André Maurício Souza Fernandes

Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward.

BackgroundNeuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay.MethodsThis is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge.ResultsThe walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change.ConclusionThe neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

COX-2 rs20417 Polymorphism Is Associated with Stroke and White Matter Disease.

BACKGROUND To investigate the effect of COX-2 polymorphism and its product, prostaglandin E2 (PGE2), on stroke risk in an endemic area for Chagas disease. In a separate cohort, to investigate the effect of COX-2 polymorphisms on the total burden of cerebral white matter disease. METHODS Cases were outpatients with ischemic stroke; controls were stroke-free subjects from 2 outpatient clinics (heart failure and caregivers of a movement disorders clinic). We extracted DNA from total blood to investigate the rs20417 COX-2 polymorphism. Serologic tests (Enzime-linked immunosorbent assay) were performed to confirm Trypanosoma cruzi infection and to quantify PGE2 levels. In the Boston cohort, white matter hyperintensity volume (WMHv) was quantified on the admission brain magnetic resonance images of subjects with ischemic stroke, who also donated DNA for the COX-2 gene region analysis. RESULTS We studied 44 patients with stroke and 96 controls (46 with heart failure and 50 caregivers) in the Brazilian cohort; and 788 stroke patients (302 cardioembolic and 486 noncardioembolic) in the Boston cohort. In the Brazilian cohort, rs20417 polymorphism was associated with both stroke (P = 5 × 10(-6)) and decreased PGE2 levels (P = 4 × 10(-5)); similarly, Chagas was associated with stroke (P = 4 × 10(-3)) and decreased PGE2 levels (P = 7 × 10(-3)). In the Boston cohort, rs20417 polymorphism was associated with increased WMHv among noncardioembolic (P = .037), but not among cardioembolic stroke patients. CONCLUSIONS Variation in COX-2 gene is associated with both symptomatic and silent brain cerebrovascular disease. This candidate gene region should be tested in population-based samples.

Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados

BACKGROUND Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p <0.001) and renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

Impact of socio-economic profile on the prosthesis type choice used on heart surgery.

BACKGROUND Valvar heart disease is an important public health problem, more common in developing countries, especially in younger. OBJECTIVE To evaluate the epidemiological features of patients and its influence on the prosthesis type choice used on patients who underwent valve surgery. METHODS Cross-sectional. Data such as age, sex, provenance, surgery procedure and prosthesis type were retrospectively analyzed. We reviewed 366 charts of all patients submitted to heart valve surgery during three years in a public health cardiovascular treatment center. RESULTS 52% of patients were female. The age range was from 5 to 82, the median was 41 years old. In regards 37.7% of patients came from Salvador (Bahia, Brazil) and 62.3% from countryside. Valve replacement was performed in 73% of patients, whereas 7.38% underwent valvuloplasty and 18.3% underwent valve repair and replacement. Regarding type of prosthesis, 70.0% received bioprosthesis and 30.0% received metal prosthesis. On note bioprosthesis were more used in younger (P<0,001). CONCLUSION Biological prostheses were used predominantly in younger. This might be possible due to a low social-economic status, avoiding metal valve implantation and the consequent anticoagulation therapy.

Evaluation of variables responsible for hospital mortality in patients with rheumatic heart disease undergoing double valve replacement

Objective To describe the hospital mortality and associated clinical and echocardiographic variables in patients with rheumatic disease who underwent double valve replacement surgery. Methods This is a cross sectional descriptive study of mortality, performed in a referral hospital in Salvador, Bahia. Records from patients with rheumatic disease who underwent double valve replacement surgery during the years 2007-2011 were analyzed. Results The studied sample comprises 104 patients and 60 (57.7%) were male. The mean age was 38.04±14.45. Sixty five bioprostheses and 38 mechanical prostheses were used in these patients at the time of surgery. There were statistically significant differences between the two groups, when we analyzed the following variables: the mean age (36.30±13.03 vs. 45.35±17.8 years-old, P=0.011), mean hemoglobin (11.10±2.19 vs. 9.22±2.26 g/dL, P=0.002), mean hematocrit (34.22±5.86 vs. 28.44±6.62%, P<0.001). New York Heart Association functional class III and IV (NYHA) (P=0.022) was statistically associated with mortality. Conclusion We concluded that the mean hemoglobin/hematocrit level and the NYHA functional class was the major variables associated to the mortality among these patients. Based on these data one may concern about the patient best moment for surgery and the patient hemoglobin level.

Silent Cerebral Infarctions with Reduced, Mid-Range and Preserved Ejection Fraction in Patients with Heart Failure

Heart failure predisposes to an increased risk of silent cerebral infarction, and data related to left ventricular ejection fraction are still limited. Our objective was to describe the clinical and echocardiographic characteristics and factors associated with silent cerebral infarction in patients with heart failure, according to the left ventricular ejection fraction groups. A prospective cohort was performed at a referral hospital in Cardiology between December 2015 and July 2017. The left ventricular ejection fraction groups were: reduced (≤ 40%), mid-range (41-49%) and preserved (≥ 50%). All patients underwent cranial tomography, transthoracic and transesophageal echocardiography. Seventy-five patients were studied. Silent cerebral infarction was observed in 14.7% of the study population (45.5% lacunar and 54.5% territorial) and was more frequent in patients in the reduced left ventricular ejection fraction group (29%) compared with the mid-range one (15.4%, p = 0.005). There were no cases of silent cerebral infarction in the group of preserved left ventricular ejection fraction. In the univariate analysis, an association was identified between silent cerebral infarction and reduced (OR = 8.59; 95%CI: 1.71 - 43.27; p = 0.009) and preserved (OR = 0.05; 95%CI: 0.003-0.817, p = 0.003) left ventricular ejection fraction and diabetes mellitus (OR = 4.28, 95%CI: 1.14-16.15, p = 0.031). In patients with heart failure and without a clinical diagnosis of stroke, reduced and mid-range left ventricular ejection fractions contributed to the occurrence of territorial and lacunar silent cerebral infarction, respectively. The lower the left ventricular ejection fraction, the higher the prevalence of silent cerebral infarction.

Assessment of Right Ventricle Function and Myocardial Fibrosis by Cardiovascular Magnetic Resonance in Patients with Inferior Wall Myocardial Infarction

Fundamentos: Disfuncao do ventriculo direito (VD) e observada em 30-50% dos pacientes com infarto do miocardio na parede inferior (IM-I) e e fator preditor de mortalidade precoce. A fibrose miocardica esta associada com disfuncao ventricular progressiva e prognostico grave. Nesses pacientes, a ressonância magnetica cardiaca (RMC) e um importante metodo de estratificacao de risco. Objetivos: Avaliar a associacao entre disfuncao do VD e fibrose miocardica em pacientes com IM-I por RMC. Metodos: Estudo coorte realizado em um centro de cardiologia de referencia. Quarenta individuos com IM-I foram incluidos no estudo. RMC foi realizada durante a internacao para estimar funcao do VD e quantificar fibrose miocardica pela tecnica de realce tardio com gadolinio (TRT). Os pacientes foram estratificados quanto a funcao ventricular, e caracteristicas clinicas foram comparadas entre os grupos. Resultados: Quarenta pacientes foram incluidos no estudo, 75% eram homens e 43% idosos (idade ≥ 60 anos). Entre os fatores de risco cardiovasculares, hipertensao (45%) e tabagismo (33%) foram os mais prevalentes. A disfuncao do VD estava presente em 33% dos pacientes. A massa de fibrose media foi 22 ± 12g nos pacientes com disfuncao do VD e 15 ± 8 g nos pacientes com funcao ventricular preservada (p = 0,051). Conclusoes: Os resultados deste estudo indicam uma possivel associacao entre disfuncao do VD e fibrose miocardica nos pacientes com IM-I. No entanto, outros estudos envolvendo um maior numero de pacientes sao necessarios para confirmar nossos achados.

Subclinical Atherosclerosis in Non-dialysis Chronic Renal Patients

Background: Nowadays cardiovascular diseases are the main cause of morbid-mortality. Atherosclerosis is one of the most important in this class of diseases. Aim: Identifying subclinical atherosclerosis in a population of non-dialytic patients with chronic kidney disease. Methods: From November 2012 to December 2013, we selected 40 patients with stage 3 or 4 of CKD (Chronic kidney disease) who did not need hemodialysis. CACS (coronary artery calcium score) and MTCA (miointimal tichness carotid artery) were calculated and their mean and standard deviation, median and quartiles. To verify the association between the variables we used the Fisher exact test and the Spearman correlation (p<0.05). Results: The distribution of the CACS was not as expected and the median increased with age groups. The CACS was null in : 50% of the sample in all patients below 45 years of age, 50% of those between 45-49 years of age and 50-54 years of age, 53.8% in those 55-59 years of age and 25% of those 60-65 years of age, however p value=0.102. The median MTCA was 0.9 mm with interquartile range of 0.7-1.2 mm. In percentil75 for age and sex were : 80% of 45 year olds, 25% of 45-49 year olds, 66.7% of 50-54 year olds, 69.2% of 55-59 year olds and 50% of 60-65 year olds, though p value was 0.602. We found a moderate positive correlation between age and CACS (r=0.458 p=0.03) and between age and MTCA weak (r=0.346 p=0.029) when performed correlation of age with the values of CACS and MTCA. The correlation between MTCA and CACS was strong(r=0.807) p<0.001. Conclusion: Non-invasive tests in CKD non-dialytic patients can identify subclinical atherosclerosis through the CACS and MTCA. This may change the clinical management, evolution and prognosis.

In-hospital mortality in patients with rheumatic heart disease undergoing double valve replacement

Fundamentos: A cardiopatia reumatica e um importante problema de saude publica. Ha escassez de dados sobre influencia de variaveis cirurgicas na mortalidade de pacientes reumaticos submetidos dupla-troca valvar (DTV). Objetivo: Identificar possiveis variaveis cirurgicas associadas a mortalidade de pacientes reumaticos submetidos a DTV. Metodos: Estudo retrospectivo de corte transversal, incluindo 104 pacientes >18 anos, com diagnostico previo de valvopatia reumatica, submetidos a cirurgia de DTV no periodo de janeiro de 2007 a dezembro de 2011. A coleta de dados utilizou os prontuarios de pacientes do Hospital Ana Nery, Salvador, BA, Brasil. Resultados: Observou-se diferenca estatistica significativa entre os grupos do desfecho (obito intra-hospitalar/ alta hospitalar) em relacao as variaveis, respectivamente: tempo de anoxia (minutos) de 149,17±40,99 e 123,99±24,12 (p=0,001); tempo de CEC 185,53±54,59 e 157,34±34,62 (p=0,006); e o tempo cirurgico total 350,29±56,69 e 295,23±63,98 (p=0,002). Os pacientes que realizaram outro procedimento associado a DTV, no mesmo tempo cirurgico, apresentaram maior mortalidade (n=10; 31,2%), em relacao aos que realizaram apenas a DTV (n=9; 12,8%) (p=0,027). Houve tambem associacao significativa na comparacao de pacientes com reabordagem cirurgica com aqueles que realizaram unica abordagem (p<0,001). Nao houve diferenca estatistica quando se comparou desfecho hospitalar e os tipos de proteses utilizadas (p=0,219). Conclusoes: As variaveis cirurgicas que tiveram influencia na mortalidade foram: tempos de anoxia, de CEC, de cirurgia total, com possiveis pontos de corte, respectivamente, de 150 min, 100 min e 300 min. A necessidade de reabordagem no pos-operatorio hospitalar e a realizacao de outro procedimento no mesmo ato tambem mostraram significância.

Influence of valve prosthesis type on early mortality in patients undergoing valve surgery

OBJECTIVE To evaluate the influence of the type of prosthesis in-hospital mortality in the post-operative period in patients who had valve replacement. METHODS A cross-sectional data, such as gender, origin, age, etiology, echocardiograph data, the type of surgery performed and the prosthesis used in cases of valve replacement were analyzed retrospectively. RESULTS We reviewed 353 charts of patients who underwent valve replacement surgery. The mean age was 41.87±17.9 years. Regarding gender, 52.8% were female. As for the origin, 61.1% came from small cities within the state. Of all patients, 58.5% suffered from rheumatic disease. Assessing the type of prosthesis implanted, 70% held replace by bioprosthesis and 30% metallic. The hospital mortality in this study was 11%, with no significant difference between the types of prosthesis utilized. CONCLUSION The type of implant used had no effect on in-hospital mortality.