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Palmeira NGF, Bianco HT, Bombig MTN, Povoa FF, Fonseca FAH, Izar MC, Thalenberg JM, Luna B, Marui F, Fischer SM, Amodeo C, de Souza DDSM, Povoa R. Association between Morning Surge and Left Ventricular Hypertrophy in Obese Hypertensive Patients. Arq Bras Cardiol 2023; 120:e20230050. [PMID: 37820172 PMCID: PMC10519347 DOI: 10.36660/abc.20230050] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. OBJECTIVE To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. METHODS A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. RESULTS A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the "obese group", it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12-6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. CONCLUSION High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group.
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Affiliation(s)
- Natascha Gonçalves Francisco Palmeira
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Henrique Tria Bianco
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | | | - Fernando Focaccia Povoa
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Francisco A. H. Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - José Marcos Thalenberg
- Escola Paulista de MedicinaUniversidade Federal de São PauloSão PauloSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo (EPM/UNIFESP), São Paulo, SP – Brasil
| | - Braulio Luna
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Fabiane Marui
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Simone Matheus Fischer
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Celso Amodeo
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | | | - Rui Povoa
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
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Bacchin AS, Fonseca FAH, Povoa R, Szarf G, Pinto IM, Caixeta AM, Teixeira D, Maugeri IL, Ishimura ME, Coste MER, Bianco HT, França CN, Izar MC. Pharmacoinvasive Strategy in Elderly Up to 75 Years or Non-Elderly: Analysis of Biochemical and Cardiac Magnetic Resonance Imaging Parameters. Arq Bras Cardiol 2022; 120:e20220177. [PMID: 36629600 PMCID: PMC9833293 DOI: 10.36660/abc.20220177] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/01/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pharmacoinvasive strategy is an alternative when primary percutaneous coronary intervention (PCI) is not feasible. OBJECTIVES This study aimed to evaluate the effects of early pharmacoinvasive strategy on the infarct size and left ventricular ejection fraction in elderly and non-elderly patients. The role of inflammatory markers was also examined. METHODS Patients (n=223) with ST segment elevation myocardial infarction (STEMI) were prospectively included and submitted to pharmacological thrombolysis in the first six hours, and underwent coronary angiogram and PCI when necessary, in the first 24 hours. Blood samples were collected in the first day (D1) and after 30 days (D30). Cardiac magnetic resonance imaging (cMRI) was performed at D30. Significance was set at p<0.05. RESULTS Elderly and non-elderly patients showed similar percentage of infarcted mass (13.7 [6.9-17.0] vs. 14.0 [7.3-26.0], respectively, p=0.13) (median [interquartile range]). However, elderly patients had better left ventricular ejection fraction (53 [45-62] vs. 49 [39-58], p=0.025). Titers of interleukin (IL)1beta, IL-4, IL-6, and IL-10 did not differ between D1 and D30, but elderly patients had higher titers for IL-18 at D1 and D30. Absolute numbers of B and T lymphocytes were similar in both groups at D1 and D30, but elderly patients had higher neutrophil/lymphocyte ratio at D30. Multivariate linear regression analysis of cMRI outcomes in the whole population showed that the independent predictors were not different between elderly and non-elderly patients. CONCLUSION Pharmacoinvasive strategy in elderly patients was associated with small differences in inflammatory parameters, similar infarct size and better left ventricular function than non-elderly patients.
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Affiliation(s)
- Amanda S. Bacchin
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Francisco A. H. Fonseca
- Escola Paulista de MedicinaUniversidade Federal de São PauloSantana de ParnaíbaSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo, Santana de Parnaíba, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Gilberto Szarf
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Ibraim Masciarelli Pinto
- Instituto Dante Pazzanese de CardiologiaSão PauloSPBrasilInstituto Dante Pazzanese de Cardiologia – Cardiovascular CT/MR, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Daniela Teixeira
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Ieda Longo Maugeri
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Mayari E. Ishimura
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Maria E. R. Coste
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
| | - Henrique Tria Bianco
- Escola Paulista de MedicinaUniversidade Federal de São PauloSantana de ParnaíbaSPBrasilEscola Paulista de Medicina da Universidade Federal de São Paulo, Santana de Parnaíba, SP – Brasil
| | - Carolina N. França
- Universidade de Santo AmaroSão PauloSPBrasilUniversidade de Santo Amaro – Pós-Graduação, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São PauloSão PauloSPBrasilUniversidade Federal de São Paulo, São Paulo, SP – Brasil
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Bianco HT, Povoa R, Izar MC, Alves CMR, Barbosa AHP, Bombig MTN, Gonçalves I, Luna B, Aguirre AC, Moraes PIDM, Almeida D, Moreira FT, Povoa FF, Stefanini E, Caixeta AM, Bacchin AS, Moisés VA, Fonseca FA. Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors. Arq Bras Cardiol 2022; 119:691-702. [PMID: 36453760 PMCID: PMC9750212 DOI: 10.36660/abc.20211055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 01/13/2022] [Revised: 04/15/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. OBJECTIVES To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. METHODS Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. RESULTS Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. CONCLUSION Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation.
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Affiliation(s)
- Henrique Tria Bianco
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Rui Povoa
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Maria Cristina Izar
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Claudia Maria Rodrigues Alves
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Henrique Pereira Barbosa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Maria Teresa Nogueira Bombig
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Iran Gonçalves
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Bráulio Luna
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Ana Caroline Aguirre
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Pedro Ivo de Marqui Moraes
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Dirceu Almeida
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Flávio Tocci Moreira
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Fernando Focaccia Povoa
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Edson Stefanini
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Adriano Mendes Caixeta
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Amanda S. Bacchin
- Universidade Federal de São PauloCardiologiaSão PauloSPBrasilUniversidade Federal de São Paulo – Cardiologia, São Paulo, SP – Brasil
| | - Valdir Ambrósio Moisés
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
| | - Francisco A.H. Fonseca
- Universidade Federal de São Paulo Escola Paulista de MedicinaMedicinaSão PauloSPBrasilUniversidade Federal de São Paulo Escola Paulista de Medicina – Medicina, São Paulo, SP – Brasil
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Bianco HT, Povoa R, Izar MC, Luna Filho B, Moreira FT, Stefanini E, Fonseca HA, Barbosa AHP, Alves CMR, Caixeta AM, Gonçalves I, Moraes PIDM, Lopes RD, Paola AAVD, Almeida D, Moises VA, Fonseca FAH. Accuracy of Post-thrombolysis ST-segment Reduction as an Adequate Reperfusion Predictor in the Pharmaco-Invasive Approach. Arq Bras Cardiol 2021; 117:15-25. [PMID: 34320062 PMCID: PMC8294746 DOI: 10.36660/abc.20200241] [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: 03/24/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
Fundamento A intervenção coronária percutânea primária é considerada o “padrão-ouro” para reperfusão coronária. Entretanto, quando não disponível, a estratégia fármaco-invasiva é método alternativo, e o eletrocardiograma (ECG) tem sido utilizado para identificar sucesso na reperfusão. Objetivos Nosso estudo teve como objetivo examinar alterações no segmento-ST pós-lise e seu poder de prever a recanalização, usando os escores angiográficos TIMI e blush miocárdio (MBG) como critério de reperfusão ideal. Métodos Foram estudados 2.215 pacientes com infarto agudo do miocárdio com supra-ST submetidos à fibrinólise [(Tenecteplase)-TNK] e encaminhados para angiografia coronária em até 24 h pós-fibrinólise ou imediatamente encaminhados à terapia de resgate. O ECG foi realizado pré-TNK e 60 min-pós. Os pacientes foram categorizados em dois grupos: aqueles com reperfusão ideal (TIMI-3 e MBG-3) e aqueles com reperfusão inadequada (fluxo TIMI <3). Foi definido o critério de reperfusão do ECG pela redução do segmento ST >50%. Consideramos p-valor <0,05 para as análises, com testes bicaudais. Resultados O critério de reperfusão pelo ECG apresentou valor preditivo positivo de 56%; valor preditivo negativo de 66%; sensibilidade de 79%; e especificidade de 40%. Houve fraca correlação positiva entre a redução do segmento-ST e os dados angiográficos de reperfusão ideal (r = 0,21; p <0,001) e baixa precisão diagnóstica, com AUC de 0,60 (IC-95%; 0,57-0,62). Conclusão Em nossos resultados, a redução do segmento-ST não conseguiu identificar com precisão os pacientes com reperfusão angiográfica apropriada. Portanto, mesmo pacientes com reperfusão aparentemente bem-sucedida devem ser encaminhados à angiografia brevemente, a fim de garantir fluxo coronário macro e microvascular adequados.
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Affiliation(s)
- Henrique Tria Bianco
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | | | - Flavio Tocci Moreira
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Edson Stefanini
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | | | - Adriano Mendes Caixeta
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Iran Gonçalves
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | | | - Renato Delascio Lopes
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil.,Duke University Hospital, Durham, North Carolina - EUA
| | | | - Dirceu Almeida
- Universidade Federal de Sao Paulo, São Paulo, SP - Brasil
| | - Valdir Ambrosio Moises
- Escola Paulista de Medicina da Universidade Federal de São Paulo, São Paulo, SP - Brasil
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Povoa FF, Luna Filho B, Bianco HT, Amodeo C, Povoa R, Bombig MTN, Miranda RD, Fischer SM, Izar MCO, Fonseca FAH. Performance of the Electrocardiogram in the Diagnosis of Left Ventricular Hypertrophy in Older and Very Older Hypertensive Patients. Arq Bras Cardiol 2021; 117:924-931. [PMID: 34378674 PMCID: PMC8682087 DOI: 10.36660/abc.20200600] [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: 06/03/2020] [Accepted: 11/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH) is an important cardiovascular risk factor, regardless of arterial hypertension. Despite the evolution of imaging tests, the electrocardiogram (ECG) is still the most used in the initial evaluation, however, with low sensitivity. OBJECTIVE To evaluate the performance of the main electrocardiographic criteria for LVH in elderly and very elderly hypertensive individuals. METHODS In a cohort of hypertensive patients, ECGs and doppler echocardiographies (ECHO) were performed and separated into three age groups: <60 years, Group I; 60-79 years Group II; and ≥80 years, Group III. The most used electrocardiographic criteria were applied for the diagnosis of LVH: Perugia; Pegaro-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duration; Cornell voltage; Cornell voltage duration; Sokolow-Lyon voltage; R of aVL ≥11 mm; RaVL duration. In evaluating the performance of these criteria, in addition to sensitivity (Sen) and specificity (Esp), the "Diagnostic Odds Ratios" (DOR) were analyzed. We considered p-value <0.05 for the analyses, with two-tailed tests. RESULTS In 2,458 patients, LVH was present by ECHO in 781 (31.7%). In Groups I and II, the best performances were for the criteria of Narita, Perugia, (Rm+Sm) x duration, with no statistical differences between them. In Group III (very elderly) the Perugia criteria and (Rm+Sm) x duration had the best performances: Perugia [44,7/89.3; (Sen/Esp)] and (Rm+Sm) duration [39.4%/91.3%; (Sen/Esp), p<0.05)], with the best PAIN results:6.8. This suggests that in this very elderly population, these criteria have greater discriminatory power to separate patients with LVH. CONCLUSION In very elderly hypertensive patients, the Perugia electrocardiographic criteria and (Rm+Sm) x duration showed the best diagnostic performance for LVH.
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Affiliation(s)
| | | | - Henrique Tria Bianco
- Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP - Brasil
| | - Celso Amodeo
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | - Francisco A H Fonseca
- Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, SP - Brasil
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Melo E Silva FV, Almonfrey FB, Freitas CMND, Fonte FK, Sepulvida MBDC, Almada-Filho CDM, Cendoroglo MS, Quadrado EB, Amodeo C, Povoa R, Miranda RD. Association of Body Composition with Arterial Stiffness in Long-lived People. Arq Bras Cardiol 2021; 117:457-462. [PMID: 34287568 PMCID: PMC8462957 DOI: 10.36660/abc.20190774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/20/2019] [Accepted: 08/16/2020] [Indexed: 11/25/2022] Open
Abstract
Fundamento Pouco se conhece sobre a relação entre sarcopenia e hemodinâmica central em idosos longevos. Objetivo Estudar a relação da rigidez arterial com a composição corporal em idosos longevos. Métodos A composição corporal foi avaliada por meio da absortometria de Raio X de dupla energia (DEXA) e dos parâmetros de circulação central (PCC) obtidos por método oscilométrico não invasivo, com o Mobil-O-Graph 24h PWA Monitor®. Os parâmetros centrais avaliados foram: velocidade da onda de pulso (VOP), augmentation index (AIx), índice de amplificação da pressão de pulso (iAPP) e pressão de pulso central (PPc). Estes foram correlacionados com massa magra total (MM) e apendicular (MA), percentual de gordura corporal e índice de Baumgartner (IB). Aceitou-se nível de significância de 5%. Resultados Participaram 124 longevos, com idade média de 87,1 anos (DP±4,3 anos), sendo 74,2% mulheres e 57,3% brancos. Houve correlação inversa do AIx com as variáveis MM (r = - 0,391, p < 0,001), MA (r= -0,378, p< 0,001) e IB (r = -0,258, p 0,004). A PPc apresentou associação inversa com MM (r= -0,268, p =0,003), MA (r=-0,288, p= 0,001) e IB (r= -0,265, p = 0,003). Houve relação direta apenas entre AIx e percentual de gordura corporal (r= 0,197, p= 0,029). Conclusão Em idosos longevos, o percentual de gordura corporal se associa diretamente com a rigidez arterial e tem associação inversa com a quantidade de MM. Esses achados podem estar associados ao maior risco cardiovascular.
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Affiliation(s)
| | | | | | - Flávia Kurebayashi Fonte
- Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp- EPM), São Paulo, SP - Brasil
| | | | | | - Maysa Seabra Cendoroglo
- Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp- EPM), São Paulo, SP - Brasil
| | - Egli Belinazzi Quadrado
- Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp- EPM), São Paulo, SP - Brasil
| | - Celso Amodeo
- Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp- EPM), São Paulo, SP - Brasil
| | - Rui Povoa
- Universidade Federal de São Paulo - Escola Paulista de Medicina (Unifesp- EPM), São Paulo, SP - Brasil
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Bianco HT, Izar MC, Povoa R, Bombig MT, Fonseca HA, Nicolau JC, Neto AA, Faludi AA, Jardim PC, Xavier HT, Fonseca FA. Left ventricular hypertrophy and QTc dispersion are predictors of long-term mortality in subjects with type 2 diabetes. BBA Clinical 2015. [DOI: 10.1016/j.bbacli.2015.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alessi A, Bonfim AV, Brandão AA, Feitosa A, Amodeo C, Alves CR, Brasil DP, Souza DDSM, Barbosa E, Consolim-Colombo FM, Borelli F, Fonseca FH, Lopes HF, Chaves H, Bortolotto LA, Martin LC, Scala LCN, Mota-Gomes MA, Malachias MVB, Izar MC, Fonseca MIH, Neves MFT, Morais NS, Passarelli O, Jardim PCV, Toscano PR, Miranda RD, Franco R, Betti RTB, Pedrosa RP, Povoa R, Carneiro SB, Jardim T, Barroso WKS. I Brazilian position statement on arterial hypertension and diabetes mellitus. Arq Bras Cardiol 2014; 100:491-501. [PMID: 23842875 DOI: 10.5935/abc.20130123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Santos MAB, Costa FDA, Travessa AF, Bombig MTN, Fonseca FH, Luna Filho B, Mussi A, Souza DD, Oliveira AD, Povoa R. [Duchenne muscular dystrophy: electrocardiographic analysis of 131 patients]. Arq Bras Cardiol 2010; 94:620-4. [PMID: 20379617 DOI: 10.1590/s0066-782x2010005000024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 09/02/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiac involvement is known to occur in patients with Duchenne muscular dystrophy (DMD). The electrocardiogram (ECG) shows some typical changes in DMD, which makes it a useful test for the diagnosis of cardiac lesion in this disease. OBJECTIVE To evaluate the electrocardiographic changes in patients with DMD and to correlate these changes with the age of the population studied. METHODS ECG of 131 patients diagnosed with DMD were examined. Several electrocardiographic variables were analyzed, and the patients were divided into two groups - one with and one without changes, for each variable studied. The correlation between the two groups and the age of the patients was analyzed. Garson's criteria were used to establish the electrocardiographic parameters of normality. RESULTS ECG was abnormal in 78.6% of the patients. All showed normal sinus rhythm. The following percentages were found for the main variables studied: short PR interval = 18.3%; abnormal R waves in V1 = 29.7%; abnormal Q waves in V6 = 21.3%; abnormal ventricular repolarization = 54.9%; abnormal QS waves in inferior and/or upper lateral wall = 37.4%; conduction disturbances in right bundle branch = 55.7%; prolonged QT C interval = 35.8%, and wide QRS = 23.6%. Unpaired t test was used to establish the correlation between age and the electrocardiographic variables studied in the two groups. Statistically significant differences were found only for the abnormal repolarization variable. CONCLUSION Electrocardiographic abnormalities are common in DMD, revealing early cardiac involvement. Only the abnormal ventricular repolarization variable was more frequent, however at a lower age range (p < 0.05).
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Brollo L, Bombig MTN, Mazzaro CDL, Francisco YA, Fonseca FAH, Carvalho ACC, Harima H, Hirai A, Povoa R. Associação do eletrocardiograma com diabete melito e síndrome metabólica em nipo-brasileiros. Arq Bras Cardiol 2009; 92:351-5, 381-6. [DOI: 10.1590/s0066-782x2009000500008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 08/04/2008] [Indexed: 11/21/2022] Open
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Brandao S, Izar M, Helfenstein T, Fischer S, Santos A, Monteiro C, Manzoli M, Povoa R, Pereira V, Rodgerio T, Fonseca F. METABOLIC EFFECTS OF ANTYHYPERTENSIVE AGENTS IN NORMOGLYCEMIC, NORMOLIPIDEMIC HYPERTENSIVE PATIENTS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70764-5] [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: 11/27/2022]
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de Souza D, Riera ARP, Bombig MT, Francisco YA, Brollo L, Filho BL, Dubner S, Schapachnik E, Povoa R. Electrocardiographic changes by accidental hypothermia in an urban and a tropical region. J Electrocardiol 2006; 40:47-52. [PMID: 17027018 DOI: 10.1016/j.jelectrocard.2006.08.094] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 05/05/2006] [Accepted: 08/28/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hypothermia is defined as a condition in which core temperature (rectal, esophageal, or tympanic) reaches values below 35 degrees C. This may be accidental, metabolic, or therapeutic. The accidental form is frequent in cold-climate countries and rare in those with tropical or subtropical climate. The aim of this study was to evaluate electrocardiographic changes of patients with accidental hypothermia. METHODS In 59 patients with hypothermia, the following electrocardiogram parameters were analyzed: rhythm and heart rate (HR), P-wave characteristics, PR-interval duration, QRS-complex duration, presence of J wave and its location characteristics, polarity, voltage, aspect and its correlation with the degree of hypothermia, changes in T wave regarding its polarity and characteristics, duration of the QT interval corrected for HR using both Bazett and Friderica formulas, and possible presence of both supraventricular and ventricular arrhythmias were independently and blindly analyzed in the tracings by experienced cardiologists. RESULTS In 6 patients, electrocardiogram was normal. Sinus bradycardia was observed in 52.5% of the patients. J wave was present in 51 patients, and its voltage correlated inversely and was statistically significantly with the core temperature. Changes in T wave were observed in 47.4% of the cases. QT interval, adjusted for HR, was prolonged in 72.8% of the cases. Idioventricular rhythm was found in 6 cases, total atrioventricular block in 3 cases, and junctional rhythm and atrial fibrillation in 2 patients. CONCLUSIONS Electrocardiogram changes in accidental hypothermia are frequent and characteristic for this entity improving diagnosis in usually unconscious patients, and in many cases, it may be the diagnostic clue in patients with conscience deficit in emergency units, even in patients from a tropical climate where the population at risk may be exposed to temperatures below 20 degrees C.
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Affiliation(s)
- Dilma de Souza
- Escola Paulista de Medicina, UNIFESP, São Paulo CEP, Brazil
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Fialho G, Cavichio L, Povoa R, Pimenta J. Effects of 24-h shift work in the emergency room on ambulatory blood pressure monitoring values of medical residents. Am J Hypertens 2006; 19:1005-9. [PMID: 17027818 DOI: 10.1016/j.amjhyper.2006.03.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [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: 12/23/2005] [Revised: 01/26/2006] [Accepted: 03/09/2006] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medical residency is marked by long work hours and shift work. The acute effects of these factors on the blood pressure (BP) of medical residents have not been adequately evaluated. METHODS A total of 61 medical residents underwent to ambulatory blood pressure monitoring (ABPM) during a 24-h shift work in the emergency room (ER) and during a common working day. RESULTS Both mean 24-h systolic and diastolic BP (DBP) and mean diastolic BP readings during sleep were higher during the 24-h shift work in the ER than during common working day (117 v 113 mm Hg, P < .05; 73 v 69 mm Hg, P < .05; and 61 v 58 mm Hg, P < .05, respectively). Abnormally high mean BP readings were more frequent during the 24-h shift work in the ER than in common working day (19 v 8, P < .05). Pressure load, nocturnal BP fall and pulse pressure values were similar in these two different working situations. CONCLUSION Working in the ER on a 24-h shift leads to abnormal BP behavior in medical residents, thus suggesting that this type of work may be a risk factor for cardiovascular disease.
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Affiliation(s)
- Guilherme Fialho
- Cardiology Department of the Public Worker State Hospital of São Paulo, São Paulo, Brazil.
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Caravachio L, Povoa R, Pimenta J. WHITE-COAT HYPERTENSION AND ITS RELATIONSHIP WITH BLOOD PRESSURE LEVELS. J Hypertens 2004. [DOI: 10.1097/00004872-200402001-00834] [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: 11/25/2022]
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