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Melo Santos AC, de Melo EV, Sousa ACS, Oliveira JLM, Martins-Filho PR, Noronha NCM, do Nascimento CIS, Campos MDSB. Long-Term Impact of Left Bundle Branch Block on Cardiopulmonary Exercise Test Variables and Left Ventricular Systolic Function: A Two-Stage Observational Study. Cardiology 2024:000538522. [PMID: 38531333 DOI: 10.1159/000538522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Left bundle branch block (LBBB) disrupts the electrical activation of the left ventricle (LV), potentially impairing its systolic function, leading to LBBB-induced cardiomyopathy. This study examined cardiopulmonary exercise test (CPET) variables in patients with and without LBBB and assessed the longitudinal development of left ventricular ejection fraction (LVEF). METHOD An observational, comparative clinical study was executed in two stages at a private hospital in Brazil. The sample consisted of 27 individuals: 11 with LBBB and 16 without LBBB, all with preserved LVEF (>50%) and without confirmed ischemia. CPET variables were assessed, and after four years, participants had a transthoracic echocardiogram (TTE) for LVEF re-evaluation. Groups were compared using the t-test or the Chi-square (X²) test. Multivariate analysis of covariance (MANCOVA) determined effect magnitude. RESULTS Patients with LBBB demonstrated significant differences in CPET variables, particularly in predicted peak V̇O2, predicted peak PO2, V̇E/V̇CO2 slope, and T½V̇O2. They also exhibited a more significant decline in LVEF over a four-year span compared to the patients without LBBB. Although initial preservation of LVEF, changes in contractile patterns due to LBBB interfered with its systolic function, suggesting early ventricular dysfunction indicated by a reduction in LVEF and an increase in the V̇E/V̇CO2 slope. Despite differences in cardiopulmonary function and changes in LVEF over time between patients with and without LBBB, the effect size was considered mild to moderate. CONCLUSIONS LBBB patients with initially preserved LVEF displayed reduced exercise tolerance and a decrease in LVEF over time, emphasizing the need for vigilant monitoring and early intervention in these patients.
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Martins-Santos CB, Duarte LTA, Ferreira-Junior CR, Feitosa AGT, Oliveira EVG, Campos ICMB, Melo EVD, Andrade SM, Sousa ACS, Oliveira JLM. Exaggerated Systolic Blood Pressure Increase with Exercise and Myocardial Ischemia on Exercise Stress Echocardiography. Arq Bras Cardiol 2023; 120:e20230047. [PMID: 38126513 PMCID: PMC10773463 DOI: 10.36660/abc.20230047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Central Illustration : Exaggerated Systolic Blood Pressure Increase with Exercise and Myocardial Ischemia on Exercise Stress Echocardiography ESBPRE: exaggerated systolic blood pressure response to exercise; HR: heart rate; SBP: systolic blood pressure. BACKGROUND The association between exaggerated systolic blood pressure response to exercise (ESBPRE) and myocardial ischemia is controversial and little studied in patients with established or suspected chronic coronary syndrome. OBJECTIVE To verify the relationship between myocardial ischemia and ESBPRE in patients undergoing exercise stress echocardiography (ESE). METHODS This is a cross-sectional study with 14,367 patients undergoing ESE, from January 2000 to January 2022, divided into the following 2 groups: G1, composed of patients whose peak systolic pressure increased ≥ 90 mmHg (value corresponding to the 95th percentile of the study population), and G2, patients who did not demonstrate an exaggerated hypertensive response. The groups were compared using Student's t and chi-square tests. P values < 0.05 were considered significant. Logistic regression was also performed to identify independent risk factors for myocardial ischemia, ESBPRE, complaints of typical chest pain prior to the exam, and angina during the test. RESULTS Of the 14,367 patients, 1,500 (10.4%) developed ESBPRE, and 7,471 (52.0%) were female. The percentages of previous complaints of typical chest pain, angina during the test, and myocardial ischemia in patients with ESBPRE were 5.8%, 2.4% and 18.1%, compared to 7.4%, 3.9%, and 24.2%, in patients without ESBPRE, respectively (p = 0.021,p = 0.004, p < 0.001). In multivariate analysis, ESBPRE was independently associated with a lower probability of myocardial ischemia (odds ratio: 0.73; 95% confidence interval: 0.58 to 0.93; p = 0.009). CONCLUSION Exaggerated increase in systolic blood pressure during ESE may be a marker for excluding myocardial ischemia.
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Affiliation(s)
| | | | | | | | | | - Iana Carine Machado Bispo Campos
- Rede D'Or São Luiz - Clínica e Hospital São Lucas , Aracaju , SE - Brasil
- Rede Primavera - Setor de Métodos Gráficos do Hospital Primavera , Aracaju , SE - Brasil
- Fundação de Beneficência Hospital de Cirurgia - Setor de Métodos Gráficos , Aracaju , SE - Brasil
| | | | - Stephanie Macedo Andrade
- Rede D'Or São Luiz - Clínica e Hospital São Lucas , Aracaju , SE - Brasil
- Rede Primavera - Setor de Métodos Gráficos do Hospital Primavera , Aracaju , SE - Brasil
| | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Rede D'Or São Luiz - Clínica e Hospital São Lucas , Aracaju , SE - Brasil
| | - Joselina Luzia Menezes Oliveira
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Rede D'Or São Luiz - Clínica e Hospital São Lucas , Aracaju , SE - Brasil
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3
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Ferreira EJP, Cardoso LVSDC, de Matos CJO, Mota IL, Lira JMC, Lopes MEG, Santos GV, Dória Almeida ML, Aguiar-Oliveira MH, Sousa ACS, de Melo EV, Oliveira JLM. Cardiovascular Prognosis of Subclinical Chronic Obstructive Pulmonary Disease in Patients with Suspected or Confirmed Coronary Artery Disease. Int J Chron Obstruct Pulmon Dis 2023; 18:1899-1908. [PMID: 37662489 PMCID: PMC10474840 DOI: 10.2147/copd.s410416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/06/2023] [Indexed: 09/05/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) worsens prognosis in patients with coronary artery disease (CAD). However, the cardiovascular prognosis in patients with stable or mildly symptomatic COPD remains unclear. Here, we sought to determine the long-term cardiovascular events in patients with subclinical or early-stage COPD with concomitant CAD. Methods This was a longitudinal analytical study involving 117 patients with suspected or established CAD who underwent assessment of pulmonary function by spirometry and who were followed up for six years (March 2015-January 2021). The patients were divided into two groups, one comprising COPD (n=44) and the other non-COPD (n=73) patients. Cox regression was used to evaluate the association between COPD and cardiovascular events, with adjustment for the established CAD risk factors, and the effect size was measured by the Cohen test. Results COPD patients were older (p=0.028), had a greater frequency of diabetes (p=0.026), were more likely to be smokers (p<0.001), and had higher modified Medical Research Council scores (p<0.001). There was no difference between the groups regarding gender, body mass index, hypertension, dyslipidemia, family history of CAD, and type of angina. CAD frequency and the proportion of patients with severe and multivessel CAD were significantly higher among COPD than among non-COPD patients (all p<0.001). At six-year follow-up, patients with COPD were more likely to have experienced adverse cardiovascular events than those without COPD (p<0.001; effect size, 0.720). After adjusting for established CAD risk factors, COPD occurrence remained an independent predictor for long-term adverse cardiovascular events (OR: 5.13; 95% CI: 2.29-11.50; p<0.0001). Conclusion COPD was associated with increased severity of coronary lesions and a greater number of adverse cardiovascular events in patients with suspected or confirmed CAD. COPD remained a predictor of long-term cardiovascular events in stable patients with subclinical or early-stage of COPD, independently of the established CAD risk factors.
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Affiliation(s)
- Eduardo José Pereira Ferreira
- Department of Medicine, Federal University of Sergipe, Lagarto, 49400-000, Brazil
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Lucas Villar Shan de Carvalho Cardoso
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | | | - Igor Larchert Mota
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
| | - Juliana Maria Chianca Lira
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Mayara Evelyn Gomes Lopes
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Giulia Vieira Santos
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Maria Luiza Dória Almeida
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Manuel Herminio Aguiar-Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Enaldo Vieira de Melo
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
| | - Joselina Luzia Menezes Oliveira
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- University Hospital, Federal University of Sergipe, Aracaju, 49100-000, Brazil
- São Lucas Clinic and Hospital- Rede D’Or São Luiz, Aracaju, 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe, Aracaju, 49100-000, Brazil
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4
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Marin-Neto JA, Rassi A, Oliveira GMM, Correia LCL, Ramos Júnior AN, Luquetti AO, Hasslocher-Moreno AM, Sousa ASD, Paola AAVD, Sousa ACS, Ribeiro ALP, Correia Filho D, Souza DDSMD, Cunha-Neto E, Ramires FJA, Bacal F, Nunes MDCP, Martinelli Filho M, Scanavacca MI, Saraiva RM, Oliveira Júnior WAD, Lorga-Filho AM, Guimarães ADJBDA, Braga ALL, Oliveira ASD, Sarabanda AVL, Pinto AYDN, Carmo AALD, Schmidt A, Costa ARD, Ianni BM, Markman Filho B, Rochitte CE, Macêdo CT, Mady C, Chevillard C, Virgens CMBD, Castro CND, Britto CFDPDC, Pisani C, Rassi DDC, Sobral Filho DC, Almeida DRD, Bocchi EA, Mesquita ET, Mendes FDSNS, Gondim FTP, Silva GMSD, Peixoto GDL, Lima GGD, Veloso HH, Moreira HT, Lopes HB, Pinto IMF, Ferreira JMBB, Nunes JPS, Barreto-Filho JAS, Saraiva JFK, Lannes-Vieira J, Oliveira JLM, Armaganijan LV, Martins LC, Sangenis LHC, Barbosa MPT, Almeida-Santos MA, Simões MV, Yasuda MAS, Moreira MDCV, Higuchi MDL, Monteiro MRDCC, Mediano MFF, Lima MM, Oliveira MTD, Romano MMD, Araujo NNSLD, Medeiros PDTJ, Alves RV, Teixeira RA, Pedrosa RC, Aras Junior R, Torres RM, Povoa RMDS, Rassi SG, Alves SMM, Tavares SBDN, Palmeira SL, Silva Júnior TLD, Rodrigues TDR, Madrini Junior V, Brant VMDC, Dutra WO, Dias JCP. SBC Guideline on the Diagnosis and Treatment of Patients with Cardiomyopathy of Chagas Disease - 2023. Arq Bras Cardiol 2023; 120:e20230269. [PMID: 37377258 PMCID: PMC10344417 DOI: 10.36660/abc.20230269] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- José Antonio Marin-Neto
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Anis Rassi
- Hospital do Coração Anis Rassi , Goiânia , GO - Brasil
| | | | | | | | - Alejandro Ostermayer Luquetti
- Centro de Estudos da Doença de Chagas , Hospital das Clínicas da Universidade Federal de Goiás , Goiânia , GO - Brasil
| | | | - Andréa Silvestre de Sousa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe , São Cristóvão , SE - Brasil
- Hospital São Lucas , Rede D`Or São Luiz , Aracaju , SE - Brasil
| | | | | | | | - Edecio Cunha-Neto
- Universidade de São Paulo , Faculdade de Medicina da Universidade, São Paulo , SP - Brasil
| | - Felix Jose Alvarez Ramires
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Fernando Bacal
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Martino Martinelli Filho
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Maurício Ibrahim Scanavacca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Magalhães Saraiva
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Adalberto Menezes Lorga-Filho
- Instituto de Moléstias Cardiovasculares , São José do Rio Preto , SP - Brasil
- Hospital de Base de Rio Preto , São José do Rio Preto , SP - Brasil
| | | | | | - Adriana Sarmento de Oliveira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Ana Yecê das Neves Pinto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | | | - Andre Schmidt
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | - Andréa Rodrigues da Costa
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Barbara Maria Ianni
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Carlos Eduardo Rochitte
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Hcor , Associação Beneficente Síria , São Paulo , SP - Brasil
| | | | - Charles Mady
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Christophe Chevillard
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Marselha - França
| | | | | | | | - Cristiano Pisani
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | - Edimar Alcides Bocchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Evandro Tinoco Mesquita
- Hospital Universitário Antônio Pedro da Faculdade Federal Fluminense , Niterói , RJ - Brasil
| | | | | | | | | | | | - Henrique Horta Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
| | - Henrique Turin Moreira
- Hospital das Clínicas , Faculdade de Medicina de Ribeirão Preto , Universidade de São Paulo , Ribeirão Preto , SP - Brasil
| | | | | | | | - João Paulo Silva Nunes
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
- Fundação Zerbini, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | | | | | | | - Luiz Cláudio Martins
- Universidade Estadual de Campinas , Faculdade de Ciências Médicas , Campinas , SP - Brasil
| | | | | | | | - Marcos Vinicius Simões
- Universidade de São Paulo , Faculdade de Medicina de Ribeirão Preto , Ribeirão Preto , SP - Brasil
| | | | | | - Maria de Lourdes Higuchi
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | - Mauro Felippe Felix Mediano
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
| | - Mayara Maia Lima
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | | | | | - Renato Vieira Alves
- Instituto René Rachou , Fundação Oswaldo Cruz , Belo Horizonte , MG - Brasil
| | - Ricardo Alkmim Teixeira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | - Roberto Coury Pedrosa
- Hospital Universitário Clementino Fraga Filho , Instituto do Coração Edson Saad - Universidade Federal do Rio de Janeiro , RJ - Brasil
| | | | | | | | | | - Silvia Marinho Martins Alves
- Ambulatório de Doença de Chagas e Insuficiência Cardíaca do Pronto Socorro Cardiológico Universitário da Universidade de Pernambuco (PROCAPE/UPE), Recife , PE - Brasil
| | | | - Swamy Lima Palmeira
- Secretaria de Vigilância em Saúde , Ministério da Saúde , Brasília , DF - Brasil
| | | | | | - Vagner Madrini Junior
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , SP - Brasil
| | | | | | - João Carlos Pinto Dias
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz , Rio de Janeiro , RJ - Brasil
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Barbosa JS, de Souza MFC, Costa JO, Alves LVS, de Oliveira LMSM, de Almeida RR, Oliveira VB, Pereira LMC, Rocha RMS, Costa IMNBDC, Vieira DADS, Baumworcel L, Almeida-Santos MA, Oliveira JLM, Neves EB, Díaz-de-Durana AL, Merino-Fernández M, Aidar FJ, Sousa ACS. Assessment of Malnutrition in Heart Failure and Its Relationship with Clinical Problems in Brazilian Health Services. Int J Environ Res Public Health 2022; 19:10090. [PMID: 36011722 PMCID: PMC9408367 DOI: 10.3390/ijerph191610090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Malnutrition in heart failure (HF) is frequent and associated with a worse prognosis. Due to differences in investment and the profile of those assisted, the objective of this study was to evaluate the frequency of malnutrition in hospitalized patients with HF and its association with clinical outcomes in the public and private health systems. Methodology: A cross-sectional study, with 247 volunteers hospitalized with HF in three public hospitals and one private hospital in Aracaju, SE, Brazil. A subjective global nutritional assessment (SGA) and mini nutritional assessment (MNA) were performed. Results: Sample with 72.5% users of the public health system and 75.3% with malnutrition (public = 74.9%; private = 76.5%; p = 0.793). Regardless of the healthcare system, hospital stay (>14 days) was longer (p = 0.020) among those with malnutrition (48.4%) than well-nourished patients (29.5%). Malnutrition in the public system had higher mortality (7.5%; 5.8%; p < 0.001) and hospital transfer rate (21.1%; 0.0%; p < 0.001) than those in the private system. Death after discharge was observed only in the public system (p = 0.039). Conclusion: Malnutrition was frequent in both systems and was associated with longer hospital stays and, in the public hospital, in-hospital death and transfers.
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Affiliation(s)
- Juliana Santos Barbosa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | - Márcia Ferreira Cândido de Souza
- Graduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe, Aracaju 49100-000, Brazil
| | - Jamille Oliveira Costa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | | | | | - Rebeca Rocha de Almeida
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | - Victor Batista Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
| | | | | | | | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, Brazil
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Graduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49032-490, Brazil
| | - Joselina Luzia Menezes Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, Brazil
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty—INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | | | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Graduate Program in Physical Education, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Graduate Program in Physiological Science, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, Brazil
- Clinic and Hospital São Lucas/Division, Rede D’Or São Luiz, Aracaju 49060-676, Brazil
- Department of Medicine, Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristovão 49100-000, Brazil
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6
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Costa JO, Aidar FJ, Barbosa JS, Alves LVS, Oliveira VB, de Oliveira LMSM, Rocha RMS, Vieira DADS, Costa IMNBDC, de Souza MFC, Oliveira JLM, Baumworcel L, Neves EB, Díaz-de-Durana AL, Almeida-Santos MA, Sousa ACS. BALANCE Dietary Index in Patients with Heart Failure, and Its Adherence in Sergipe, Brazil. Clin Pract 2022; 12:383-395. [PMID: 35735662 PMCID: PMC9221597 DOI: 10.3390/clinpract12030043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: “The effective treatment of Heart Failure (HF) involves care with food intake. Recently, the Ministry of Health created the Brazilian Cardioprotective Diet and its dietary index, BALANCE, which assesses adherence to the standard’s recommendations”. Methods: This observational prospective study is part of the Congestive Heart Failure Registry (VICTIM-CHF) of Aracaju/SE. Observations and data collection took place from April 2018 to February 2021. Sociodemographic and clinical aspects and food consumption were evaluated. Food intake was determined using the food frequency questionnaire. Foods were categorized using the BALANCE dietary index into green, yellow, blue and red food groups. The BALANCE dietary index was obtained using median and interquartile ranges, scores of the Mann–Whitney U test, and associations between clinical variables and the index, through linear regression. Results: Participants included 240 patients with HF (61.12 ± 1.06 years), who were assisted by the Unified Health System (67.5%). Individuals with a partner showed greater adherence to the green food group recommendations (0.09; 0.00–0.17). The lowest adherence to recommendations regarding the blue food group was observed in individuals with excess weight, who had a higher consumption of foods rich in animal protein (0.54; 0.38–0.78). As for the red food group (ultra-processed foods) the highest adherence was observed by patients with diabetes mellitus (0.41; 0.05–0.77). The greatest adherence to the yellow food group, and a higher score, was observed in patients with the smallest left ventricular systolic diameter (LVSD). Conclusions: Being married was directly associated with the consumption of foods in the green group, while being overweight and having diabetes were inversely associated with adherence to the blue and red food groups, respectively. Greater adherence to the yellow food group recommendations was inversely associated with less change in the DSFVE.
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Affiliation(s)
- Jamille Oliveira Costa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Correspondence:
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil;
- Graduate Program in Physical Education, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Graduate Program in Physiological Science, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
| | - Juliana Santos Barbosa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Luciana Vieira Sousa Alves
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Victor Batista Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Larissa Marina Santana Mendonça de Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Raysa Manuelle Santos Rocha
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
| | - Diva Aliete dos Santos Vieira
- Department of Nutrition, Campus Prof. Antônio Garcia Filho, Federal University of Sergipe (UFS), Lagarto 49400-000, SE, Brazil;
| | | | - Márcia Ferreira Cândido de Souza
- Graduate Program Professional in Management and Technological Innovation in Health, Federal University of Sergipe, Aracaju 49100-000, SE, Brazil;
| | - Joselina Luzia Menezes Oliveira
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Leonardo Baumworcel
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
| | - Eduardo Borba Neves
- Graduate Program in Biomedical Engineering, Federal Technological University of Paraná (UTFPR), Curitiba 80230-901, PR, Brazil;
| | - Alfonso López Díaz-de-Durana
- Sports Department, Physical Activity and Sports Faculty-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Marcos Antonio Almeida-Santos
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
- Graduate Program in Health and Environment, Tiradentes University (UNIT), Aracaju 49010-390, SE, Brazil
| | - Antônio Carlos Sobral Sousa
- Graduate Program in Health Sciences, Federal University of Sergipe (UFS), Aracaju 49060-676, SE, Brazil; (J.S.B.); (L.V.S.A.); (V.B.O.); (L.M.S.M.d.O.); (R.M.S.R.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Division of Cardiology, University Hospital of Federal University of Sergipe (UFS), São Cristóvão 49100-000, SE, Brazil
- Clinic and Hospital São Lucas/Rede D’Or São Luiz, Aracaju 49060-676, SE, Brazil; (L.B.); (M.A.A.-S.)
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7
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Barroso GMHDM, Teles JCOC, Silva PVDJ, Fonseca KYS, Aragão VAS, Aquino MM, Melo EVD, Ferreira KO, Assis RJFD, Alves MFS, Sousa ACS, Oliveira JLM. Subclinical Systolic Dysfunction during Chemotherapy for Breast Cancer. International Journal of Cardiovascular Sciences 2021. [DOI: 10.36660/ijcs.20210089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Fernandes de Oliveira Santos B, de Araujo Paz D, Fernandes VM, Dos Santos JC, Chaddad-Neto FEA, Sousa ACS, Oliveira JLM. Minimally invasive supratentorial neurosurgical approaches guided by Smartphone app and compass. Sci Rep 2021; 11:6778. [PMID: 33762597 PMCID: PMC7991647 DOI: 10.1038/s41598-021-85472-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/02/2021] [Indexed: 01/19/2023] Open
Abstract
The precise location in the scalp of specifically planned points can help to achieve less invasive approaches. This study aims to develop a smartphone app, evaluate the precision and accuracy of the developed tool, and describe a series of cases using the referred technique. The application was developed with the React Native framework for Android and iOS. A phantom was printed based on the patient's CT scan, which was used for the calculation of accuracy and precision of the method. The points of interest were marked with an "x" on the patient's head, with the aid of the app and a compass attached to a skin marker pen. Then, two experienced neurosurgeons checked the plausibility of the demarcations based on the anatomical references. Both evaluators marked the frontal, temporal and parietal targets with a difference of less than 5 mm from the corresponding intended point, in all cases. The overall average accuracy observed was 1.6 ± 1.0 mm. The app was used in the surgical planning of trepanations for ventriculoperitoneal (VP) shunts and for drainage of abscesses, and in the definition of craniotomies for meningiomas, gliomas, brain metastases, intracranial hematomas, cavernomas, and arteriovenous malformation. The sample consisted of 88 volunteers who exhibited the following pathologies: 41 (46.6%) had brain tumors, 17 (19.3%) had traumatic brain injuries, 16 (18.2%) had spontaneous intracerebral hemorrhages, 2 (2.3%) had cavernomas, 1 (1.1%) had arteriovenous malformation (AVM), 4 (4.5%) had brain abscesses, and 7 (7.9%) had a VP shunt placement. In cases approached by craniotomy, with the exception of AVM, straight incisions and minicraniotomy were performed. Surgical planning with the aid of the NeuroKeypoint app is feasible and reliable. It has enabled neurological surgeries by craniotomy and trepanation in an accurate, precise, and less invasive manner.
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Affiliation(s)
- Bruno Fernandes de Oliveira Santos
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil. .,Unimed Sergipe Hospital, Aracaju, SE, Brazil. .,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil. .,Department of Neurosurgery, Hospital de Cirurgia, Aracaju, SE, Brazil.
| | - Daniel de Araujo Paz
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Antonio Carlos Sobral Sousa
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil.,Department of Internal Medicine, Federal University of Sergipe, Aracaju, SE, Brazil.,Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil.,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil
| | - Joselina Luzia Menezes Oliveira
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, SE, Brazil.,Department of Internal Medicine, Federal University of Sergipe, Aracaju, SE, Brazil.,Division of Cardiology, University Hospital, Federal University of Sergipe, Aracaju, SE, Brazil.,Clinic and Hospital São Lucas / Rede D`Or São Luiz, Aracaju, SE, Brazil
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9
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Souto MJS, Almeida-Santos MA, Ferreira EJP, Gonçalves LFG, Oliveira JLM, Sousa ACS. Spontaneous Coronary Artery Dissection in a Patient with Cerebrotendinous Xanthomatosis. Arq Bras Cardiol 2020; 115:18-21. [PMID: 32935759 PMCID: PMC8386949 DOI: 10.36660/abc.20190456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/13/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
| | - Marcos Antônio Almeida-Santos
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade Tiradentes, Aracaju, SE - Brasil.,Centro de Educação e Pesquisa da Fundação São Lucas, Aracaju, SE - Brasil
| | - Eduardo José Pereira Ferreira
- Universidade Federal de Sergipe, São Cristovão, SE - Brasil.,Centro de Educação e Pesquisa da Fundação São Lucas, Aracaju, SE - Brasil
| | - Luiz Flávio Galvão Gonçalves
- Universidade Federal de Sergipe, São Cristovão, SE - Brasil.,Centro de Educação e Pesquisa da Fundação São Lucas, Aracaju, SE - Brasil
| | - Joselina Luzia Menezes Oliveira
- Universidade Federal de Sergipe, São Cristovão, SE - Brasil.,Centro de Educação e Pesquisa da Fundação São Lucas, Aracaju, SE - Brasil
| | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe, São Cristovão, SE - Brasil.,Centro de Educação e Pesquisa da Fundação São Lucas, Aracaju, SE - Brasil
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10
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Rocha de Almeida R, Cândido de Souza MF, Gama de Matos D, Monteiro Costa Pereira L, Batista Oliveira V, Menezes Oliveira JL, Soares Barreto-Filho JA, Almeida-Santos MA, de Souza RF, de Freitas Zanona A, Machado Reis V, Aidar FJ, Sobral Sousa AC. A Retrospective Study about the Differences in Cardiometabolic Risk Indicators and Level of Physical Activity in Bariatric Surgery Patients from Private vs. Public Units. Int J Environ Res Public Health 2019; 16:ijerph16234751. [PMID: 31783626 PMCID: PMC6926728 DOI: 10.3390/ijerph16234751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Abstract
Background: Obesity is a pathology with a growing incidence in developing countries. Objective: To evaluate the evolution of cardiometabolic, anthropometrics, and physical activity parameters in individuals undergoing bariatric surgery (BS) in the public healthcare system (PUS) and private healthcare system (PHS). Methods: A longitudinal, observational, and retrospective study was conducted with 111 bariatric patients on two different health systems, with 60 patients from the PUS and 51 from the PHS. Cardiometabolic risk (CR) was analyzed by the assessment of obesity-related comorbidities (AORC) on admission and 3, 6, and 12 months after BS, and the International Physical Activity Questionnaire (IPAQ) was surveyed before and 12 months after BS. In addition, cardiometabolic risk was also assessed by biochemical (fasting glucose and complete lipidogram) and anthropometric (weight, weight loss, waist circumference, and waist-to-height ratio) parameters. Results: On admission, the parameters of severe obesity, systemic arterial hypertension (SAH), Diabetes mellitus (DM), and waiting time to BS were higher in the PUS. Additionally, in the PUS, AORC was reduced only in the SAH parameter. However, in the post-surgery moment, AORC reduced, and there was no difference between the two groups after BS. Regarding physical activity, the IPAQ showed a higher level of activity in the PHS before and one year after BS. Conclusion: At the PUS, BS is performed in patients with a higher degree of comorbidities, but BS improved the reduction of the CR at a similar level to those observed in the PHS.
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Affiliation(s)
- Rebeca Rocha de Almeida
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Estácio Sergipe University Center, Aracaju, Sergipe 49020-490, Brazil
| | - Márcia Ferreira Cândido de Souza
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
| | - Dihogo Gama de Matos
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Institute of Parasitology, McGill University, Montreal, QC H3A 0E6, Canada
| | - Larissa Monteiro Costa Pereira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Estácio Sergipe University Center, Aracaju, Sergipe 49020-490, Brazil
| | - Victor Batista Oliveira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
| | - Joselina Luzia Menezes Oliveira
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
| | - José Augusto Soares Barreto-Filho
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
| | | | - Raphael Fabrício de Souza
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Department of Physical Education, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49060-108, Brazil
| | - Aristela de Freitas Zanona
- Department of Occupational Therapy, Federal University of Sergipe—UFS, Lagarto, Sergipe 49170-000, Brazil;
| | - Victor Machado Reis
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 5000-801 Vila Real, Portugal;
| | - Felipe J. Aidar
- Group of Studies and Research in Performance, Sport, Health and Paralympic Sports—GEPEPS, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil; (D.G.d.M.); (R.F.d.S.)
- Department of Physical Education, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49060-108, Brazil
- Graduate Program in Physiological Sciences, Federal University of Sergipe—UFS, São Cristovão, Sergipe 49100-000, Brazil
- Correspondence: ; Tel.: +55-79-3194-6600
| | - Antônio Carlos Sobral Sousa
- Post Graduate Program in Health Sciences, Federal University of Sergipe—UFS, Aracaju, Sergipe 49060-108, Brazil; (R.R.d.A.); (M.F.C.d.S.); (L.M.C.P.); (V.B.O.); (J.L.M.O.); (A.C.S.S.)
- Department of Medicine, Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Cardiovascular System Unit Federal University of Sergipe, Aracaju, Sergipe 49060-108, Brazil
- Clinic and Hospital São Lucas—Rede D’Or São Luiz, Aracaju, Sergipe 49015-400, Brazil
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11
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Mota IL, Sousa ACS, Almeida MLD, de Melo EV, Ferreira EJP, Neto JB, Matos CJO, Telino CJCL, Souto MJS, Oliveira JLM. Coronary lesions in patients with COPD (Global Initiative for Obstructive Lung Disease stages I-III) and suspected or confirmed coronary arterial disease. Int J Chron Obstruct Pulmon Dis 2018; 13:1999-2006. [PMID: 29983554 PMCID: PMC6027684 DOI: 10.2147/copd.s162713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Systemic inflammation is the pathophysiological link between coronary artery disease (CAD) and COPD. However, the influence of subclinical COPD on patients with suspected or diagnosed CAD is largely unknown. Thus, this study was designed to evaluate the degree of coronary involvement in patients with COPD and suspected or confirmed CAD. Methods In this cross-sectional study, carried out between March 2015 and June 2017, 210 outpatients with suspected or confirmed CAD were examined by both spirometry and coronary angiography or multidetector computed tomography. These patients were divided into two groups: with and without COPD. Size, site, extent, and calcification of the coronary lesions, and the severity of COPD were analyzed. Results COPD patients (n = 101) presented with a higher frequency of obstructive coronary lesions ≥50% (n = 72, 71.3%), multivessels (n = 29, 28.7%), more lesions of the left coronary trunk (n = 18, 17.8%), and more calcified atherosclerotic plaques and higher Agatston coronary calcium score than the patients without COPD (P < 0.0001). The more severe the COPD in the Global Initiative for Obstructive Lung Disease stages, the more severe the CAD and the more calcified coronary plaques (P < 0.0001). However, there was no difference between the two groups with respect to the main risk factors for CAD. In the univariate analysis, COPD was an independent predictor of obstructive CAD (odds ratio [OR] 4.78; 95% confidence interval: 2.21–10.34; P < 0.001). Conclusion In patients with suspected CAD, comorbid COPD was associated with increased severity and extent of coronary lesions, calcific plaques, and elevated calcium score independent of the established risk factors for CAD. In addition, the more severe the COPD, the greater the severity of coronary lesions and calcification present.
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Affiliation(s)
- Igor Larchert Mota
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil,
| | - Antônio Carlos Sobral Sousa
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Luiza Doria Almeida
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Enaldo Vieira de Melo
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Eduardo José Pereira Ferreira
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - José Barreto Neto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil
| | - Carlos José Oliveira Matos
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Caio José Coutinho Leal Telino
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Maria Júlia Silveira Souto
- Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
| | - Joselina Luzia Menezes Oliveira
- Department of Internal Medicine, Pneumology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil, .,Department of Internal Medicine, Cardiology Division, Federal University of Sergipe (FUS), São Cristóvão, Sergipe, Brazil.,Echocardiography Laboratory (ECOLAB), Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil
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12
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Gabriel FS, Gonçalves LFG, Melo EVD, Sousa ACS, Pinto IMF, Santana SMM, Matos CJOD, Souto MJS, Conceição FMDS, Oliveira JLM. Atherosclerotic Plaque in Patients with Zero Calcium Score at Coronary Computed Tomography Angiography. Arq Bras Cardiol 2018; 110:420-427. [PMID: 29723329 PMCID: PMC5967134 DOI: 10.5935/abc.20180063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 11/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background In view of the high mortality for cardiovascular diseases, it has become
necessary to stratify the main risk factors and to choose the correct
diagnostic modality. Studies have demonstrated that a zero calcium score
(CS) is characteristic of a low risk for cardiovascular events. However, the
prevalence of individuals with coronary atherosclerotic plaques and zero CS
is conflicting in the specialized literature. Objective To evaluate the frequency of patients with coronary atherosclerotic plaques,
their degree of obstruction and associated factors in patients with zero CS
and indication for coronary computed tomography angiography (CCTA). Methods This is a cross-sectional, prospective study with 367 volunteers with zero CS
at CCTA in four diagnostic imaging centers in the period from 2011 to 2016.
A significance level of 5% and 95% confidence interval were adopted. Results The frequency of atherosclerotic plaque in the coronary arteries in 367
patients with zero CS was 9.3% (34 individuals). In this subgroup, mean age
was 52 ± 10 years, 18 (52.9%) were women and 16 (47%) had significant
coronary obstructions (> 50%), with involvement of two or more segments
in 4 (25%) patients. The frequency of non-obese individuals (90.6% vs 73.9%,
p = 0.037) and alcohol drinkers (55.9% vs 34.8%, p = 0.015) was
significantly higher in patients with atherosclerotic plaques, with an odds
ratio of 3.4 for each of this variable. Conclusions The frequency of atherosclerotic plaque with zero CS was relatively high,
indicating that the absence of calcification does not exclude the presence
of plaques, many of which obstructive, especially in non-obese subjects and
alcohol drinkers.
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Affiliation(s)
- Fabíola Santos Gabriel
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Clínica de Medicina Nuclear de Diabetes - CLIMEDI - Aracaju, SE - Brazil
| | - Luiz Flávio Galvão Gonçalves
- Centro de Pesquisas da Fundação São Lucas - Aracaju, SE - Brazil.,Clínica de Medicina Nuclear de Diabetes - CLIMEDI - Aracaju, SE - Brazil
| | - Enaldo Vieira de Melo
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Antônio Carlos Sobral Sousa
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia (ECOLAB) do Hospital e Fundação São Lucas - Aracaju, SE - Brazil
| | | | | | - Carlos José Oliveira de Matos
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Maria Júlia Silveira Souto
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Flávio Mateus do Sacramento Conceição
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil
| | - Joselina Luzia Menezes Oliveira
- Núcleo de Pós-Graduação em Medicina da Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Departamento de Medicina - Universidade Federal de Sergipe (UFS) - São Cristóvão, SE - Brazil.,Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia (ECOLAB) do Hospital e Fundação São Lucas - Aracaju, SE - Brazil.,Instituto Dante Pazzanese de Cardiologia - São Paulo, SP - Brazil.,Centro de Ensino e Pesquisa da Fundação São Lucas - Aracaju, SE - Brazil
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13
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Fontes VJB, Souto MJS, Sousa ACS, Melo EVD, Conceição FMDS, Telino CJCL, Silveira MS, Dória JADS, Matos CJOD, Oliveira JLM. Low to Moderate Alcohol Consumption and Myocardial Ischemia on Exercise Stress
Echocardiography. International Journal of Cardiovascular Sciences 2018. [DOI: 10.5935/2359-4802.20180019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Maia CA, Barbosa IL, Sousa ACS, Melo EVD, Martins TM, Tavares IDS, Mota IL, Gabriel FS, Matos CJO, Oliveira JLM. Predictors of Atherosclerotic Plaque in Individuals with Asymptomatic Ischemia on
Physical Stress Echocardiography. International Journal of Cardiovascular Sciences 2017. [DOI: 10.5935/2359-4802.20170006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tavares IDS, Matos CJOD, Nunes MAP, Sousa ACS, Lyra Júnior DPD, Oliveira JLM. Overview with Meta-analysis of Systematic Reviews of the Diagnostic and Prognostic
Value of Coronary Computed Tomography Angiography in the Emergency Department. International Journal of Cardiovascular Sciences 2017. [DOI: 10.5935/2359-4802.20170086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Barros MDS, Amorim RS, Rocha RO, Melo EVD, Barreto-Filho JA, Sousa ACS, Meneghelo RS, Oliveira JLM. Cardiopulmonary Exercise Testing in Patients With Left Bundle Branch Block and
Preserved Ejection Fraction. International Journal of Cardiovascular Sciences 2017. [DOI: 10.5935/2359-4802.20170018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Andrade SM, Telino CJCL, Sousa ACS, de Melo EV, Teixeira CCC, Teixeira CKC, Santana JS, Mota IL, de Matos CJO, Oliveira JLM. Low Prevalance of Major Events Adverse to Exercise Stress Echocardiography. Arq Bras Cardiol 2016; 107:116-23. [PMID: 27355587 PMCID: PMC5074064 DOI: 10.5935/abc.20160096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 03/24/2016] [Indexed: 11/20/2022] Open
Abstract
Background: Stress echocardiography is well validated for diagnosis and risk
stratification of coronary artery disease. Exercise stress echocardiography
(ESE) has been shown to be the most physiological among the modalities of
stress, but its safety is not well established. Objective: To study the complications related to ESE and clinical and echocardiographic
variables most commonly associated with their occurrence. Methods: Cross-sectional study consisting of 10250 patients submitted to ESE for
convenience, from January 2000 to June 2014. Cardiac Arrhythmias (CA) were
the most frequent complications observed during the examination. The
volunteers were divided into two groups according to the occurrence of CA
during ESE: G1 group, composed of patients who have CA, and G2 formed by
individuals who did not show such complication. Results: Group G1,
consisting of 2843 patients (27.7%), and Group G2 consisting of 7407
patients (72.3%). There was no death, acute myocardial infarction,
ventricular fibrillation or asystole. Predominant CAs were: supraventricular
extrasystoles (13.7%), and ventricular extrasystoles (11.5%). G1 group had a
higher mean age, higher frequency of hypertension and smoking, larger aortic
roots and left atrium (LA) and lower ejection fraction than G2. G1 group
also had more ischemic changes (p < 0.001). The predictor variables were
age (RR 1.04; [CI] 95% from 1.038 to 1.049) and LA (RR 1.64; [CI] 95% from
1.448 to 1.872). Conclusion: ESE proved to be a safe modality of stress, with non-fatal complications
only. Advanced age and enlargement of the left atrium are predictive of
cardiac arrhythmias.
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Affiliation(s)
| | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe, Aracaju, SE- Brazil
- Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia
(ECOLAB) do Hospital e Fundação São Lucas, Aracaju, SE -
Brazil
| | | | | | | | | | | | | | - Joselina Luzia Menezes Oliveira
- Universidade Federal de Sergipe, Aracaju, SE- Brazil
- Centro de Ensino e Pesquisa e Laboratório de Ecocardiografia
(ECOLAB) do Hospital e Fundação São Lucas, Aracaju, SE -
Brazil
- Mailing Address: Joselina Luzia Menezes Oliveira.
Praça Graccho Cardoso, 76/402, São José. Postal Code
49015-180, Aracaju, SE - Brazil E-mail: ,
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Gabriel FS, Almeida-Santos MA, Hirata TDC, Hirata MH, Pinto IMF, Sousa ACS, Mota FBS, Oliveira DPD, Oliveira JLM. Coronary Computed Tomography Angiography and C-Reactive Protein in the Evaluation
of Coronary Artery Disease. International Journal of Cardiovascular Sciences 2016. [DOI: 10.5935/2359-4802.20160059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jorge JDG, Santos MAA, Barreto Filho JAS, Oliveira JLM, de Melo EV, de Oliveira NA, Faro GBDA, Sousa ACS. Level of Physical Activity and In-Hospital Course of Patients with Acute Coronary Syndrome. Arq Bras Cardiol 2015; 106:33-40. [PMID: 26690692 PMCID: PMC4728593 DOI: 10.5935/abc.20160006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/04/2015] [Indexed: 11/20/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is one of the main causes of morbidity and
mortality in the modern world. A sedentary lifestyle, present in 85%
of the Brazilian population, is considered a risk factor for the
development of coronary artery disease. However, the correlation of a
sedentary lifestyle with cardiovascular events (CVE) during
hospitalization for ACS is not well established. Objective To evaluate the association between physical activity level, assessed
with the International Physical Activity Questionnaire (IPAQ), with
in-hospital prognosis in patients with ACS. Methods Observational, cross-sectional, and analytical study with 215 subjects
with a diagnosis of ACS consecutively admitted to a referral hospital
for cardiac patients between July 2009 and February 2011. All
volunteers answered the short version of the IPAQ and were observed
for the occurrence of CVE during hospitalization with a standardized
assessment conducted by the researcher and corroborated by data from
medical records. Results The patients were admitted with diagnoses of unstable angina (34.4%),
acute myocardial infarction (AMI) without ST elevation (41.4%), and
AMI with ST elevation (24.2%). According to the level of physical
activity, the patients were classified as non-active (56.3%) and
active (43.7%). A CVE occurred in 35.3% of the cohort. The occurrence
of in-hospital complications was associated with the length of
hospital stay (odds ratio [OR] = 1.15) and physical inactivity (OR =
2.54), and was independent of age, systolic blood pressure, and prior
congestive heart failure. Conclusion A physically active lifestyle reduces the risk of CVE during
hospitalization in patients with ACS.
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Affiliation(s)
- Juliana de Goes Jorge
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | | | | | | | - Enaldo Vieira de Melo
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Norma Alves de Oliveira
- Núcleo de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brazil
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Almeida-Santos MA, Barreto-Filho JA, Oliveira JLM, Reis FP, da Cunha Oliveira CC, Sousa ACS. Aging, heart rate variability and patterns of autonomic regulation of the heart. Arch Gerontol Geriatr 2015; 63:1-8. [PMID: 26791165 DOI: 10.1016/j.archger.2015.11.011] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/15/2015] [Accepted: 11/17/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the effects of aging, gender and body mass index on the heart rate variability (HRV), and to compare the patterns of global autonomic regulation (GAR) and parasympathetic outflow (PO) throughout the aging process. DESIGN, SETTING AND PARTICIPANTS CROSS-SECTIONAL: Large sample of community-based adults and elderly people. Individuals aged from 40 to 100 years, functionally independent and with satisfactory cognitive function defined as the self-capacity to interact with an interviewer (N= 1743). MATERIAL AND METHODS The study enrolled individuals of both genders, stratified into five age-groups. We did adjustments for hypertension, dyslipidemia and non-insulin-dependent diabetes, as well as the body mass index (BMI). All groups undertook long-term electrocardiograms and five time-domain HRV parameters were measured, three (SDNN, SDANN, SDNN-index) reflecting the GAR and two (rMSSD and pNN50) the PO. RESULTS SDNN, SDANN and SDNN-index decreased linearly with age and BMI, and women had lower values than men (p<0.001). There was a U-shaped pattern of rMSSD and pNN50, with the nadir between 60 and 69 years for both genders, and women had higher values than men (p<0.001). The lowest levels of all HRV variables were found in diabetics (p<0.001). There was no influence of hypertension or dyslipidemia. CONCLUSIONS The GAR decreased linearly with the age in both genders. It is comparatively lower in women, diabetics and overweight individuals. The PO presented the U-shape in both genders with the nadir at the 7th decade. It was also comparatively lower in men and diabetics. Hypertension and dyslipidemia imparted no significant influence.
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Affiliation(s)
- Marcos Antonio Almeida-Santos
- Division of Postgraduation in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Sao Lucas Foundation, Center of Researches, Aracaju, Sergipe, Brazil; Postgraduation in Health and Environment, Tiradentes University, Aracaju, Sergipe, Brazil.
| | - Jose Augusto Barreto-Filho
- Division of Postgraduation in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Sao Lucas Foundation, Center of Researches, Aracaju, Sergipe, Brazil
| | - Joselina Luzia Menezes Oliveira
- Division of Postgraduation in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Sao Lucas Foundation, Center of Researches, Aracaju, Sergipe, Brazil
| | - Francisco Prado Reis
- Postgraduation in Health and Environment, Tiradentes University, Aracaju, Sergipe, Brazil
| | | | - Antonio Carlos Sobral Sousa
- Division of Postgraduation in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Sao Lucas Foundation, Center of Researches, Aracaju, Sergipe, Brazil
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Oliveira JLM, Hirata MH, Sousa AGDMR, Gabriel FS, Hirata TDC, Tavares IDS, Melo LD, Dória FDS, Sousa ACS, Pinto IMF. Male Gender and Arterial Hypertension are Plaque Predictors at Coronary Computed Tomography Angiography. Arq Bras Cardiol 2015; 104:409-16. [PMID: 25861034 PMCID: PMC4495456 DOI: 10.5935/abc.20150028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 01/15/2015] [Accepted: 01/19/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Systemic Arterial Hypertension (SAH) is one of the main risk factors for Coronary Artery Disease (CAD), in addition to male gender. Differences in coronary artery lesions between hypertensive and normotensive individuals of both genders at the Coronary Computed Tomography Angiography (CCTA) have not been clearly determined. OBJECTIVE To Investigate the calcium score (CS), CAD extent and characteristics of coronary plaques at CCTA in men and women with and without SAH. METHODS Prospective cross-sectional study of 509 patients undergoing CCTA for CAD diagnosis and risk stratification, from November 2011 to December 2012, at Instituto de Cardiologia Dante Pazzanese. Individuals were stratified according to gender and subdivided according to the presence (HT +) or absence (HT-) of SAH. RESULTS HT+ women were older (62.3 ± 10.2 vs 57.8 ± 12.8, p = 0.01). As for the assessment of CAD extent, the HT+ individuals of both genders had significant CAD, although multivessel disease is more frequent in HT + men. The regression analysis for significant CAD showed that age and male gender were the determinant factors of multivessel disease and CS ≥ 100. Plaque type analysis showed that SAH was a predictive risk factor for partially calcified plaques (OR = 3.9). CONCLUSION Hypertensive men had multivessel disease more often than women. Male gender was a determinant factor of significant CAD, multivessel disease, CS ≥ 100 and calcified and partially calcified plaques, whereas SAH was predictive of partially calcified plaques.
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Silveira MGM, Sousa ACS, Santos MAA, Tavares IDS, Andrade SM, Melo LD, de Andrade LSO, Santos ELA, Oliveira JLM. Assessment of Myocardial Ischemia in Obese Individuals Undergoing Physical Stress Echocardiography (PSE). Arq Bras Cardiol 2015; 104:394-400. [PMID: 25714197 PMCID: PMC4495454 DOI: 10.5935/abc.20150006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 11/04/2014] [Accepted: 11/21/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Physical stress echocardiography is an established methodology for diagnosis and risk stratification of coronary artery disease in patients with physical capacity. In obese (body mass index ≥ 30 kg/m2) the usefulness of pharmacological stress echocardiography has been demonstrated; however, has not been reported the use of physical stress echocardiography in this growing population group. OBJECTIVE To assess the frequency of myocardial ischemia in obese and non-obese patients undergoing physical stress echocardiography and compare their clinical and echocardiographic differences. METHODS 4,050 patients who underwent treadmill physical stress echocardiography were studied according to the Bruce protocol, divided into two groups: obese (n = 945; 23.3%) and non-obese (n = 3,105; 76.6%). RESULTS There was no difference regarding gender. Obese patients were younger (55.4 ± 10.9 vs. 57.56 ± 11.67) and had a higher frequency of hypertension (75.2% vs. 57, 2%; p < 0.0001), diabetis mellitus (15.2% vs. 10.9%; p < 0.0001), dyslipidemia (59.5% vs 51.9%; p < 0.0001), family history of coronary artery disease (59.3% vs. 55.1%; p = 0.023) and physical inactivity (71.4% vs. 52.9%, p < 0.0001). The obese had greater aortic dimensions (3.27 vs. 3.14 cm; p < 0.0001), left atrium (3.97 vs. 3.72 cm; p < 0.0001) and the relative thickness of the ventricule (33.7 vs. 32.8 cm; p < 0.0001). Regarding the presence of myocardial ischemia, there was no difference between groups (19% vs. 17.9%; p = 0.41). In adjusted logistic regression, the presence of myocardial ischemia remained independently associated with age, female gender, diabetes and hypertension. CONCLUSION Obesity did not behave as a predictor of the presence of ischemia and the physical stress echocardiography. The application of this assessment tool in large scale sample demonstrates the feasibility of the methodology, also in obese.
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Affiliation(s)
| | - Antônio Carlos Sobral Sousa
- Departamento de Medicina da Universidade Federal de Sergipe
(UFS), São Cristóvão, SE - Brazil
- Centro de Ensino e Pesquisa e Laboratório de
Ecocardiografia da Fundação São Lucas, Aracaju, SE - Brazil
- Fellow of the American College of Cardiology
- Núcleo de Pós-Graduação em
Medicina da UFS, São Cristóvão, SE − Brazil
| | - Marcos Antônio Almeida Santos
- Departamento de Medicina da Universidade Federal de Sergipe
(UFS), São Cristóvão, SE - Brazil
- Centro de Ensino e Pesquisa e Laboratório de
Ecocardiografia da Fundação São Lucas, Aracaju, SE - Brazil
- Núcleo de Pós-Graduação em
Medicina da UFS, São Cristóvão, SE − Brazil
| | - Irlaneide da Silva Tavares
- Departamento de Medicina da Universidade Federal de Sergipe
(UFS), São Cristóvão, SE - Brazil
- Centro de Ensino e Pesquisa e Laboratório de
Ecocardiografia da Fundação São Lucas, Aracaju, SE - Brazil
- Núcleo de Pós-Graduação em
Medicina da UFS, São Cristóvão, SE − Brazil
| | | | - Luiza Dantas Melo
- Departamento de Medicina da Universidade Federal de Sergipe
(UFS), São Cristóvão, SE - Brazil
| | | | | | - Joselina Luzia Menezes Oliveira
- Departamento de Medicina da Universidade Federal de Sergipe
(UFS), São Cristóvão, SE - Brazil
- Centro de Ensino e Pesquisa e Laboratório de
Ecocardiografia da Fundação São Lucas, Aracaju, SE - Brazil
- Instituto Dante Pazzanese de Cardiologia, São Paulo,
SP - Brazil
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Araujo ACPD, Santos BFDO, Calasans FR, Pinto IMF, Oliveira DPD, Melo LD, Andrade SM, Tavares IDS, Sousa ACS, Oliveira JLM. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia. Arq Bras Cardiol 2014; 103:418-425. [PMID: 25352460 PMCID: PMC4262103 DOI: 10.5935/abc.20140144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 06/02/2014] [Indexed: 11/20/2022] Open
Abstract
Background Studies have demonstrated the diagnostic accuracy and prognostic value of physical
stress echocardiography in coronary artery disease. However, the prediction of
mortality and major cardiac events in patients with exercise test positive for
myocardial ischemia is limited. Objective To evaluate the effectiveness of physical stress echocardiography in the
prediction of mortality and major cardiac events in patients with exercise test
positive for myocardial ischemia. Methods This is a retrospective cohort in which 866 consecutive patients with exercise
test positive for myocardial ischemia, and who underwent physical stress
echocardiography were studied. Patients were divided into two groups: with
physical stress echocardiography negative (G1) or positive (G2) for myocardial
ischemia. The endpoints analyzed were all‑cause mortality and major cardiac
events, defined as cardiac death and non-fatal acute myocardial infarction. Results G2 comprised 205 patients (23.7%). During the mean 85.6 ± 15.0-month follow-up,
there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal
myocardial infarction cases. The independent predictors of mortality were: age,
diabetes mellitus, and positive physical stress echocardiography (hazard ratio:
2.69; 95% confidence interval: 1.20 – 6.01; p = 0.016). The independent predictors
of major cardiac events were: age, previous coronary artery disease, positive
physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval:
1.15 – 6.53; p = 0.022) and absence of a 10% increase in ejection fraction.
All-cause mortality and the incidence of major cardiac events were significantly
higher in G2 (p < 0. 001 and p = 0.001, respectively). Conclusion Physical stress echocardiography provides additional prognostic information in
patients with exercise test positive for myocardial ischemia.
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Secundo Junior JA, Santos MAA, Faro GBDA, Soares CB, Silva AMP, Secundo PFC, Teixeira CKC, Oliveira JLM, Barreto Filho JAS, Sousa ACS. Left atrial volume index and prediction of events in acute coronary syndrome: Solar Registry. Arq Bras Cardiol 2014; 103:282-91. [PMID: 25119895 PMCID: PMC4206358 DOI: 10.5935/abc.20140122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/30/2014] [Indexed: 12/21/2022] Open
Abstract
Background According to some international studies, patients with acute coronary syndrome
(ACS) and increased left atrial volume index (LAVI) have worse long-term
prognosis. However, national Brazilian studies confirming this prediction are
still lacking. Objective To evaluate LAVI as a predictor of major cardiovascular events (MCE) in patients
with ACS during a 365-day follow-up. Methods Prospective cohort of 171 patients diagnosed with ACS whose LAVI was calculated
within 48 hours after hospital admission. According to LAVI, two groups were
categorized: normal LAVI (≤ 32 mL/m2) and increased LAVI (> 32
mL/m2). Both groups were compared regarding clinical and
echocardiographic characteristics, in- and out-of-hospital outcomes, and
occurrence of ECM in up to 365 days. Results Increased LAVI was observed in 78 patients (45%), and was associated with older
age, higher body mass index, hypertension, history of myocardial infarction and
previous angioplasty, and lower creatinine clearance and ejection fraction. During
hospitalization, acute pulmonary edema was more frequent in patients with
increased LAVI (14.1% vs. 4.3%, p = 0.024). After discharge, the occurrence of
combined outcome for MCE was higher (p = 0.001) in the group with increased LAVI
(26%) as compared to the normal LAVI group (7%) [RR (95% CI) = 3.46
(1.54-7.73) vs. 0.80 (0.69-0.92)]. After Cox regression, increased LAVI
increased the probability of MCE (HR = 3.08, 95% CI = 1.28-7.40, p = 0.012). Conclusion Increased LAVI is an important predictor of MCE in a one-year follow-up.
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Souto FM, Andrade SM, Barreto ATF, Souto MJS, Russo MA, de Mendonça JT, Oliveira JLM, Gonçalves LFG. [Anomalous pulmonary venous return in a pregnant woman identified by cardiac magnetic resonance]. Rev Port Cardiol 2014; 33:383.e1-5. [PMID: 25001162 DOI: 10.1016/j.repc.2014.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 01/27/2014] [Accepted: 02/01/2014] [Indexed: 11/28/2022] Open
Abstract
Anomalous pulmonary venous return (APVR) is a rare cardiac anomaly defined as one or more pulmonary veins draining into a structure other than the left atrium, with venous return directly or indirectly to the right atrium. The most common form is partial APVR, in which one to three pulmonary veins drain into systemic veins or into the right atrium. We report the case of a woman diagnosed with partial APVR by magnetic resonance imaging during pregnancy.
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Affiliation(s)
- Fernanda Maria Souto
- Departamento de Medicina, Universidade Federal de Sergipe, São Cristóvão, Sergipe, Brasil.
| | | | | | | | | | | | - Joselina Luzia Menezes Oliveira
- Serviço de Ressonância Magnética e Laboratório de Ecocardiografia (ECOLAB), Clínica e Hospital São Lucas, Aracaju-SE, Brasil
| | - Luiz Flávio Galvão Gonçalves
- Serviço de Ressonância Magnética e Laboratório de Ecocardiografia (ECOLAB), Clínica e Hospital São Lucas, Aracaju-SE, Brasil
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Gonçalves LFG, Souto FMS, Faro FN, Mendonça RDC, Oliveira JLM, Sousa ACS. Dextrocardia with situs inversus associated with non-compaction cardiomyopathy. Arq Bras Cardiol 2014; 101:e33-6. [PMID: 24030083 PMCID: PMC3998156 DOI: 10.5935/abc.20130158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Luiz Flávio Galvão Gonçalves
- Serviço de Ressonância Cardiovascular e Laboratório de Ecocardiografia,
Hospital e Fundação São Lucas, Aracaju, SE - Brazil
| | | | | | - Rodrigo de Castro Mendonça
- Serviço de Ressonância Cardiovascular e Laboratório de Ecocardiografia,
Hospital e Fundação São Lucas, Aracaju, SE - Brazil
| | - Joselina Luzia Menezes Oliveira
- Serviço de Ressonância Cardiovascular e Laboratório de Ecocardiografia,
Hospital e Fundação São Lucas, Aracaju, SE - Brazil
- Departamento de Medicina, Universidade Federal de Sergipe (UFS), São
Cristóvão, SE - Brazil
- Mailing address: Joselina Luzia Menezes Oliveira, Praça Graccho Cardoso,
76/402, São José. Postal Code 49015-180, Aracaju, SE - Brazil, E-mail:
,
| | - Antônio Carlos Sobral Sousa
- Serviço de Ressonância Cardiovascular e Laboratório de Ecocardiografia,
Hospital e Fundação São Lucas, Aracaju, SE - Brazil
- Departamento de Medicina, Universidade Federal de Sergipe (UFS), São
Cristóvão, SE - Brazil
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Souto FMS, Oliveira JLM, Sousa ACS. Reply: To PMID 24030083. Arq Bras Cardiol 2014; 102:308. [PMID: 24843866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Santana JS, Sousa ACS, Oliveira JLM, de Melo EV. Reply: To PMID 23657263. Arq Bras Cardiol 2014; 102:199. [PMID: 24809076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Calasans FR, Santos BFDO, Silveira DCR, de Araújo ACP, Melo LD, Barreto-Filho JA, Sousa ACS, Oliveira JLM. Stress echocardiography and major cardiac events in patients with normal exercise test. Arq Bras Cardiol 2013; 101:35-42. [PMID: 23765384 PMCID: PMC3998167 DOI: 10.5935/abc.20130124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 12/17/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exercise test (ET) is the preferred initial noninvasive test for the diagnosis and risk stratification of coronary artery disease (CAD), however, its lower sensitivity may fail to identify patients at greater risk of adverse events. OBJECTIVE To assess the value of stress echocardiography (SE) for predicting all-cause mortality and major cardiac events (MACE) in patients with intermediate pretest probability of CAD and a normal ET. METHODS 397 patients with intermediate CAD pretest probability , estimated by the Morise score, and normal ET who underwent SE were studied. The patients were divided into two groups according to the absence (G1) or presence (G2) of myocardial ischemia on SE .End points evaluated were all-cause mortality and MACE, defined as cardiac death and nonfatal acute myocardial infarction (AMI). RESULTS G1 group was comprised of 329 (82.8%) patients. The mean age of the patients was 57.37 ± 11 years and 44.1% were male. During a mean follow-up of 75.94 ± 17.24 months, 13 patients died, three of them due to cardiac causes, and 13 patients suffered nonfatal AMI. Myocardial ischemia remained an independent predictor of MACE (HR 2.49; [CI] 95% 1.74-3.58). The independent predictors for all-cause mortality were male gender (HR 9.83; [CI] 95% 2.15-44.97) and age over 60 years (HR 4.57; [CI] 95% 1.39-15.23). CONCLUSION Positive SE for myocardial ischemia is a predictor of MACE in the studied sample, which helps to identify a subgroup of patients at higher risk of events despite having normal ET.
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Affiliation(s)
| | | | | | | | | | | | - Antônio Carlos Sobral Sousa
- Universidade Federal de Sergipe, Aracaju, SE - Brazil , Laboratório de Ecocardiografia da Clínica e Hospital São Lucas -
ECOLAB, Aracaju, SE - Brazil
| | - Joselina Luzia Menezes Oliveira
- Universidade Federal de Sergipe, Aracaju, SE - Brazil , Laboratório de Ecocardiografia da Clínica e Hospital São Lucas -
ECOLAB, Aracaju, SE - Brazil ,Mailing Address: Joselina Luzia Menezes Oliveira, Praça Graccho Cardoso,
76/402, São José. Postal Code: 49015-180, Aracaju, SE - Brazil, E-mail:
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Santana JS, Franco Filho JCS, Sá Neto AAD, Melo EVD, Santana NOD, Barreto ATF, Melo LD, Barreto Filho JA, Sousa ACS, Oliveira JLM. Prognostic value of chronotropic incompetence in elderly patients undergoing exercise echocardiography. Arq Bras Cardiol 2013; 100:429-36. [PMID: 23657263 DOI: 10.5935/abc.20130091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 02/14/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Chronotropic incompetence (CI), defined as failure to achieve less than 80% of age-expected heart rate, is a predictor of mortality and adverse cardiovascular events and may confer a worse prognosis in elderly diabetic individuals. OBJECTIVE To evaluate the prognostic value of chronotropic incompetence (CI) in elderly diabetic patients considering endpoints with acute myocardial infarction (AMI), cerebrovascular disease (CVD) and overall mortality and compare clinical and echocardiographic characteristics between patients with and without CI. METHOD A total of 298 elderly diabetic patients undergoing exercise echocardiography (EE) were studied from January 2001 to December 2010. Of these, 109 were chronotropic incompetent (group 1) and were compared with the chronotropic competent ones (group 2) regarding the occurrence of cardiovascular events, clinical and echocardiographic characteristics. RESULTS Chronotropic incompetents patients showed a higher frequency of cerebrovascular disease (9.2% vs. 3.2, p = 0.027) and higher mortality was observed in those who had cerebrovascular disease or acute myocardial infarction. The presence of typical angina and dyspnea prior to the performance of EE and male gender were more frequent in group 1. Rest and exercise left ventricular wall motion score index, rate of left ventricle mass and left atrium diameter were higher in chronotropic incompetent individuals. CONCLUSION Chronotropic incompetence was independently associated with the occurrence of cerebrovascular disease in elderly diabetic individuals.
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Affiliation(s)
- Juliana Silva Santana
- Universidade Federal de Sergipe1; Hospital e Clínica São Lucas2, Aracaju, SE - Brazil.
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Pinheiro CP, Oliveira MDP, Faro GBDA, Silva EC, Rocha EAAD, Barreto-Filho JAS, Oliveira JLM, Sousa ACS. Prognostic Value of Stress Hyperglycemia for In-Hospital Outcome in Acute Coronary Artery Disease. Arq Bras Cardiol 2013; 100:127-34. [DOI: 10.5935/abc.20130025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 10/09/2012] [Indexed: 11/20/2022] Open
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Gonçalves LFG, Souto FMS, Faro FN, Oliveira JLM, Barreto-Filho JAS, Sousa ACS. Trombo biventricular e fibrose endomiocárdica na síndrome antifosfolípide. Arq Bras Cardiol 2012. [DOI: 10.1590/s0066-782x2012001400017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Secundo PFC, Santos BFDO, Secundo Júnior JA, Silva JBD, Souza ARD, Faro GBDA, Barreto-Filho JA, Sousa ACS, Oliveira JLM. Clinical and echocardiographic parameters associated with low chronotropic index in non-elderly patients. Arq Bras Cardiol 2012; 98:413-20. [PMID: 22481642 DOI: 10.1590/s0066-782x2012005000033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 01/27/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Despite abundant evidence of increased morbidity and mortality, chronotropic incompetence (CI) is not a routine diagnosis well defined in protocols of cardiac evaluation and its clinical importance is still underestimated. OBJECTIVE To evaluate the clinical and echocardiographic parameters associated with HF in non-elderly patients submitted to stress echocardiography (SE). METHODS One thousand seven hundred ninety-eight patients with a mean age of 48.4 ± 7.5 years, who underwent SE between January/2000 and August/2009 were evaluated. Patients with chronotropic index smaller than 0.8 were considered chronotropic incompetent as compared to competent patients as to clinical and echocardiographic characteristics. RESULTS The duration of the exercise was 9.3 ± 2.4 minutes on average. Two hundred and seventy (15%) patients were chronotropic incompetent. The chronotropic index of this group was 0.7 ± 0.1 vs. 1.0 ± 0.1 for competent patients. Multivariate logistic regression analysis identified the following parameters as independently associated with HF: dyspnea on examination [odds ratio (OR) = 4.27, p <0.0001], previous chest pain on medical history (OR = 1.51; p = 0.0111), higher left ventricular mass rate in incompetent patients (LVMI) (OR = 1.16, p = 0.0001), metabolic equivalents (METs) (OR = 0.70, p = 0 , 0001), ST segment depression (OR = 0.58, p = 0.0003) and high systolic blood pressure (ΔSBP) (OR = 0.87, p = 0.0011). Myocardial ischemia was not associated with HF. CONCLUSION HF is associated with functional parameters, such as dyspnea on exertion, history of chest pain and lower METS. It is also associated with structural benchmark index of left ventricular mass. In addition, chronotropic incompetence does not appear to increase the chance of myocardial ischemia in non-elderly patients.
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Tavares IDS, Sousa ACS, Menezes Filho RS, Aguiar-Oliveira MHD, Barreto-Filho JA, Brito AFD, Oliveira JLM. Função diastólica do ventrículo esquerdo em obesos graves em pré-operatório para cirurgia bariátrica. Arq Bras Cardiol 2012; 98:300-6. [DOI: 10.1590/s0066-782x2012005000028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 12/27/2011] [Indexed: 11/21/2022] Open
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Leite NTF, Salvatori R, Alcântara MRS, Alcântara PRS, Oliveira CRP, Oliveira JLM, Anjos-Andrade FD, Farias MIT, Britto CTF, Nóbrega LMA, Nascimento AC, Alves ÉO, Pereira RMC, Campos VC, Menezes M, Martinelli CE, Aguiar-Oliveira MH. Effects of depot growth hormone replacement on thyroid function and volume in adults with congenital isolated growth hormone deficiency. J Endocrinol Invest 2012; 35:265-8. [PMID: 21422802 DOI: 10.3275/7608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conflicting data exist on the effects of GH replacement therapy (GHRT) on thyroid function and thyroid volume (TV) in GH-deficient (GHD) patients. AIM The aim of this study was to assess the effects of GHRT on thyroid function and TV in adults with congenital lifetime isolated GHD (IGHD). SUBJECTS AND METHODS We studied 20 GH-naïve adults with IGHD due to a homozygous mutation of the GHRH-receptor gene at baseline, after 6-month depot- GH replacement therapy (pGH), and 6-month washout (6mo). Total T(3), free T(4) (FT(4)), reverse T(3) (rT(3)), TSH, IGF-I, SHBG, and TV were measured; body surface area-corrected TV (CTV) was calculated. RESULTS IGF-I and T(3) increased pGH. T(3) levels remained elevated at 6mo. GHRT did not significantly change FT(4), rT(3), TSH, and SHBG. TV and CTV increased pGH and remained elevated at 6mo. CONCLUSIONS GHRT in IGHD adults caused an increase in serum T(3) levels and TV, suggesting an important role of the GH-IGF-I axis in thyroid function.
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Affiliation(s)
- N T F Leite
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Federal University of Sergipe, Aracaju, Brazil
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Vasconcelos FDL, Santos BFDO, Santana NDO, Faro GBDA, Rocha RDO, Leal VV, Barreto-Filho JA, Sousa ACS, Oliveira JLM. Prognostic value of exercise stress echocardiography in patients with left bundle branch block. Arq Bras Cardiol 2011; 97:478-84. [PMID: 22001956 DOI: 10.1590/s0066-782x2011005000098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The literature lacks studies about the prognostic value of exercise stress echocardiography (ESE) in patients with complete left bundle branch block (LBBB) of the bundle of His. OBJECTIVE To assess the prognostic value of ESE in patients with LBBB. METHODS This is a retrospective cohort that evaluated 135 patients with LBBB, from January 2001 to October 2009, of which 37.8% were men, mean age 63.6 ± 11.5 years submitted to ESE according to Bruce protocol on a treadmill. Cox regression was used, considering these outcomes: death from all causes and from cardiac events, defined as acute myocardial infarction (AMI), percutaneous angioplasty (PA), coronary artery bypass grafting (CABG) and death from cardiac causes. RESULTS Positive ESE was observed in 42 patients (31%). The mean follow-up was 45.8 ± 4.7 months. During this period, there were 9 deaths from all causes and 9 cardiac events (3 deaths from cardiac causes, 3 myocardial infarctions, 2 PA and one CABG). The mortality rate from all causes during five years was 16.1% in the group with positive ESE and 2.5% in the group with negative test (p = 0.171), whereas the rate of cardiac events in the same period was 15.1% for the positive ESE and 1.6% in the group with negative test (p = 0.009). CONCLUSION ESE showed to be a predictor of cardiac events in patients with LBBB.
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Anjos-Andrade FD, Sobral Sousa AC, Barreto-Filho JAS, Oliveira Alves É, Nascimento-Júnior AC, Oliveira De Santana N, Lima De Vasconcelos F, Barreto Garcez F, Porto De Araujo V, Pereira De Araujo AC, Fernandes De Oliveira Santos B, Rocha Silveira DC, Siqueira Amorim R, Cruz Lima Garcia DL, Sizino Franco Filho JC, Aristides De Sá Neto A, Ricci Calasans F, Vieira De Melo E, Menezes Oliveira JL. Chronotropic incompetence and coronary artery disease. Acta Cardiol 2010; 65:631-8. [PMID: 21302668 DOI: 10.1080/ac.65.6.2059859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although chronotropic incompetence (CI) represents an independent predictor of mortality and incidence of coronary artery disease, its pathophysiological mechanisms remain unknown. The purpose of this investigation was to evaluate wall motion abnormalities of the left ventricle and location of coronary arterial lesions in patients with and without CI. METHODS After exclusion of confounding factors, 610 patients (mean age of 58.4 +/- 11 years; 275 men) with ischaemia who underwent exercise echocardiography were studied. Based on heart rate (HR) reached in treadmill testing, patients were divided into two groups: Chl (97 patients who did not reach 85% of maximum HR recommended for age) and ChC (513 patients who achieved 85% of the maximum age-predicted HR). RESULTS There was a higher frequency of dyspnoea (5.2% vs. 0.6%, P = 0.003), systemic hypertension (69.1% vs. 57.3%, P = 0.031) and obesity (38.1% vs. 22.6%, P = 0.001), and a lower tolerance to effort (dyspnoea as limitation of physical effort: 36.1% vs. 8.0%, P < 0.0001; duration of treadmill test: 4.4 +/- 2.2 vs. 7.2 +/- 2.8, P < 0.0001; METs: 6.0 +/- 2.6 vs. 8.4 +/- 2.9, P = 0.002) in Chl compared to ChC. The wall motion score index (WMSI) was higher in Chl than in ChC, both at rest (1.15 +/- 0.29 vs. 1.07 +/- 0.19, P = 0.011) and after exercise (1.24 +/- 0.29 vs. 1.15 +/- 0.19, P = 0.002). Systolic function, which was evaluated in peak exercise through WMSI, was significantly more altered in the Chl group. The presence of severe injuries in right coronary was independently associated with CI (adjusted OR = 3.57, CI 95%: 1.86-6.87). CONCLUSION Chronotropic incompetence is associated with ventricular dysfunction in peak exercise and critical right coronary artery lesions.
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Affiliation(s)
| | - Antônio Carlos Sobral Sousa
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
- Laboratory of Echocardiography of São Lucas Clinic and Hospital, Aracaju, Sergipe, Brazil
| | | | - Érica Oliveira Alves
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | | | | | | | - Flávia Barreto Garcez
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | - Vanessa Porto De Araujo
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | | | | | | | - Rívia Siqueira Amorim
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | | | | | | | - Flávia Ricci Calasans
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | - Enaldo Vieira De Melo
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
| | - Joselina Luzia Menezes Oliveira
- Department of Internal Medicine, Cardiology Division of Federal University of Sergipe, Sergipe, Brazil
- Laboratory of Echocardiography of São Lucas Clinic and Hospital, Aracaju, Sergipe, Brazil
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Oliveira JLM, Góes TJS, Santana TA, Silva IS, Travassos TF, Teles LD, Barreto MA, Barreto-Filho JA, D'Oliveira A, Sousa ACS. Exercise stress echocardiography in the identification of coronary artery disease in the elderly with chronotropic incompetence. Arq Bras Cardiol 2008; 89:100-6, 111-8. [PMID: 17874016 DOI: 10.1590/s0066-782x2007001400007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 03/26/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chronotropic incompetence (CTI) is frequent in elderly patients and may limit the role of the exercise test in the identification of coronary artery disease (CAD) in this population. OBJECTIVE To assess the value of CTI in an elderly population in the diagnosis of CAD. METHODS A total of 3,308 patients were studied, 804 were elderly individuals (age > 65 years) who underwent exercise stress echocardiography (ESE). Based on the heart rate (HR) reached during the exercise test, were divided into two groups: G1 150 patients who did not reach 85% of the age-predicted HR, and G2 654 patients who did. The groups were compared to clinical characteristics, segmental left ventricular contractility rate (WMSI) and coronary angiography (CAG). RESULTS Clinical characteristics were similar between the groups. WMSI was higher in G1 than in G2, both at rest (1.09 +/- 0.21 versus 1.04 +/- 0.15) and after exercise (1.15 +/- 0.29 versus 1.08 +/- 0.2) (p < 0.001). Abnormalities in wall contractility were more frequent in G1 than in G2 (55% versus 37%; p < 0.05), thus suggesting that elderly with CTI have a higher frequency of CAD. CAG was performed in 69% ESE positive for myocardial ischemia. In the G1 group, 91% of the ESE were true positive versus 84.5% in G2, that is, presence of obstructive coronary artery disease (> 50%). CONCLUSION CTI is associated with a higher frequency of contractile alterations in the elderly population and adds a positive predictive value to ESE in the identification of patients with obstructive CAD.
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Salvatori R, Serpa MG, Parmigiani G, Britto AVO, Oliveira JLM, Oliveira CRP, Prado CM, Farias CT, Almeida JC, Vicente TAR, Aguiar-Oliveira MH. GH response to hypoglycemia and clonidine in the GH-releasing hormone resistance syndrome. J Endocrinol Invest 2006; 29:805-8. [PMID: 17114911 DOI: 10.1007/bf03347374] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
GH secretion by the pituitary is the result of the balance between the stimulatory effect of GHRH and the inhibitory effect of SS. Patients with mutations in GHRH receptor (GHRH-R) gene (GHRH-R) offer a unique model to study the mechanism of action of different GH secretion stimuli. In the past, we have demonstrated a small but significant GH response to a GH secretagogue (GHRP-2) in a homogenous cohort of patients with severe GH deficiency (GHD) due to a homozygous null mutation in GHRH-R (IVS1+1G-->A). Now, we sought to determine if we could detect a GH response to hypoglycemia (ITT: insulin tolerance test) or clonidine (CL) in these patients. Nine young GHD subjects underwent both ITT and CL tests, and 2 additional subjects underwent only CL test. There was a small but significant GH increase during ITT, but not during CL test. These results indicate that a minimal albeit significant GH response to ITT can occur despite complete lack of GHRH-R function.
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Affiliation(s)
- R Salvatori
- Division of Endocrinology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Menezes Oliveira JL, Marques-Santos C, Barreto-Filho JA, Ximenes Filho R, de Oliveira Britto AV, Oliveira Souza AH, Prado CM, Pereira Oliveira CR, Pereira RMC, Ribeiro Vicente TDA, Farias CT, Aguiar-Oliveira MH, Salvatori R. Lack of evidence of premature atherosclerosis in untreated severe isolated growth hormone (GH) deficiency due to a GH-releasing hormone receptor mutation. J Clin Endocrinol Metab 2006; 91:2093-9. [PMID: 16522693 DOI: 10.1210/jc.2005-2571] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND GH deficiency (GHD) acquired at adult age as a result of pathological processes of the pituitary gland or the hypothalamus causes changes that are associated with worsening cardiovascular risk. They include increase in abdominal obesity, total and low- density lipoprotein cholesterol, and C-reactive protein. GHD adults also have thickening of the carotid arteries. It has been postulated that GHD is the link between hypopituitarism and the increase in cardiovascular and cerebrovascular mortality observed in hypopituitarism. However, several confounding factors exist, such as associated pituitary deficits and replacement of other hormones or surgical or radiological therapies used to treat the underlying pituitary of hypothalamic pathologies. OBJECTIVE The aim of this study was to determine the consequences of lifetime isolated GHD (IGHD) on the metabolic and cardiovascular status of adult members of a large Brazilian cohort with severe IGHD due to a homozygous mutation in the GHRH receptor gene. DESIGN Twenty-two GH naive adult dwarfs (10 men and 12 women; aged 44 +/- 12 yr) were compared with 22 healthy volunteers (10 men and 12 women; aged 45 +/- 12 yr) living in the same area. RESULTS GHD subjects had increased abdominal obesity, higher total and low-density lipoprotein cholesterol, and higher C-reactive protein than controls. They did not have an increase in carotid wall thickness, and there was no evidence of premature atherosclerosis as evaluated by exercise echocardiography. CONCLUSIONS In this homogeneous cohort residing in a rural area of Brazil, lifetime, untreated severe IGHD is not associated with evidence of premature atherosclerosis despite unfavorable cardiovascular risk profile.
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