortality; Biomarkers; Antioxidants; Adult.


Cardiometabolic Alterations in Wistar Rats on a Six-Week Hyperlipidic, Hypercholesterolemic Diet
Alterações Cardiometabólicas em Ratos Wistar Alimentados com Dieta Hiperlipídica e Hipercolesterolêmica por Seis Semanas

Danilo Roberto Xavier de Oliveira Crege, Alexandre Marcucci Miotto, Filipy Borghi, Valéria Wolf-Nunes, Dora Maria Grassi Kassisse
Int J Cardiovasc Sci. 2016;29(5):362-369

+   Abstract  
BACKGROUND: The diet of modern society is composed by large intakes of lipids and cholesterol, involved in the development of cardiometabolic diseases. However, there are gaps in the literature regarding the existence of dyslipidemia models in Wistar rats.
OBJECTIVES: To analyze the cardiometabolic profile of Wistar rats on a six-week hyperlipidic, hypercholesterolemic diet.
METHODS: Young Wistar rats were kept on a hyperlipidic, hypercholesterolemic diet for six weeks to induce hyperlipidemia. The rats underwent catheterization of the carotid artery to determine blood pressure. After fasting, blood samples were drawn through the catheter, and concentrations of total cholesterol, HDL cholesterol, triglycerides and glucose were etermined. Cardiac tissue samples were taken for a histological analysis to check for ventricular hypertrophy.
RESULTS: The six-week diet was effective in inducing cardiometabolic alterations. The dyslipidemic profile presented by the Wistar rats was accompanied by hyperinsulinemia, moderate hypertension and cardiac ventricular hypertrophy. There were no alterations in glycemia.
CONCLUSION: The six-week hyperlipidic, hypercholesterolemic diet in young Wistar rats induced cardiometabolic alterations, becoming an effective model for disorders of this nature. (Int J Cardiovasc Sci. 2016;29(5):362-369)

KEYWORDS: Rats; Diet-High-Fat; Caloric Restriction; Hypercholesterolemia; Hypertension, Hypertrophy, Left Ventricular.


Ratio between Maximum and Minimum P Wave Duration (MaxPWD/MinPWD Ratio): a New Electrocardiographic Predictor for Atrial Fibrillation in Patients with ST-Elevation Acute Myocardial Infarction
Razão entre Duração Máxima e Mínima da Onda P (Pmax/Pmin): um Novo Preditor Eletrocardiográfico para Fibrilação Atrial em Pacientes com Infarto Agudo do Miocárdio com Supradesnível do Segmento ST

Yaniel Castro-Torres, Raimundo Carmona-Puerta, Elibet Chávez-González
Int J Cardiovasc Sci. 2016;29(5):370-377

+   Abstract  
BACKGROUND: There are electrocardiographic markers for prediction of atrial fibrillation (AF) in the clinical practice, but there is no consensus on their real utility. The development of new markers may be an alternative to improve AF prediction. This investigation has the aim to demonstrate the utility of MaxPWD/MinPWD ratio for AF prediction in patients with ST-elevation acute myocardial infarction (STEAMI).
OBJECTIVE: The development of new markers may be an alternative to improve AF prediction. This investigation has the aim to demonstrate the utility of MaxPWD/MinPWD ratio for AF prediction in patients with ST-elevation acute myocardial infarction (STEAMI).
METHODS: We retrospectively studied 108 patients with STEAMI admitted at Celestino Hernández Robau Hospital between January 2012 to July 2014. P wave dispersion and MaxPWD/MinPWD ratio in patients with AF were calculated. Sensibility and specificity of MaxPWD/MinPWD ratio for AF prediction was determined. Pearson linear correlation to determine the association between glycaemia values and MaxPWD/MinPWD ratio was explored.
RESULTS: P wave dispersion and MaxPWD/MinPWD ratio were higher in patients with AF compared without AF (46.2 ms ± 8.9 ms vs. 38.7 ms ± 9.8 ms; p = 0.019) and (1.89 ± 0.37 vs. 1.65 ± 0.24, p = 0.003). The area under the ROC curve for the MaxPWD/MinPWD ratio was 0.755; 95% CI: 0.633 to 0.876; p = 0.006. There is a direct correlation between glycaemia values and MaxPWD/MinPWD ratio in patients with AF (r = 0.765; p = 0.016), but not in patients without AF (r = 0.076; p = 0.474).
CONCLUSION: MaxPWD/MinPWD ratio is useful to identify patients at risk for AF during STEAMI. There is association between the glycemic values and MaxPWD/MinPWD ratio. (Int J Cardiovasc Sci. 2016;29(5):370-377)

KEYWORDS: Atrial Fibrillation/physiopathology; Electrocardiography; Myocardial Infarction; Glycemic Index; p Wave.


Cardiovascular Risk Factors in Critical Coronary Lesions: Myth or Reality?
Fatores de Risco Cardiovasculares em Lesões Coronarianas Críticas: Mito ou Realidade?

Fernando Augusto Alves da Costa, Cibele Emilia Torres Clemente, Fernando Henrique Ueno, André Renzi Motta
Int J Cardiovasc Sci. 2016;29(5):378-384

+   Abstract  
BACKGROUND: Cardiovascular disease (CVD) is responsible for the greatest morbidity and mortality rates in the world, and acute myocardial infarction (AMI) and cerebral ischemic attack are its main manifestations. Risk factors that contribute to the development of the disease are widely known, but there remains the question of whether a higher number of risk factors explains more serious illnesses, or if the isolated impact of a risk factor could also be determinant in patients.
OBJECTIVES: The study correlates the risk factors for coronary artery disease (CAD) and patients undergoing angioplasty and / or coronary artery bypass graft (CABG) due to critical injuries, clarifying the role of classic risk factors for cardiovascular disease (CVD) and analyzing if factors such as gender, marital status and education level are related to a greater presence of these risk factors.
METHODS: We used questionnaires of risk factors for CVD with patients at the Hemodynamics Department and Cardiac Surgery Charity Hospital Portuguese São Paulo, in São Paulo, Brazil, followed by statistical analysis.
RESULTS: In our sample most patients showed two risk factors for CVD, and hypertension, dyslipidemia and diabetes mellitus were the most prevalent ones in this population.
CONCLUSION: The study confirmed that the role of classic risk factors in cardiovascular disease is not a myth but a reality, especially when patients with fewer risk factors presented obstructive situations similarly to patients with more risk factors. (Int J Cardiovasc Sci. 2016;29(5):378-384)

KEYWORDS: Cardiovascular Diseases; Myocardial Infarction / surgery; Risk Factors; Myocardial Revascularization.


Surgical Risk and Functionality in Patients Undergoing Heart Surgery
Risco Cirúrgico e Funcionalidade em Pacientes Submetidos à Cirurgia Cardíaca

André Luiz Lisboa Cordeiro, Alina Ávila Oliveira Ribeiro Brito, Isabela Carvalho, Jessielle Oliveira, André Raimundo Guimarães, Thiago Melo de Araújo, Giulliano Gardenghi
Int J Cardiovasc Sci. 2016;29(5):385-389

+   Abstract  
BACKGROUND: Cardiac surgery can lead to a decline in lung and peripheral function. EuroSCORE is a scale that assesses cardiac surgery risk and the measurement of functional independence evaluates the ability to perform functional activities.
OBJECTIVES: To identify the correlation between a cardiac risk scale and functionality in patients undergoing CS.
METHODS: This is a prospective cross-sectional study, carried out with patients submitted to functional evaluation in the preoperative period, through the measurement of functional independence and evaluation by the EuroSCORE, to establish the level of risk for cardiac surgery. After the surgical procedure, on the first day after discharge from the intensive care unit, the functional independence measurement (FIM) was reevaluated and compared to the initial value.
RESULTS: We included 52 patients (55.8% men) with a mean age of 56.9 ± 14.2 years. The mean preoperative and postoperative FIM values were 125.4 and 106.78. The t test was performed, which showed a significant reduction between the analyzed periods, with a value of p = 0.000. By correlating the postoperative FIM values with the cardiac risk, it was observed that there was an important association, with p = 0.006 and r = -0.37.
CONCLUSION: We concluded that a preoperative assessment showing an increased cardiac risk has a negative impact on the functionality of patients undergoing cardiac surgery. (Int J Cardiovasc Sci. 2016;29(5):385-389)

KEYWORDS: Myocardial Infarction / surgery; Thoracic Surgery; Cardiac Surgical Procedures; Risk; Physical Therapy Speciality.



Cardiopulmonary Exercise Testing in Pulmonary Hypertension
Teste Cardiopulmonar de Exercício na Hipertensão Pulmonar

Carlos Alberto Cordeiro Hossri, Romulo Leal Almeida, Felipe Rodrigues da Costa Teixeira, Glauber Luasse Osima, Luiz Eduardo Mastrocola
Int J Cardiovasc Sci. 2016;29(5):390-395

+   Abstract  
The cardiopulmonary exercise test (CPET) is a complementary test that provides important data about the patient’s actual functional capacity, metabolic and ventilatory responses, and gas exchange. Thus, it enables a classification of the cardiorespiratory fitness of an individual and identification of disorders that limit exercise continuity by analyzing several variables drawn from this diagnostic and prognostic propaedeutic method. In this regard, situations that are relatively common in clinical practice but are not often identified, such as pulmonary hypertension (PH), can be better addressed, assessed, and measured. Thus, the analysis of exhaled gases using CPET may provide better PH management by enabling a classification of the aerobic capacity, ventilatory response and gas exchange in patients with this pulmonary vascular disorder.

KEYWORDS: Hypertension, Pulmonary / physiopathology; Respiratory, Function Tests; Breathing Exercises; Exercise Test


Cardiovascular Semiotics: The Personalities Behind the Eponyms
Semiologia Cardiovascular: As Personalidades por Detrás dos Epônimos

Renata Gudergues Pereira de Almeida, Juliana dos Santos Macaciel, Érico Araújo Reis Santos, Thiago Calvet Cavalcanti Garcia, Anastacia Midori Hashimoto, Cláudio Tinoco Mesquita
Int J Cardiovasc Sci. 2016;29(5):396-406

+   Abstract  
Since its inception, medicine has been based on observation of signs and specific findings in ill patients. Semiotics is, therefore, an ancient study. Cardiac semiology, although more recent, is more complex in its learning due to ifficulties in the interpretation of auscultatory findings. Austin Flint, Rivero Carvallo, Antonio Valsalva, and Adolf Kussmaul are some of the many physicians who have dedicated themselves to the academic study of cardiac semiology and became eternalized in the medical field through eponyms in cardiology. A selection of the main and most iconic eponyms in cardiology is necessary to complement and highlight the importance of the knowledge of cardiovascular physical examination at the bedside and the interpretation of its findings, especially in an era in which medicine is involved with so many technological innovations in the imaging area. The aim of this review article is to address historical aspects of selected cardiologic eponyms and the importance of these eponyms in current medical practice, especially for those in training who want to deepen their study of cardiovascular semiotics.

KEYWORDS: Anamnesis; Physical Examination; Diagnostic Techniques, Cardiovascular; Eponyms.


Left Ventricular Involvement in Arrhythmogenic Dysplasia of the Right Ventricle
Envolvimento do Ventrículo Esquerdo na Displasia Arritmogênica do Ventrículo Direito

Karine Betzel Reetz, Marcelo Nacif, Eduardo Nani Silva, Wolney Martins, Humberto Villacorta Junior
Int J Cardiovasc Sci. 2016;29(5):407-411

Recombinant Human Erythropoietin in Hemolytic Anemia in a Patient With Mechanical Heart Valve
Eritropoetina Recombinante Humana na Anemia Hemolítica em Paciente com Valva Mecânica

Caio de Almeida Monteiro, Luís Otávio Cardoso Mocarzel, Pedro Gemal Lanzieri, Henrique Camargo de Carvalho, Karina Agrizzi Verediano, Washington Luiz Batista da Costa
Int J Cardiovasc Sci. 2016;29(5):412-416


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