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

IJCS - International Journal of Cardiovascular Sciences
Edition: 29.6 - 14 Articles


Editorial: The Rise of Cardio-Oncology
Editorial: O Surgimento da Cardio-Oncologia

Claudio Tinoco Mesquita
Int J Cardiovasc Sci. 2016;29(6):419-421



Scientific Output on Transesophageal Echocardiography from Iberoamerican Countries
Produção Científica Sobre Ecocardiografia Transesofágica por Países Ibero-Americanos

Alejandro Diaz, Viviana Prener, Daniela Dominguez, Sergio Rivera Varas, Lisandro Damian Colantonio
Int J Cardiovasc Sci. 2016;29(6):422-430

+   Abstract  
Background: Transesophageal echocardiography (TEE) has attracted great attention and is becoming an important, rapid‑progressing scientific field.
Objective: To analyse the contribution and characteristics of scientific publications on TEE from Iberoamerica.
Methods: A literature search was conducted in PubMed (US National Library of Medicine National Institutes of Health) to identify scientific publications on TEE indexed before May 1, 2015. Terms used for the literature search included "transesophageal echocardiography", "transesophageal echocardiogram", "3D transesophageal echocardiography", and "three-dimensional echocardiography". These terms were combined with each Iberoamerican country. Additional data from the journal of each scientific publication were obtained from the SCImago Journal & Country Rank.
Results: Iberoamerica originated 4% of all publications on TEE. The number of publications from Iberoamerica increased from zero before 1990 to 60 in 2015. Spain, Mexico, and Brazil originated 75% of all publications from the region. About 30% of full-texts were freely available. Most of the scientific publications were in English. About 90% of the publications were case reports or case series about infectious endocarditis, tumors or cardiac masses, congenital heart disease, cardioembolic sources of stroke, and invasive interventional cardiology. Spain and Argentina were the countries that originated manuscripts with a higher likelihood of being published in foreign journals. About 40% of Iberoamerican publications were in journals ranked in the top 25% of scientific journals in their field.
Conclusions: The scientific production on TEE from Iberoamerica is limited, but is increasing. The number and characteristics of publications on TEE show notable differences between Iberoamerican countries. (Int J Cardiovasc Sci. 2016;29(6):422-430)

Keywords: Echocardiography, Transesophageal / trends; Scientific and Technical Publications; Databases, Bibliographic.


Costs and Clinical Outcomes in Percutaneous Coronary Intervention by the Brazilian National Health System
Custos e Desfechos Clínicos na Intervenção Coronária Percutânea no Sistema Único de Saúde

Antônio Fernandino de Castro Bahia Neto, Fabianno Zaghetto Campos, Ricardo Braga Gonçalves, Isabel Cristina Gomes, Eduardo Back Sternick, Alessandra Maciel Almeida
Int J Cardiovasc Sci. 2016;29(6):431-442

+   Abstract  
Background: Percutaneous treatment of coronary arterial disease (CAD) can present adverse outcomes related to population characteristics and technical issues. CAD is one of the main sources of expense, with admission in the Brazilian Unified Health System (SUS), more specifically with treatments for acute coronary syndromes (ACS), mainly associated to interventional procedures.
Objectives: To evaluate the effectiveness and cost of percutaneous myocardial revascularization performed through SUS at a tertiary hospital in the Brazilian State of Minas Gerais.
Methods: We used a prospective open cohort, with individuals who underwent coronary angioplasty, through SUS, between September 2014 and April 2015. The patients were classified according to clinical and angiographic characteristic and character of the procedure. A six-month follow up was carried out and we evaluated treatment effectiveness. We verified the health system’s expenditures with patients who underwent the procedure electively or as emergency surgery. We compared hospital costs with the amounts paid by SUS.
Results: Of the 101 patients, 83.2% of cases underwent the procedure as emergency surgery. In six months, we observed: death (10.9%), clinical restenosis (7.9%), and non-fatal infarction (2%). No differences were observed, regarding the outcomes, between angiographic, clinical groups and character of the procedure. Amounts paid by SUS for elective treatments were smaller than emergency ones, with a median difference in expenditure of R$ 1,768.75. When comparing the amounts paid by SUS to institution costs, the deficit was of R$ 430,095.30, with a median difference of R$ 2,283.74.
Conclusions: Percutaneous myocardial revascularization treatment is effective through SUS. Costs are higher in emergency scenarios, and the amounts paid by SUS are deficient. (Int J Cardiovasc Sci. 2016;29(6):431-442)

Keywords: Percutaneous Coronary Intervention / economy; Unified Health System / economy; Coronary Artery Disease; Evaluation of Results of Therapeutic Intervention; Hospital Costs.


Basic Life Support Knowledge and Interest among Laypeople
Conhecimento e Interesse sobre Suporte Básico de Vida entre Leigos

José Antonio Chehuen Neto, Igor Vilela Brum, Débora Rodrigues Pereira, Letícia Gomes Santos, Silvia Lopes de Moraes, Renato Erothildes Ferreira
Int J Cardiovasc Sci. 2016;29(6):443-452

+  Abstract 
Background: Laypeople can save lives and reduce sequelae in certain emergency situations if they have enough knowledge on Basic Life Support. Nonetheless, laypeople’s knowledge of Basic Life Support has been little investigated in Brazil.
Objective: To investigate laypeople’s knowledge, possible barriers and interest regarding Basic Life Support.
Methods: A questionnaire containing 30 questions was applied to a sample of 377 individuals. Chi-square and unpaired t test were calculated to assess the possible association between socioeconomic variables and the knowledge of Basic Life Support.
Results: Approximately 41.1% of the sample affirmed they knew what Basic Life Support was, but only 5.8% felt prepared to perform it, if needed. Nearly the whole sample considered the knowledge of Basic Life Support important and 89.9% would be available to take a Basic Life Support learning course. The average of correct answers was 37.8% ± 18.1%. This value was higher among subjects with higher level of education (38.6% ± 18.3%; p = 0.014) and among those who reported previous training in Basic Life Support (43.5% ± 17.8%; p = 0.002).
Conclusions: Laypeople recognize their role in the immediate care given to victims of certain emergency situations. Even though laypeople lack training, they show interest in learning Basic Life Support. (Int J Cardiovasc Sci. 2016;29(6):443-452)

Keywords: Cardiopulmonary Resuscitation; Data Collection; Health Education; Emergency Medical Services.


Knowledge About Heart Failure in Participants and Non-Participants Cardiac Rehabilitation
Conhecimento Sobre a Insuficiência Cardíaca em Participantes e não Participantes de Reabilitação

Christiani Decker Batista Bonin, Rafaella Zulianello dos Santos, Nathascha Erkmann, Viviane Fernandes de Souza, Amberson Vieira de Assis, Magnus Benetti
Int J Cardiovasc Sci. 2016;29(6):453-459

+  Abstract 
Background: Heart failure is a systemic character syndrome whose complexity aggregate to lack of knowledge of the patients about the disease can affect adherence to treatment.
Objective: To compare the level of knowledge about the disease in patients with heart failure participants and non-participants of cardiopulmonary and metabolic rehabilitation programs.
Method: Cross-sectional study with an intentional sample stratified into two groups: 61 participants and 62 non-participating of rehabilitations. The level of knowledge about the disease was assessed by the questionnaire.
Results: Participants rehabilitations had higher knowledge when compared to non-participants (41.9 ± 8.5 and 33.8 ± 11.6, respectively; p <0.001). The level of knowledge had positive correlations with sociodemographic variables schooling for both group of rehabilitation (p < 0.001) and for the group of non-participants (p < 0.001). We found moderate positive correlation between income and the level of knowledge only in the group of rehabilitation participants (p < 0.003) and moderate negative correlation between age the level of knowledge only in the non-participant group of rehabilitation (p < 0.001).
Conclusion: Patients with heart failure participating in rehabilitations programs had more knowledge about their disease compared to non-participants. (Int J Cardiovasc Sci. 2016;29(6):453-459)

Keywords: Heart Failure; Rehabilitation; Medication Adherence; Surveys and Questionnaires.


Predictors of Atherosclerotic Plaque in Individuals with Asymptomatic Ischemia on Physical Stress Echocardiography
Preditores de Placa Aterosclerótica em Assintomáticos Isquêmicos à Ecocardiografia sob Estresse Físico

Camila Andrade Maia, Igor Lobão Barbosa, Antonio Carlos Sobral Sousa, Enaldo Vieira de Melo, Thaiane Muniz Martins, Irlaneide da Silva Tavares, Igor Larchert Mota, Fabíola Santos Gabriel, Carlos José Oliveira Matos, Joselina Luzia Menezes Oliveira
Int J Cardiovasc Sci. 2016;29(6):460-470

+  Abstract 
Background: Myocardial ischemia may occur in asymptomatic patients without a history of coronary artery disease (CAD). Stress echocardiography (SE) is a method with good diagnostic accuracy, while coronary cineangiography (CCA) is the gold standard method to detect obstructive CAD. However, many patients with ischemia on functional tests show nonobstructive lesions on CCA.
Objective: To assess the presence of predictors of obstructive atherosclerotic plaques in asymptomatic individuals with an SE positive for myocardial ischemia.
Methods: Cross-sectional study with 278 asymptomatic individuals who underwent SE and CCA, divided into groups G1 (obstructive atherosclerotic lesions ≥ 50%) and G2 (plaques below 50% or nonexistent). Quantitative variables were compared with Student’s t test or Mann-Whitney test for independent groups, according to the normality of the sample. For categorical variables, we used the chi-square test or Fisher's exact test, as appropriate. Logistic regression was used to identify independent predictors of atherosclerotic lesions.
Results: The numbers of patients in G1 and G2 were 233 (83.3%) and 45 (16.2%), respectively. The mean age was higher in G1 (60.9 ± 9.56 years versus 51.8 ± 10.05 years, p < 0.001). G1, when compared with G2, had more patients with hypertension (65.2% versus 48.9%, respectively, p = 0.03) and dyslipidemia (77.3% versus 57.8%, respectively, p = 0.006). G2, when compared with G1, had a higher frequency of mild obesity (33.3% versus 14.2%, respectively, p = 0.002), which emerged as a protective factor for atherosclerotic lesions.
Conclusion: The predictors of atherosclerotic plaques in asymptomatic patients with ischemia on SE were age, male gender, and fixed ischemia. (Int J Cardiovasc Sci. 2016;29(6):460-470)

Keywords: Plaque, Atherosclerosis; Coronary Artery Disease; Myocardial Ischemia; Coronary Angiography; Echocardiography, Stress.


Association between rs4730153 Gene SNP and Fasting Glucose, Triglyceride, HDL and Body Mass Index Levels Iin Overweight Brazilian Adults
Relação entre SNP rs4730153 e Nível de Glicemia, Triglicérides, HDL e Índice de Massa Corporal de Brasileiros Acima do Peso

Gustado Duarte Ferrari, Jhennyfer Aline Lima Rodrigues, Igor Alexandre Fernandes, Carlos Roberto Bueno Júnior
Int J Cardiovasc Sci. 2016;29(6):471-476

+  Abstract 
Background: Metabolic syndrome is an obesity-related comorbidity with increasing worldwide occurrence. In addition to environmental factors, it is speculated that the variables included in the metabolic syndrome (waist, fasting glycemia, HDL, triglycerides and blood pressure values) can be modulated by genetic variants. It has recently been reported that some polymorphisms of the pre-beta cell growth factor gene may play a modulatory role in glucose and lipid metabolism, as well as influence body mass index.
Objective: To investigate the influence of the rs4730153 polymorphism of the pre-beta cell growth factor gene on the levels of glycemia, triglycerides, HDL and body mass index of overweight and sedentary individuals.
Methods: Brazilian men and women with a body mass index >24.9 kg/m2, over 18 years of age, who did not use medication for glycemia or hypercholesterolemia were included. The rs4730153 polymorphism was amplified by real-time polymerase chain reaction using a genotyping kit. Genotypes AA, AG and GG were evaluated separately.
Results: A total of 112 individuals with a mean age of 40.52 ± 10.30 years were included, of which 77% were women. Genotype frequency was 29.5, 41.0 and 29.5% (AA, GA and GG, respectively). No association was observed between glycemia, triglycerides, HDL and body mass index in the different alleles of the studied SNP.
Conclusions: Despite reports of studies in other ethnicities, in the present study no association was found between the rs4730153 polymorphism of the pre-beta cell growth factor gene and serum levels of glycemia, triglycerides, HDL and body mass index in a sample of the Brazilian population with overweight/obesity. (Int J Cardiovasc Sci. 2016;29(6):471-476)

Keywords: Metabolic Syndrome; Hyperlipidemias; Polymorphism, Genetic; Hypertension; Obesity; Sedentary Lifestyle.


Trends and Hospital Mortality in Myocardial Revascularization Procedures Covered by the Brazilian Unified Health System in Rio de Janeiro State from 1999 to 2010
Tendências e Letalidade Hospitalar dos Procedimentos de Revascularização Miocárdica Pagos pelo SUS no Estado do Rio de Janeiro, 1999-2010

Christina Grüne de Souza e Silva, Carlos Henrique Klein, Paulo Henrique Godoy, Nelson Albuquerque de Souza e Silva
Int J Cardiovasc Sci. 2016;29(6):477-491

+  Abstract 
Background: Ischemic heart diseases (IHD) are important causes of deaths in the state of Rio de Janeiro (RJ). Coronary artery bypass grafting (CABG) and coronary angioplasty (CA) procedures aim to mitigate the effects of IHD. Awareness of the efficiency of these procedures is crucial for clinical and administrative decision making.
Objective: To describe temporal evolution and hospital mortality of CABG and CA performed in RJ from 1999 to 2010.
Methods: Study on data of CA and CABG, covered by the Brazilian Unified Health System in RJ from 1999 to 2010, obtained from the Authorization for Hospital Admission database, concerning diagnosis, age, sex, admission date and hospital internment duration, and type of hospital discharge. Trends analysis was performed by descriptive statistics and linear regression analysis.
Results: In 34,413 patients with mean age of 61±10 years, 38,509 procedures were performed, 66.3% CA and 65.4% in men. There was an annual increase by 15.8% in CA and 3.2% in CABG. The diagnosis of acute IHD was recorded in 60.6% of admissions related to CA, and in 57.9% of admissions related to CABG. Median hospital stay was 2 days in CA and 10 days in CABG. Hospital mortality was 1.8% and 6.8% in CA and CABG, respectively, and was higher in patients aged 70 years or older, in women and in acute IHD.
Conclusion: The number of myocardial revascularizations in RJ, especially CA with stent, has increased which differs from other regions of the world. In addition, post-CA and post-CABG hospital mortality was higher than that reported in other locations and controlled studies. (Int J Cardiovasc Sci. 2016;29(6):477-491)

Keywords: Myocardial Revascularization / mortality; Cardiovascular Diseases / surgery; Epidemiology; Patient Admission; Unified Health System; Hospital Mortality.


Moderate Resistance Training Attenuates the Increase in Blood Pressure and Decreases the Cardiomyocyte Nuclei Number in Hypertensive Rats
Treinamento de Força Moderado Atenua o Aumento da Pressão Arterial e Diminui o Número de Núcleos em Cardiomiócitos de Ratos Hipertensos

Rodrigo Vanerson Passos Neves, Thiago Santos Rosa, Michel Kendy Souza, Clévia Santos Passos, Adriana Aparecida Ferraz Carbonel, Cristiane Paula Teixeira, Francisco Navarro, Ricardo Santos Simões, Brande Ranter Alves Soares, Maria Carmo Pinho Franco, Milton Rocha Moraes
Int J Cardiovasc Sci. 2016;29(6):492-499

+  Abstract 
Background: Resistance training (RT) is a strategy that decreases blood pressure (BP) in patients with stage 1 hypertension and attenuates BP progression in hypertensive rats (stage 3). The influence of RT in cardiac remodeling in uncontrolled hypertension is not yet established.
Objective: The aim of this study was to evaluate the long-term effects of RT in moderate intensity in cardiac remodeling in spontaneously hypertensive rats (SHRs) without treatment.
Methods: Ten male SHRs with stage 3 hypertension (systolic BP ≥ 180 mmHg) and five normotensive Wistar‑Kyoto (WKY) rats (systolic BP < 120 mmHg) were divided into three groups: sedentary normotensive (SED-WKY), sedentary hypertensive (SED-SHR), and RT hypertensive (RT-SHR). The RT was conducted in a vertical ladder (3 days/week for 12 weeks, on nonconsecutive days) at 70% of the maximum load. BP and heart rate were recorded. At the end of the protocol, the animals were euthanized and had their left ventricles sectioned for histological analysis (hematoxylin and eosin and picrosirius red).
Results: RT did not attenuate the absolute and relative weight gains of the heart and left ventricle in the RT-SHR group compared with the sedentary group (SED-SHR). There was no difference in nuclear cardiomyocyte volume and collagen content between groups. However, RT decreased the number of nuclei in the cardiomyocytes and attenuated the increase in systolic BP in the RT-SHR when compared with the SED-SHR group. The Δ of the rate-pressure product was lower in the RT-SHR group compared with the groups SED-WKY and SED-SHR.
Conclusions: The data obtained demonstrate that RT did not attenuate the cardiac hypertrophy, but reduced the nuclear proliferation in cardiomyocytes and the BP progression in SHRs with severe hypertension. (Int J Cardiovasc Sci. 2016;29(6):492-499)

Keywords: Hypertension; Rats; Hypertrophy, Left Ventricular; Myocytes, Cardiac



Understanding Umbrella Review of the Cardiovascular Research
Compreendendo a Revisão Guarda-Chuva na Pesquisa Cardiovascular

Leonardo Silva Roever Borges e Giuseppe Biondi-Zoccai
Int J Cardiovasc Sci. 2016;29(6):500-503

+   Abstract  
The umbrella review is a synthesis of systematic reviews which allows the results of relevant assessments in a review question can be compared and contrasted. The umbrella review this type of synthesis evidence only considers the inclusion of the higher level of evidence, ie, systematic reviews and meta-analysis. The purpose of this article is to describe the methodology and methods developed for driving an umbrella review in cardiovascular research.

Keywords: Evidence-Based Medicine; Evidence-Based Practice; Epidemiology; Review.


Sudden Death in Hypertrophic Cardiomyopathy
Morte Súbita na Cardiomiopatia Hipertrófica

Marcelo Imbroinise Bittencourt, Samária Ali Cader, Denizar Vianna Araújo, Ana Luiza Ferreira Salles, Felipe Neves de Albuquerque, Pedro Pimenta de Mello Spineti, Denilson Campos de Albuquerque, Ricardo Mourilhe Rocha
Int J Cardiovasc Sci. 2016;29(6):504-511

+  Abstract 
Hypertrophic cardiomyopathy is an autosomal dominant, genetic heart muscle disease, characterized by ventricular hypertrophy in the absence of any other medical condition causing heart overload. The disease has an estimated prevalence of 1:500 and is a significant cause of sudden death, especially in young individuals, with an annual incidence of approximately 1%. Among the risk markers for the occurrence of malignant ventricular arrhythmias and sudden death in this scenario, we emphasize, in addition to a fatal event that has occurred and was aborted, the family history of sudden death; wall thickness greater or equal to 30 mm; unexplained syncope; presence of non-sustained ventricular tachycardia on Holter; abnormal blood pressure response during exercise testing; and the presence of delayed enhancement on cardiac magnetic resonance. The presence or absence of these markers can define the need or not of an implantable cardioverter-defibrillator to prevent sudden death in these patients. However, there is still much controversy about how these patients should be stratified. It is known that these markers do not have the same weight in predicting who is more likely to suffer a fatal event. This fact becomes particularly important when it is considered that the cardioverter-defibrillator implantation procedure is not free of complications, in addition to the economic impact, in terms of cost, to the health system. The purpose of this article is to carry out a review of the main aspects involved in the sudden death in these patients, from the pathophysiology, risk assessment, prevention and future perspectives.

Keywords: Cardiomyopathy, Hypertrophic, Familial; Heart Failure; Arrhythmias, Cardiac; Myocardial Ischemia; Death, Sudden, Cardiac.



Quality of Life and Hypertension
Qualidade de Vida e Hipertensão Arterial

Denise Castro de Souza Côrtes, Adriana Alvarez Arantes, Ana Paula Pimentel Mendonça, Janaína dos Santos Silva
Int J Cardiovasc Sci. 2016;29(6):512-516

+  Abstract 
Due to the increase in life expectancy and, consequently, of the number of patients with chronic diseases and associated comorbidities, the concern with those individuals’ quality of life becomes imperative. Validated questionnaires have been used to assess quality of life, and the Mini-cuestionario de calidad de vida en la hipertensión arterial (MINICHAL) is a specific tool used in the hypertensive population. Aiming at assessing quality of life of hypertensive employees at a public bank that participates in the Program for Arterial Hypertension Support, forty‑eight hypertensive employees were evaluated through the MINICHAL. The median scores corresponding to the mental, somatic and overall domains were 3, 1 e 4, respectively, showing that quality of life was good in this group. Although none of the assessed variables significantly influenced the score, gender was determinant for result modification, with the score for females being higher than that for males, reflecting a worse quality of life in women.

Keywords: Hypertension; Quality of Life; Survivorships (Public Health); Morbidity; Survey and Questionnaires; Chronic Disease.



Polycythemia Vera: A Rare Ethiology of Heart Failure
Policitemia Vera: Uma Etiologia Rara da Insuficiência Cardíaca

Monyck Barros Cardoso, Marcelo Foradini Albuquerque, Rosa Regina Sannuti Pais, Renata Rodrigues Teixeira de Castro
Int J Cardiovasc Sci. 2016;29(6):517-519

+   Introduction  
The prevalence of heart failure (HF) with systolic dysfunction exceeds 20 million patients worldwide, which corresponds to 2% of the Western population.1 Over the past two decades, there have been major advances in the outpatient treatment of individuals with HF, including the use of not only pharmacotherapy (use of beta-blockers and aldosterone receptor blockers),2 but also implantable devices (resynchronization devices and implantable defibrillators).3 Despite all these advances, the mortality of patients with HF remains high, exceeding, for example, many oncological diseases. Another major treatment challenge in this area refers to the outcomes considered as secondary but also important, such as the improvement in quality of life and the reduction in the number of hospitalizations in these patients.1
With regard to the etiology, there are different causes of HF, and their recognition can be crucial for treatment optimization. Ventricular dysfunction secondary to myocardial ischemia, arrhythmias, and hypothyroidism, among others, should be treated with a focus on the underlying disease.2 Thus, the identification of the HF cause must be pursued until possibilities are exhausted, so that its treatment can be individualized. In fact, the so-called cardiomyopathies of idiopathic origin have a worse prognosis when compared with those whose etiology is known.4
The objective of this study was to report a case of HF secondary to polycythemia vera, a rare hematologic disease.

Keywords: Heart Failure / etiology; Polycythemia Vera / etiology; Microcirculation; Hematologic Diseases / physiopathology.


Acute Pericarditis as a Rare Presentation of Cardiac Involvement in Sarcoidosis
Pericardite Aguda como uma Rara Apresentação de Envolvimento Cardíaco na Sarcoidose

Ioannis Bostanitis, Stella-Lida Papadopoulou, Maria Tsalidou, Konstantinos Triantafyllou, Chrysafios Girasis
Int J Cardiovasc Sci. 2016;29(6):520-523

+  Introduction 
Sarcoidosis is a chronic systemic disease without any identified etiology. In general, it affects the lungs and lymph nodes, but can implicate any other organ. Cardiac involvement in patients with systemic sarcoidosis is usually the cause of death.1 Usually, patients present with complete heart block, bundle branch block, ventricular tachycardia (VT), congestive heart failure, and/or sudden death.2 The myocardium and, to a lesser extent, the endocardium are usually involved. Pericardial involvement often presents as moderate to large pericardial effusion detected in echocardiography.3 We here present a case of symptomatic acute pericarditis, which is a rare manifestation of cardiac involvement in sarcoidosis.1,4,5

Keywords: Pericarditis; Sarcoidosis, Pulmonary; Hypertension; Stroke.


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