Alice Tatsuko Yamada

Comparison between clinical and autopsy diagnoses in a cardiology hospital

Background: A few recent studies have evaluated diagnostic accuracy by comparison between clinical and autopsy diagnoses in a hospital specialising in cardiology. Methods: 406 consecutive autopsy cases during 2 years were studied. Patients were aged 47.4±28.4 years; 236 (58.1%) were men and 170 (41.9%) women. Diagnostic comparison was categorised in classes I to V (I, II, III and IV: discrepancy in decreasing order of importance regarding therapy and prognosis; V: concordance). Categorisation was ranked on the basis of the highest degree of discrepancy. Statistical analysis was performed with the Χ2 test and stepwise logistic regression. Results: Each age increase of 10 years added 16.2% to the risk of the diagnostic comparison to be categorised in classes I and II (major discrepancy) in comparison to classes III, IV and V (OR 1.16, 95% CI 1.07 to 1.27, p<0.001). By contrast, admission to intensive care units decreased the risk of categorisation in classes I and II by 47% (OR 0.53, 95% CI 0.32 to 0.85, p = 0.009). The most frequent diagnostic discrepancy occurred for pulmonary embolism: 30 out of 88 (34.1%) diagnoses in classes I and II. The concordance rate was 71.1% for acute myocardial infarction, 75% for aorta dissection, 73.1% for infective endocarditis and 35.2% for pulmonary embolism. Conclusion: Age and hospital ward influenced the distribution of diagnostic discrepancy or concordance between clinical and autopsy diagnoses. The lower discrepancy rate for myocardial infarction and infective endocarditis may be related to the fact that the study was carried out in a specialist hospital.

Lipidic profile of individuals without cardiopathy with overweight and obesity

OBJECTIVE To assess the lipidic profile of overweight and obese individuals submitted to cardiologic assessment and who did not show evidences of cardiopathy. METHODS Sample with 684 individuals, 389 (56.9%) women and 295 (43.1%) men, with age ranging from 14 to 74 (average of 40.6) years old, without evidences of cardiopathy after clinical assessment and analysis of electrocardiogram, thorax radiography, ergometric test on treadmill and two-dimensional Doppler echocardiogram. The serum profile of lipids and glucose regarding sex and ranges of body mass index (BMI) -- eutrophic up to 24.9 Kg/m2, overweight 25-29.9 Kg/m2 and obese > 30 Kg/m2, was studied. RESULTS The following means showed a significant statistic difference between the sexes: glucose (mg/dL) in women 90.21+/-23.13 and men 95.28+/-28.64 (p < 0.001); triglycerides (mg/dL) in women 97.27+/-55.24 and men 141.47+/-57.06 (p < 0.001) and HDL-C (mg/dL) in women 52.63+/-13.92 and men 43+/-10.88 (p < 0.001). The average BMI in women was 26.15 and in men 26.33 (p = ns). In the analysis through BMI ranges there was a significant difference between the sexes (p = 0.037). In the categories of overweight and obesity, only the means of triglycerides in women showed a significant statistic difference: overweight women with 102.25+/-60.68 mg/dL and obese 121.64+/-63.57 mg/dL (p = 0.034). CONCLUSION Women without cardiopathy showed serum levels of glucose, triglycerides and HDL-cholesterol lower than mens. In both sexes, the means are lower in the comparison with eutrophic and overweight, and only the triglycerides average of women with overweight and obesity showed significant statistic difference.

Diferenças relacionadas ao sexo nos volumes ventriculares e na fração de ejeção do ventrículo esquerdo estimados por cintilografia de perfusão miocárdica: comparação entre os programas Quantitative Gated SPECT (QGS) e Segami

OBJECTIVES To test for gender differences in the measurements obtained by Segami and Quantitative Gated SPECT (QGS) software programs. METHODS 181 asymptomatic individuals without heart disease were submitted to myocardial perfusion imaging. End-diastolic volumes (EDV), end-systolic volumes (ESV) and left ventricular ejection fraction (LVEF) were measured by QGS and Segami software programs to evaluate the influence of gender, age, weight, height, heart rate, systolic blood pressure, diastolic blood pressure, body mass index and body surface area. RESULTS The means in the QGS method were: EDV (women= 68 ml; men= 95 ml; p<0.001), LVEF (women= 66.24%; men= 58, 7%) and Segami: EDV (women= 137 ml; men= 174 ml), LVEF (women= 62.67%; men= 58, 52%). There were significant differences between men and women in the EDV (p<0.001), ESV (p<0.001) and LVEF (p=0.001) that persisted after adjusting for body surface area. CONCLUSION Ventricular volumes were significantly lower and LVEF was significantly higher in women, estimated by QGS or Segami software programs.

Aumento do índice de massa corporal em relação a variáveis clínicas e laboratoriais quanto ao sexo em indivíduos sem evidências de cardiopatia

BACKGROUND In clinical practice, the patients we care for display a wide range of body mass indices, from lean to obese. This finding may be the sole apparent clinical abnormality. OBJECTIVE To evaluate clinical and laboratory variables that might be associated with increased body mass index in asymptomatic men and women with no evidence of heart disease, to provide data to substantiate medical recommendations in a study sample from our everyday practice. METHODS The subjects aged 14 to 74 years (mean 40.6 years), 295 men (43.1%) and 389 women (56.9%) The associations between body mass index stratified by gender and clinical and laboratory variables were analyzed using the Spearman correlation coefficient and multiple linear regression. RESULTS The mean body mass index (BMI) did not differ significantly between women (26.15 Kg/m(2)) and men (26.33 Kg/m(2)). In the multiple linear regression model, the ratios of total cholesterol/high-density lipoprotein cholesterol (TC/HDL-C) (beta = 1.1320; p < 0.001) and serum glucose (beta= 0.0233; p = 0.023) were independently correlated with body mass index in women. In men, the variables independently correlated with BMI were the TC/HDL-C (beta = 0.793; p < 0.001) and age (beta = 0.0464; p = 0.030). CONCLUSION In men and women with no evidence of heart disease, TC/HDL-C increased with body mass index in both genders. Other indices associated with BMI included serum glucose in women and age in men. Clinical and laboratory variables associated with body mass index may differ in relation to gender.

Budd-Chiari syndrome in a 25-year-old woman with Behçet's disease: a case report and review of the literature

IntroductionThe risk that patients with Behçets disease will develop thrombotic complications has been previously described. Although it is distributed worldwide, Behçets disease is rare in the Americas and Europe. Even though the pathogenic mechanisms of vascular complications of Budd-Chiari syndrome in patients with Behçets disease are unknown, severe vascular complications of Budd-Chiari syndrome associated with Behçets disease seem to affect mainly young men.The risk that patients with Behçets disease will develop thrombotic complications has been previously described. Although it is distributed worldwide, Behçets disease is rare in the Americas and Europe. Even though the pathogenic mechanisms of vascular complications of Budd-Chiari syndrome in patients with Behçets disease are unknown, severe vascular complications of Budd-Chiari syndrome associated with Behçets disease seem to affect mainly young men.Case presentationWe report a case of Budd-Chiari syndrome, a severe vascular complication that developed in a 25-year-old Afro-Brazilian woman with Behçets disease.ConclusionSevere vascular complications of Budd-Chiari syndrome in patients with Behçets disease are much more common in young adult male patients; we present a rare case of Budd-Chiari syndrome in a young Afro-Brazilian woman with Behçets disease.

Histoplasmosis in the nasal septum without pulmonary involvement in a patient with acquired immunodeficiency syndrome: case report and literature review

CONTEXT Histoplasmosis is a fungal disease caused by inhaling spores of the fungus Histoplasma capsulatum. The spores can be found in soil contaminated with bird, bat or chicken feces. Histoplasmosis occurs worldwide and is one of the most common pulmonary and systemic mycoses. CASE REPORT We report here the case of a 37-year-old man with acquired immune deficiency syndrome and histoplasmosis in the nasal septum, without pulmonary involvement, that evolved rapidly to disseminated infection, multiple organ failure and death.

Budd-Chiari syndrome in association with Behçet's disease: review of the literature

The risk that patients with Behçets disease may develop various thrombotic complications has been previously described. Although vascular complications from Budd-Chiari syndrome associated with Behçets disease have been described, the pathogenic mechanisms are still unknown. Severe vascular complications present in Budd-Chiari syndrome associated with Behçets disease are very common among young male adults. The objective of this study was to review the literature and present the association of Budd-Chiari syndrome with Behçets disease.

Influence of Parasympathetic Modulation in Doppler Mitral Inflow Velocity in Individuals without Heart Disease

BACKGROUND The relation between left ventricular filing velocities determined by Doppler echocardiography and autonomic nervous system function assessed by heart rate variability (HRV) is unclear. The aim of this study was to evaluate the influence of the autonomic nervous system assessed by the time and frequency domain indices of HRV in the Doppler indices of left ventricular diastolic filling velocities in patients without heart disease. METHODS We studied 451 healthy individuals (255 female [56.4%]) with normal blood pressure, electrocardiogram, chest x-ray, and treadmill electrocardiographic exercise stress test results, with a mean age of 43+/-12 (range 15-82) years, who underwent transthoracic Doppler echocardiography and 24-hour electrocardiographic ambulatory monitoring. We studied indices of HRV on time (standard deviation [SD] of all normal sinus RR intervals during 24 hours, SD of averaged normal sinus RR intervals for all 5-minute segments, mean of the SD of all normal sinus RR intervals for all 5-minute segments, root-mean-square of the successive normal sinus RR interval difference, and percentage of successive normal sinus RR intervals>50 ms) and frequency (low frequency, high frequency, very low frequency, low frequency/high frequency ratio) domains relative to peak flow velocity during rapid passive filling phase (E), atrial contraction (A), E/A ratio, E-wave deceleration time, and isovolumic relaxation time. Statistical analysis was performed with Pearson correlation and logistic regression. RESULTS Peak flow velocity during rapid passive filling phase (E) and atrial contraction (A), E/A ratio, and deceleration time of early mitral inflow did not demonstrate a significant correlation with indices of HRV in time and frequency domain. We found that the E/A ratio was<1 in 45 individuals (10%). Individuals with an E/A ratio<1 had lower indices of HRV in frequency domain (except low frequency/high frequency) and lower indices of the mean of the SD of all normal sinus RR intervals for all 5-minute segments, root-mean-square of the successive normal sinus RR interval difference, and percentage of successive normal sinus RR intervals>50 ms in time domain. Logistic regression demonstrated that an E/A ratio<1 was associated with lower HF. CONCLUSION Individuals with no evidence of heart disease and an E/A ratio<1 demonstrated a significant decrease in indexes of HRV associated with parasympathetic modulation.

The effect of dobutamine without and with L-arginine on arterial compliance in heart failure patients.

The effect of dobutamine on carotid and brachial arteries compliance and the association of L‐arginine as a potential nitric oxide pathway restorer were evaluated in patients with heart failure. Twenty‐seven outpatients participated. Drugs used for the treatment of heart failure were withheld at least 24 hours before the study. The carotid and brachial artery diameters and hemodynamic variables were evaluated by ultrasonography and Doppler in baseline conditions, with dobutamine, with flow‐mediated dilatation (FMD), and with placebo or L‐arginine alone and associated with dobutamine. There was a significant increase in carotid peak blood flow with dobutamine when compared with that at baseline (P = 0.0001) or with L‐arginine or placebo (P = 0.0001 and P = 0.0001, respectively), with increase of the cardiac index (P = 0.0001). Dobutamine did not increase carotid arterial compliance. FMD significantly increased the brachial peak blood flow (P = 0.0022) and the artery diameter (P = 0.0001). Dobutamine did not change the brachial artery diameter. Brachial peak blood flow was increased with dobutamine alone or associated with placebo or L‐arginine comparing with L‐arginine or placebo alone (P = 0.0168 and P = 0.0140, respectively), but was not increased compared with that at baseline. L‐arginine infusion was not associated with changes in carotid, brachial, or in the cardiac index. We concluded that dobutamine increased carotid peak blood flow in patients with heart failure, although without changing the arterial compliance. The FMD of brachial artery was maintained, while brachial artery response to dobutamine infusion was less reliable. The carotid artery may be under the direct influence of the heart, while the brachial artery may be under predominant local control.

Premature atrial and ventricular complexes in outpatients referred from a primary care facility

Background Premature complexes are common electrocardiographic findings in daily clinical practice that require further evaluation. Investigation may sometimes be complex and expensive. The aim of our study was to analyze variables associated with premature beats identified in outpatients referred from a primary care facility. Materials and methods We performed a cross-sectional study of 407 outpatients (aged 55.8±11years; 56% women) who were followed by general practitioners and were referred for resting 12-lead electrocardiograms for a routine clinical follow-up. After signing informed consent, patients answered a questionnaire and underwent physical examinations, laboratory diagnostics, transthoracic echocardiograms and 24-hour Holter monitoring to evaluate for the presence of premature complexes. After the univariate analyses, logistic regression analyses were performed with adjustment for age, sex, and cardiovascular diseases. Results Premature complexes distribution revealed that they were frequent but with low density. Premature atrial complexes (≥ 4/hours) were associated with age (Odds Ratio (OD) = 1.030, Confidence Interval (CI) 95% = 1.002 ─ 1.059, p = 0.029), brain natriuretic peptide (BNP) levels > 20mg/dL (OR = 4.489, 95%CI = 1.918 ─ 10.507, p = 0.0005), intraventricular blocks (OR = 4.184, 95%CI = 1.816 ─ 9.406, p = 0.0005) and left atrial diameter (OR = 1.065, 95%CI = 1.001 ─ 1.134, p = 0.046). Premature ventricular complexes (≥ 5/hour) were related to age (OR = 1.032, 95%CI = 1.010 ─ 1.054, p = 0.004), the use of calcium channel blockers (OR = 2.248, 95%CI = 1.019 ─ 4.954, p = 0.045), HDL-cholesterol levels (OR = 0.971, 95%CI = 0.951 ─ 0.992, p = 0.007), BNP levels > 20mg/dL (OR = 2.079, 95%CI = 0.991 ─ 0.998, p = 0.033), heart rate (OR = 1.019, 95%CI = 1.001 ─ 1.038, p = 0.041), left ventricular hypertrophy (OR = 2.292, 95%CI = 1.402 ─ 3.746, p = 0.001) and left ventricular ejection fraction (OR = 0.938, 95%CI = 0.900 ─ 0.978, p = 0.002). Conclusions Premature complexes had low density and were associated with BNP levels > 20mg/dL, lower levels of HDL-cholesterol, left atrial enlargement and ventricular hypertrophy. The identification of premature complexes on 24-hour Holter monitor recordings of outpatients in a primary public healthcare setting was associated with uncontrolled cardiovascular risk factors that may be addressed with medical advice and therapy in a primary care setting.