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

IJCS - International Journal of Cardiovascular Sciences
Edition: 30.3 - 12 Articles


Artificial Intelligence and Machine Learning in Cardiology - A Change of Paradigm
Inteligência Artificial e Machine Learning em Cardiologia – Uma Mudança de Paradigma

Claudio Tinoco Mesquita
International Journal of Cardiovascular Sciences. 2017;30(3):187-188



Profile of Patients Hospitalized for Heart Failure in Tertiary Care Hospital
Perfil dos Pacientes Internados por Insuficiência Cardíaca em Hospital Terciário

Milton Ricardo Poffo, Amberson Vieira de Assis, Maíra Fracasso, Ozir Miguel Londero Filho, Sulyane Matos de Menezes Alves, Ana Paula Bald, Camila Bussolo Schmitt, Nilton Rogério Alves Filho
International Journal of Cardiovascular Sciences. 2017;30(3):189-198

+   Abstract  
Background: Heart failure is a highly prevalent disease, responsible for many admissions and high mortality rates in our country. The treatment influences patient's mortality and quality of life.
Objective: To identify and compare the clinical and epidemiological survivor's and non-survivor's profiles and treatment of patients hospitalized with heart failure with the international literature.
Methods: Cross-sectional, retrospective study of 816 survivors and non-survivors with heart failure. All patients had their clinical and epidemiological, laboratory and echocardiographic data and treatment recorded.
Results: Most patients were in functional class III/IV. Mean age was 66.5 ± 13.8 years. Half of the patients were men and 88.3% were Caucasians. In-hospital mortality was 11,2%. Highly mortality was associated with old age, Caucasian ethnicity, high functional class, readmissions, prolonged hospitalization, presence of coronary artery disease, chronic atrial fibrillation, severe mitral regurgitation, restrictive diastolic dysfunction, renal dysfunction, and elevated natriuretic peptide levels, as well as with patients who had pulmonary embolism, acute coronary syndrome, pulmonary infection or required dialysis during hospitalization. The use of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers at admission was significantly higher among survivors.
Conclusion: In-hospital mortality was high when compared to international averages, but it was similar to other Brazilian referral services. Numerous higher severity indicators were observed in the non-survivor group. (Int J Cardiovasc Sci. 2017;30(3):189-198)

Keywords: Heart Failure / mortality; Prevalence; Hospitalization; Restrospective Studies.


Matricial Support and Arterial Hypertension Control
Apoio Matricial e Controle da Hipertensão Arterial

Clóvis Hoepfner, Morgana Longo, Andressa de Oliveira Coiradas, Laíssa Mara Rodrigues Teixeira
International Journal of Cardiovascular Sciences. 2017;30(3):199-206

+   Abstract  
Background: A continuing education program for health professionals improves their performance and increases hypertension control rates. Objective: To estimate the prevalence of hypertension control and therapeutic inertia among adults treated at Primary Health Care Units after a continuing education program focused on cardiology for health professionals.
Methods: A cross-sectional study was carried out, which included cluster sampling and analysis of medical records. We evaluated 463 patients with high blood pressure and analyzed the blood pressure, medications, and therapeutic increments in 2013, which were compared to the data obtained in 2007.
Results: There was prevalence of female patients and appointments at the Family Health Care Units. The age ranged between 24 and 92 years (mean of 61.7 years). There was a reduction in the mean blood pressure (148.62/91.60 ± 23.52/14.51 mmHg to 137.60/84.03 ± 21.84/12.72) between the first and last records, and BP control in 58% of the sample, that is, higher than the 36.6% found in 2007. In the analyzed period, there was a therapeutic increment of 39% in appointments, which benefited 52% patients with high blood pressure, higher than the 12% and 29.5%, respectively, found in 2007. The mean number of drugs per patient increased from 1.85 to 2.05, with a predominance of diuretics and angiotensin-converting-enzyme inhibitors.
Conclusion: There was a reduction in the clinical inertia and increased control of arterial hypertension was observed, compared with the findings of the previous study. The result suggests that the matricial support program for health professionals and other measures to improve disease control in the Primary Health Care Units were effective. (Int J Cardiovasc Sci. 2017;30(3):199-206)

Keywords: Hypertension / prevention & control; Hypertension / epidemiology; Prevalence; Inertia; Health Centers; Primary Health Care; Health Education.


Gallic Acid and Cyclosporine Mixture and their Effects on Cardiac Dysfunction Induced by Ischemia/Reperfusion and eNOS/iNOS Expression
Mistura de Ácido Gálico e Ciclosporina e seus Efeitos sobre a Disfunção Cardíaca Induzida pela Isquemia / Reperfusão e Expressão de eNOS/iNOS

Mohammad Badavi, Najmeh Sadeghi, Mahin Dianat, Alireza Samarbafzadeh
International Journal of Cardiovascular Sciences. 2017;30(3):207-218

+   Abstract  
Background: Although many researches have been conducted on either a certain antioxidant or mPTP individually, little attention has been drawn to the effects of co-administration of an antioxidant and mPTP inhibitor together on cardiac dysfunction after I/R injury.
Objectives: This study aims at determining the effects of gallic acid (as Antioxidant) combined with cyclosporine A (CsA) (as mPTP inhibitor) on I/R induced cardiac and endothelial (role of NO) dysfunction.
Methods: Male Wistar rats were pretreated with gallic acid (7.5, 15, or 30 mg.kg-1 body weight, daily) for a period of 10 days. Then, the heart was isolated and exposed to 30-minute ischemia and perfused by CsA (0.2 µM) 20 min during reperfusion period.
Results: The data have shown that infarct size was decreased significantly by CsA and gallic acid alone (p < 0.05, one way ANOVA followed by LSD test), however the combination of both drugs had more significant improving effects (p < 0.001). The combination of these two drugs improved more significantly maximum rate of rise and fall of ventricular pressure (±dp.dt-1 max), rate pressure product (RPP), left ventricular developed pressure (LVDP), heart rate and coronary flow rather than applying each one alone (p < 0.05, repeated measurement ANOVA followed by LSD test).
Conclusions: In conclusion, benefiting from an antioxidant concomitant with an mPTP inhibitor could have more improving effects on the cardiac dysfunction induced by I/R injury. (Int J Cardiovasc Sci. 2017;30(3):207-218)

Keywords: Antioxidants; Gallic Acid; Cyclosporine; Ventricular Function; Endothelium; Reperfusion; Rats; Nitric Oxide Synthase.


Association between Erectile Dysfunction and Quality of Life in Patients with Coronary Artery Disease
Associação entre Disfunção Erétil e Piora na Qualidade de Vida de Pacientes com Doença Arterial Coronariana

André Tabosa, Dinaldo Cavalcanti de Oliveira, Vitor H. Stangler, Henrique Araújo, Vitor Nunes, Maria Isabel Gadelha, Danielle A. G. C. Oliveira, Emmanuelle Tenório
International Journal of Cardiovascular Sciences. 2017;30(3):219-226

+   Abstract  
Background: Erectile dysfunction (ED) and coronary artery disease (CAD) share the same risk factors and the associations between ED, quality of life (QoL) and CAD have been the subject of recent studies.
Objective: To evaluate whether ED is associated with worsening QoL in patients with CAD.
Methods: A cross-sectional, multicenter, prospective and analytic study was carried out from EDcember 2014 to April 2016, which recruited 304 men (mean age: 57 ± 9.9 years) with clinical diagnosis of CAD. QoL was assessed using Short Form-36 and ED by the International Erectile Function InEDx. EDscriptive and analytical statistical analyzes were performed, and the Kruskal-Wallis non-parametric test was used to test whether there are significant differences in each quality of life domain when comparing different types of ED. For all tests, p ≤ 0.05 was consiEDred significant.
Results: The prevalence of ED was 76.3%. The median and percentiles 25 and 75 of each life quality domain according to the absence of ED; mild ED, mild to moderate, moderate and severe ED and severe ED, respectively, were: Functional capacity: 85 (63-100), 75 (50 -95), 60 (32-85), 55 (35-75), 50 (30-70), p < 0.001; Physical aspects: 87 (0-100), 40 (0-100), 0 (0-100), 0 (0-31), 0 (0-12), p < 0.001; Pain: 72 (51-100), 66 (51-100), 74 (51-100), 62 (51-100), 51 (31-62), p = 0.001; General state of health: 77 (62-87), 72 (57-77), 67 (55-82), 67 (59-75), 52 (37-68), p < 0.001; Vitality: 75 (60-85), 65 (50-75), 65 (55-75), 60 (43-75), 50 (32-65), p < 0.001; Social Aspects: 87 (62-100), 87 (62-100), 87 (68-100), 75 (62-100), 75 (50-93), p = 0.139; Emotional Aspects: 100 (58-100), 100 (33-100), 100 (33-100), 100 (0-100), 0 (0-100), p = 0.001; Mental health: 80 (67-89), 72 (60-84), 72 (66-80), 68 (58-80), 56 (50-74), p < 0.001.
Conclusions: The prevalence of erectile dysfunction was high. ED was associated with worsening of QoL in patients with CAD. (Int J Cardiovasc Sci. 2017;30(3):219-226)

Keywords: Coronary Artery Disease, Erectile Dysfunction; Life Style, Risk Factors.


Evaluation of Endothelial Function in Pre-Menopausal Women With Coronary Arterial Disease
Avaliação da Função Endotelial em Mulheres Climatéricas com Doença Arterial Coronariana

Wilma Karlla dos Santos Farias, Tania Pavão Oliveira Rocha, Jorgileia Braga de Melo, Erika Joseth Nogueira da Cruz Fonseca, Darci Ramos Fernandes, Leticia Prince Pontes, Maria Valneide Gomes Andrade, José Albuquerque de Figueiredo Neto
International Journal of Cardiovascular Sciences. 2017;30(3):227-234

+   Abstract  
Background: The endothelium plays an important vascular regulatory function. Its dysfunction is an early marker of cardiovascular risk. However, there are few studies in our community that assess endothelial function in pre menopausal women.
Objective: To assess endothelial function in pre-menopausal women in the presence or absence of coronary artery disease, using a biophysical method (carotid intima media thickness) and a biochemical method (serum levels of hsCRP).
Methods: Cross-sectional study that evaluated carotid intima-media thickness and serum levels of hsCRP of 31 premenopausal women undergoing coronary angiography at the Hemodynamics Service of Hospital Universitário da Universidade Federal do Maranhão from March 2012 to July 2013. The data were sent to statistical analysis and a statistical significance level of 5% was considered.
Results: The sample was divided into two groups according to the presence of coronary artery disease (CAD): CAD group (n = 13) and group without CAD (n = 18). The average ages for the groups were 57.92 ± 5.17 and 51.72 ± 4.63 years, respectively (p = 0.001). CIMT was abnormal in 29.03% in the general population. Carotid intima-media thickness was 1.55 ± 0.78 mm in the general group, 1.92 ± 0.94 mm in the CAD group and 1.18 ± 0.71 mm in the group without CAD (p = 0.001). CAD patients had predominance of abnormal CMIT compared those without CAD: 36.46% vs. 22.22%, respectively. There was a sensitivity of 38%, specificity of 77% with a positive predictive value of 0.55 and a negative predictive value of 0.63 with likelihood ratio of 1.73. Patients with abnormal CIMT presented higher levels of hsCRP, but without statistical significance. CAD patients had higher levels of hsCRP, but without statistical significance.
Conclusion: In the population studied, assessment of endothelial function using the CIMT method showed higher sensitivity and specificity for the diagnosis of CAD compared to the measurement of hsCRP levels in menopausal women. (Int J Cardiovasc Sci. 2017;30(3):227-234)

Keywords: Coronary Artery Disease; Endothelium/dysfunction; Women; Premenopause; Atherosclerosis; Cineangiography.


Assessment of Bioactive Compounds, Physicochemical Composition, and In Vitro Antioxidant Activity of Eggplant Flour
Avaliação de Compostos Bioativos, Composição Físico-Química e Atividade Antioxidante In Vitro da Farinha de Berinjela

Mauara Scorsatto, Aline de Castro Pimentel, Antonio Jorge Ribeiro da Silva, Kebba Sabally, Glorimar Rosa, Gláucia Maria Moraes de Oliveira
International Journal of Cardiovascular Sciences. 2017;30(3):235-242

+   Abstract  
Background: The eggplant (Solanum melongena) is a fruit of world consumption. Its processing in the form of flour is a way to avoid losses and to take advantage of its nutritional characteristics.
Objective: This study assessed the physicochemical composition (moisture, proteins, lipids, crude fiber, carbohydrates, minerals, niacin, saponins, titratable acidity, dietary fiber, and total phenols) of eggplant flour prepared from the whole fruit dehydrated in an oven.
Methods: In vitro antioxidant activity was assessed using the following methods: 2.2-diphenyl-1-picrylhydrazyl radical (DPPH); Ferric Reducing/Antioxidant Power (FRAP); and analysis of polyphenols using HPLC (chlorogenic acid, caffeic acid, ferulic acid, and rutin).
Results: It was possible to observe: 23.09% carbohydrates; 13.34% proteins; 1.85% lipids; 39.19% total fibers; 1,540 mg/100 g total soluble phenolic compounds; 840 mg/100 g saponins; minerals (potassium, magnesium, copper, iron, zinc, manganese); and niacin. In vitro antioxidant activity was observed through DPPH (455.6 mg ascorbic acid/100 g) and FRAP (486.8 mg ascorbic acid/100 g). The HPLC method determined the presence of ascorbic acid, tyrosine, and phenolic acids (chlorogenic acid, caffeic acid, and ferulic acid).
Conclusion: The eggplant flour had great fiber content in addition to good content of phenolic compounds and saponins with important antioxidant capacity observed through in vitro assays. As a result, eggplant flour is a good addition to the diet of the population, since it can bring potential health benefits. (Int J Cardiovasc Sci. 2017;30(3):235-242)

Keywords: Solanum Melongena; Antioxidants; Diet, and Nutrition; Phenolic Compounds; Hyperlipidemias.


High Blood Pressure in Pre-Adolescents and Adolescents in Petrópolis: Prevalence and Correlation with Overweight and Obesity
Hipertensão Arterial em Pré-Adolescentes e Adolescentes de Petrópolis: Prevalência e Correlação com Sobrepeso e Obesidade

Flavio Figueirinha e Gesmar Volga Haddad Herdy
International Journal of Cardiovascular Sciences. 2017;30(3):243-250

+  Abstract
Background: Arterial hypertension is a multisystem disease that increases the risk of fatal cardiac events.
Objectives: This study aims to determine the prevalence of increased blood pressure levels of pre-adolescents and adolescents and correlate these pressure levels with the presence of overweight or obesity and family history of hypertension.
Methods: In an observational, cross-sectional study, a sample of 157 students from the city of Petropolis aged from ten to nineteen was randomly selected. The study included four public schools and one private school. The persons responsible for each student answered a questionnaire on pre-existing conditions, family history of hypertension and previous blood pressure measurements. A thorough physical examination, anthropometric evaluation and two blood pressure readings were taken at intervals of at least ten minutes, on three different occasions, totaling six measurements.
Results: Blood pressure levels have shown to be abnormal in 17 (10.8% / IC95% 5.9-15.7) studied individuals. Statistical significance was found between the change in blood pressure and the presence of overweight and obesity (p < 0.001), as well as with the presence of family history of hypertension (p < 0.05). A portion of 32.5% of the subjects had never had their blood pressure measured, and over the twelve months prior to the study, 45.5% of the sample had not measured it either.
Conclusions: This study demonstrated that a significant percentage of students in the city of Petrópolis, in the state of Rio de Janeiro, has high blood pressure with a statistically significant correlation with overweight or obesity and a family history of hypertension. (Int J Cardiovasc Sci. 2017;30(3):243-250)

Keywords: Hypertension/epidemiology; Adolescent; Child; Obesity; Oveweight; Prevalence.



Effects of Hypoxia on Heart Rate Variability in Healthy Individuals: A Systematic Review
Efeitos da Hipóxia na Variabilidade da Frequência Cardíaca em Indivíduos Saudáveis: Uma Revisão Sistemática

André Luiz Musmanno Branco Oliveira, Philippe de Azeredo Rohan, Thiago Rodrigues Gonçalves, Pedro Paulo da Silva Soares
International Journal of Cardiovascular Sciences. 2017;30(3):251-261

+   Abstract
Background: Hypoxia is a physiological condition that may affect the cardiac autonomic modulation, which can be assessed by spontaneous fluctuations in heart rate, know as heart rate variability (HRV). Studies have reported reductions or maintenance of HRV in hypoxic situation presenting controversial effects. There is a knowledge gap in relation to changes in HRV during hypoxia.
Objective: The aim of this study was to systematically review the effects of hypoxia on HRV in unacclimatized healthy adults at rest.
Methods: This systematic review was performed according to PRISMA guidelines. Search terms used in MEDLINE, SCOPUS, LILACS and EUROPE PMC database were: “heart rate variability” OR “cardiac autonomic modulation” OR “cardiac autonomic regulation” AND NOT intermittent NOT sleep (hypoxia OR altitude). Records were filtered by species, age group and language. Results: At the end of the screening and eligibility, 13 manuscripts remained for qualitative synthesis.
Discussion: The studies used different experimental protocols involving difference in barometric pressure, oxygen level, time of exposure to hypoxia and control of respiratory rate. Possibly the influence of these factors and also the interindividual variation to hypoxia may justify different responses in HRV.
Conclusion: Based on the investigated studies, hypoxia has been capable of generating a decrease in HRV, either by reduction or maintenance of vagal modulation, or by sympathetic predominance or even the combination of these responses in healthy adults unacclimatized to hypoxia. This effect appears to be dependent on altitude level and barometric pressure. (Int J Cardiovasc Sci. 2017;30(3):251-261)

Keywords: Heart Rate, Hipóxia, Altitude, Atmospheric Pressure, Autonomic Nervous System, Review.


Methods of Endothelial Function Assessment: Description and Applications
Métodos de Investigação da Função Endotelial: Descrição e suas Aplicações

Amanda Sampaio Storch, João Dario de Mattos, Renata Alves, Iuri dos Santos Galdino, Helena Naly Miguens Rocha
International Journal of Cardiovascular Sciences. 2017;30(3):262-273

+  Introduction   
The endothelium is a monolayer of cells, called endothelial cells, that lines the interior of blood vessels, including arteries, veins and cardiac chambers1 acting as a protective layer between circulating blood and other tissues.2 The endothelium is crucial for the control of vascular homeostasis, and is involved in the regulation of intracellular signaling,1 vascular tonus and permeability,3 coagulation cascade and angiogenesis,4 among others. One of the main activities of the endothelium is the release of autocrine and paracrine substances in response to stimuli.2 Injuries to the endothelium trigger an inflammatory response with participation of several cell types – lymphocytes, monocytes, platelets and smooth muscle cells5 – culminating in endothelial cell dysfunction, stiffness of vessel wall and atherosclerotic plaque formation.6
Endothelial dysfunction is an early, key characteristic of development and progression of atherosclerotic plaque and subsequent complications. This is characterized by a reduced bioavailability of endothelium-derived vasodilators, such as nitric oxide (NO), along with a relative or absolute increase in available vasoconstrictors. Such unbalanced condition impairs the endotheliumdependent vasodilation, a functional marker of endothelial dysfunction.7
At the beginning of atherosclerotic plaque formation, endothelial dysfunction is characterized by increased expression and release of adhesion molecules, including endothelial selectin (E-selectin), intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1). These molecules are released in response to stimuli of inflammatory cytokines, bacterial lipopolysaccharides and oxidized low-density lipoproteins (ox-LDL). They promote cell-cell and cell-extracellular matrix adhesion, leading to foam cell accumulation on the subendothelial space,8 increased vessel wall thickness and consequent reduction or even complete obstruction of vascular lumen.9
Assessment of endothelial function consists of the analysis of endothelial cells responsiveness to vasodilator or vasoconstrictor stimuli, contributing to advances in the understanding of atherosclerosis and possible therapeutic targets.2 The methods include in vitro analysis, such as culture of endothelial cells, and in vivo analysis, such as flow-mediated dilation (FMD), venous occlusion plethysmography (VOP) and measurement of serum markers. However, none of these methods have been currently applied in the clinical setting, due to invasiveness, high costs and difficult standardization of the techniques.1
Endothelial dysfunction precedes morphological atherosclerotic changes and may contribute to the development of lesions and clinical complications. Cardiovascular diseases (CVD) are the main cause of natural death in the world, including in Brazil. Recent data shows CVD accounted for approximately 30% of deaths in the country. In this context, the use of the aforementioned techniques in clinical research allows a better understanding of this problem and the development of new prevention and treatment strategies to decrease morbidity, mortality and also public costs. A deep understanding of endothelial dysfunction assessment tools by healthcare professionals allows the improvement of these techniques and enables the transition from clinical research to clinical practice.
Here we describe the most recent methods for the assessment of endothelial dysfunction.

Keywords: Endothelium, Vascular; Function, Endothelim; Atherosclerosis; Vasodilatation.



Case Report: Catheter-Related Interatrial Septum Endocarditis Caused by Candida Parapsilosis
Relato de Caso: Endocardite de Septo Interatrial Relacionada a Cateter Causada por Cândida Parapsilosis

Gustavo Neves de Araújo, Felipe H. Valle, Douglas M. Freitas, Felipe Martins Lampa, Miguel Gus, Luis E. Rohde
International Journal of Cardiovascular Sciences. 2017;30(3):274-276

+  Introduction  
Patients with end-stage chronic kidney disease without mature arteriovenous fistula frequently require central venous access for dialytic therapy. More than 15 percent of patients who receive these catheters have complications such as infection, arterial puncture, thrombosis and pneumothorax.1 Infective endocarditis (IE) is a rare and serious complication with high morbidity and mortality. Right-sided endocarditis is uncommon due to low hemodynamic pressure, but patients using central venous catheters have an increased risk.2 The correct therapeutic approach whenever there is no valvar involvement is not well defined. We report a case of interatrial septum endocarditis caused by candida sp., associated to the prolonged use of catheter.

Keywords: Renal Insufficiency, Chronic; Catheter-Related Infections; Endocarditis, Bacterial; Candida.


Takotsubo Cardiomyopathy with Extracorporeal Membrane Oxygenation (ECMO) Requirement After Atrial Myxoma Surgery
Cardiomiopatia de Takotsubo com Requisição de Oxigenação Extracorpórea por Membrana (ECMO) Após Cirurgia de Mixoma Atrial

Fernando Garagoli, Aníbal Arias, Vadim Kotowicz, Arturo Cagide, César Belziti
International Journal of Cardiovascular Sciences. 2017;30(3):277-280

+  Introduction  
Takotsubo’s syndrome is a cardiomyopathy characterized by transient left ventricular dysfunction. This condition is often described in postmenopausal women secondary to physical or emotional triggers.1 The clinical behavior mimics an acute coronary syndrome. However, angiography shows no obstructive epicardial coronary artery disease.2
This syndrome is considered a reversible cardiomyopathy.3 However, patients with Takotsubo cardiomyopathy have risk of serious complications, such as cardiogenic shock, ventricular tachycardia and ventricular thrombus.4
Takotsubo’s syndrome has been described as a possible complication of cardiac surgery.5 We report a case of Takotsubo’s syndrome with ECMO requirement for refractory cardiogenic shock. This is the first case after atrial myxoma surgery.

Keywords: Takotsubo Cardiomyopathy/surgery; Takotsubo Cardiomyopathy/complications;Extracorporeal Membrane Oxygenation; Ventricular Dysfunction, Left.


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