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Factors associated with diet quality among Brazilian individuals with cardiovascular diseases. J Hum Nutr Diet 2023; 36:1713-1726. [PMID: 37283442 DOI: 10.1111/jhn.13184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 05/04/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND An individual's dietary pattern contributes in different ways to the prevention and control of recurrent cardiovascular events. However, the quality of the diet is influenced by several factors. The present study aimed to evaluate the quality of the diet of individuals with cardiovascular diseases and determine whether there is an association between sociodemographic and lifestyle factors. METHODS This is a cross-sectional study carried out with individuals with atherosclerosis (coronary artery disease, cerebrovascular disease or peripheral arterial disease) recruited from 35 reference centres for the treatment of cardiovascular disease in Brazil. Diet quality was assessed according to the Modified Alternative Healthy Eating Index (mAHEI) and stratified into tertiles. For comparing two groups, the Mann-Whitney or Pearson's chi-squared tests were used. However, for comparing three or more groups, analysis of variance or Kruskal-Wallis was used. For the confounding analysis, a multinomial regression model was used. p < 0.05 was considered statistically significant. RESULTS In total, 2360 individuals were evaluated: 58.5% male and 64.2% elderly. The median (interquartile range [IQR]) of the mAHEI was 24.0 (20.0-30.0), ranging from 0.4 to 56.0 points. When comparing the odds ratios (ORs) for the low (first tertile) and medium (second tertile) diet quality groups with the high-quality group (third tertile), it was observed that there was an association between diet quality with a family income of 1.885 (95% confidence intervals [CI] = 1.302-2.729) and 1.566 (95% CI = 1.097-2.235), as well as physical activity of 1.391 (95% CI = 1.107-1.749) and 1.346 (95% CI = 1.086-1.667), respectively. In addition, associations were observed between diet quality and region of residence. CONCLUSIONS A low-quality diet was associated with family income, sedentarism and geographical area. These data are extremely relevant to assist in coping with cardiovascular disease because they enable an assessment of the distribution of these factors in different regions of the country.
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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] [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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Sex-related Disparities in Access of Patients with STEMI to PCI Hospitals in Brazil: The Contribution of Blinder–Oaxaca Decomposition Method. JOURNAL OF HEALTH MANAGEMENT 2020. [DOI: 10.1177/0972063420908357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
With regard to discrepancies in the cardiologic assistance, gender differences within predictive models are usually taken as ‘disparities’. However, such differences should be further scrutinised. We aimed to apply the Blinder–Oaxaca method in order to investigate potential sex-related disparities in the time from onset of symptoms to upscale assistance in ST-segment elevation myocardial infarction (STEMI) patients transferred to referential hospitals. All public and private hospitals with 24/7 PCI facilities in the state were included, and 1077 STEMI individuals were prospectively enrolled. We applied the Blinder–Oaxaca decomposition for the predictive model. The study included socioeconomic, clinical and geographic predictors. In ‘crude’ comparison under Student’s t-test, the logarithm of the total time was longer for female than male, reaching a difference of 0.22. In the Blinder–Oaxaca adjusted model, women presented higher total time than men. The total difference was 0.248 (95% CI = 0.051–0.445; p = 0.012), mostly related to the ‘explained’ portion, and the ‘unexplained’ portion reached a tiny fraction of the decomposition of elements, not significantly different from zero. There was no relevant unexplained fraction, also known as discrimination. Hence, the differences are attributable to the influence of the predictors as well as the contrafactual endowments for each sex.
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Disparities in Access and Mortality of Patients With ST-Segment-Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register. J Am Heart Assoc 2019; 8:e013057. [PMID: 31581873 PMCID: PMC6818046 DOI: 10.1161/jaha.119.013057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30‐day mortality for patients with ST‐segment–elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST‐segment–elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30‐day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P<0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P<0.001). The 30‐day mortality rate of SUS patients was 11.9% and of private patients was 5.9% (P=0.04). In the fully adjusted model, the odds ratio for 30‐day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15–7.61; P=0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30‐day follow‐up.
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Abstract
BACKGROUND When prescribing antiplatelet agents, physicians face the challenge of protecting patients from thromboembolic events without inducing bleeding damage. However, especially in the perioperative period, the use of these medications requires a carefully balanced assessment of their risks and benefits. OBJECTIVE To conduct a systematic review to check whether the antiplatelet agent is to be maintained or suspended in the perioperative period of noncardiac surgeries. SEARCH STRATEGY A comprehensive literature search using Science Direct, Scopus, MEDLINE-PubMed, and Web of Science was undertaken. SELECTION CRITERIA Clinical trials of noncardiac surgeries with patients taking regular anti-platelet therapy, published between 2013 and 2018. RESULTS A total of 1,302 studies were initially identified, with only four meeting the inclusion criteria. The selected studies were conducted in different countries such as, including India (2), Serbia (1), and the USA (1). The age group was similar in all studies, from 61 to 75 years. The most frequent surgery was related to tooth extraction and transurethral resection of bladder cancer. There was a group of patients who used single antiplatelet agents and groups who used single therapy and double therapy. Acetylsalicylic acid was the common drug in all studies. CONCLUSION It was concluded that the clinical trials were classified as good quality and that it was not necessary to suspend antiplatelet therapy prior to surgical procedures such as dental extraction and transurethral resection of bladder cancer. It should be noted that it is necessary to jointly evaluate the type of antiplatelet agent, the thrombotic risk of the patient, and the hemorrhagic risk of the surgical procedure.
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Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries. Arq Bras Cardiol 2018; 111:596-604. [PMID: 30281684 PMCID: PMC6199502 DOI: 10.5935/abc.20180162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/23/2018] [Indexed: 12/16/2022] Open
Abstract
Background The current guidelines dispose recommendations to manage antiplatelet agents
in the perioperative period; however, the daily medical practices lack
standardization. Objectives To asses factors associated with inadequate management of antiplatelet agents
in the perioperative period of non-cardiac surgeries. Methods Cross-sectional Study conducted in hospital from October 2014 to October
2016. The study dependent variable was a therapy that did not comply with
the recommendations in the Brazilian Association of Cardiology (SBC)
guidelines. The independent variables included some characteristics, the
people in charge of the management and causes of lack of adherence to those
guidelines. Variables were included in the multivariate model. Analysis was
based on the odds ratio (OR) value and its respective 95% confidence
interval (CI) estimated by means of logistic regression with 5% significance
level. Results The sample was composed of adult patients submitted to non-cardiac surgeries
and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161).
The management failed to comply with the recommendations in the guidelines
in 80.75% of the sample. Surgeons had the highest number of noncomplying
orientations (n = 63). After multivariate analysis it was observed that
patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and
those with a previous episode of acute myocardial infarction (AMI) (OR =
0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying
with the guidelines. Conclusion Positive association between patients’ schooling level, or those with a
history of previous AMI, with management of the use of aspirin and
clopidogrel in the perioperative period of non-cardiac surgeries. However,
diverging conducts stress the need of having internal protocol defined.
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Lung Ultrasound: The Cardiologists' New Friend. Arq Bras Cardiol 2018; 109:606-608. [PMID: 29364351 PMCID: PMC5783442 DOI: 10.5935/abc.20170169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 07/21/2017] [Indexed: 12/14/2022] Open
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Disparities in Acute Myocardial Infarction Treatment Between Users of the Public
and Private Healthcare System in Sergipe. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2018. [DOI: 10.5935/2359-4802.20180043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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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] [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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Heart rate variability and Chagas heart disease. Arq Bras Cardiol 2015; 104:90-1. [PMID: 25714408 PMCID: PMC4387616 DOI: 10.5935/abc.20150003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 12/02/2022] Open
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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] [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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Does the aging process significantly modify the Mean Heart Rate? Arq Bras Cardiol 2013; 101:388-98. [PMID: 24029962 PMCID: PMC4081162 DOI: 10.5935/abc.20130188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 06/07/2013] [Indexed: 12/03/2022] Open
Abstract
Background The Mean Heart Rate (MHR) tends to decrease with age. When adjusted for gender and
diseases, the magnitude of this effect is unclear. Objective To analyze the MHR in a stratified sample of active and functionally independent
individuals. Methods A total of 1,172 patients aged ≥ 40 years underwent Holter monitoring and were
stratified by age group: 1 = 40-49, 2 = 50-59, 3 = 60-69, 4 = 70-79, 5 = ≥ 80
years. The MHR was evaluated according to age and gender, adjusted for
Hypertension (SAH), dyslipidemia and non-insulin dependent diabetes mellitus
(NIDDM). Several models of ANOVA, correlation and linear regression were employed.
A two-tailed p value <0.05 was considered significant (95% CI). Results The MHR tended to decrease with the age range: 1 = 77.20 ± 7.10; 2 = 76.66 ± 7.07;
3 = 74.02 ± 7.46; 4 = 72.93 ± 7.35; 5 = 73.41 ± 7.98 (p < 0.001). Women showed
a correlation with higher MHR (p <0.001). In the ANOVA and regression models,
age and gender were predictors (p < 0.001). However, R2 and
ETA2 < 0.10, as well as discrete standardized beta coefficients
indicated reduced effect. Dyslipidemia, hypertension and DM did not influence the
findings. Conclusion The MHR decreased with age. Women had higher values of MHR, regardless of the age
group. Correlations between MHR and age or gender, albeit significant, showed the
effect magnitude had little statistical relevance. The prevalence of SAH,
dyslipidemia and diabetes mellitus did not influence the results.
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Diretrizes Brasileiras de Antiagregantes Plaquetários e Anticoagulantes em Cardiologia. Arq Bras Cardiol 2013; 101:1-95. [DOI: 10.5935/abc.2013s009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Comparação entre métodos de avaliação da modulação vagal autonômica. Arq Bras Cardiol 2012; 98:569; author reply 569-70. [DOI: 10.1590/s0066-782x2012000600013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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] [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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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] [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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