Cantidio Drumond Neto

Valor prognóstico do teste de caminhada de seis minutos na insuficiência cardíaca

OBJECTIVE This study aimed to assess the true usefulness of the Six-Minute Walk Test as a prognostic indicator and its contribution to clinical practice with heart failure patients. METHODS In order to investigate the actual value of the Six-Minute Walk Test as an objective measure of mortality probability in patients with heart failure, the test was applied to 179 stable patients (120 men and 59 women, mean age 58.32 +/- 12.7 years, with NYHA class II and III heart failure and an ejection fraction (LVEF) of 34.91 +/- 12.4%). Patients were instructed to walk for 6 minutes and then, four hours later, underwent a conventional exercise stress test (as per Naughton Protocol). Patients were followed for an average of eighteen months. RESULTS The average distance walked was 521.11 +/- 76.1 meters. During the follow-up period, 66 patients (36.9%) died. There was a significant correlation between the distance walked during the test and mortality (p < 0.0001). The logistic regression model identified the distance walked during the test as the most important independent predictor of mortality (p = 0.0001). A distance shorter than 520 meters identified the patients with an increased probability of death. There was a significant correlation between the number of metabolic equivalents (METs) measured during the conventional exercise stress testing and mortality rate (p = 0.0001). CONCLUSION The Six-Minute Walk test is a simple, safe and powerful method to assess the prognosis of patients with NYHA class II and III heart failure. It is an objective examination that may replace the conventional ergometric test for the prognostic evaluation of these patients.

Radionuclide imaging of myocardium with mental stress in the investigation of thoracic pain

Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.

Cintilografia miocárdica com estresse mental na investigação de dor torácica

Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.

Centellograma miocárdico con estrés mental en la investigación de dolor torácico

Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.Thoracic pain is a common symptom in emergency services, and stress radionuclide imaging represents one of the phases of risk stratification in these individuals. However, a group of patients with negative functional exams after physical or pharmacological stress develops myocardial ischemia during this psychological stress. Alterations in vascular tonus as a response to endogenous mechanisms are the physiopathologic basis for such alterations. We report a case that illustrates how mental stress radionuclide imaging has the potential to be used in the assessment of myocardial ischemia non-detected by conventional methods in patients with suspicion of ischemic thoracic pain.

P-665: Effect of hormone replacement therapy and raloxifene on exercise testing and dispersion of ventricular repolarization in treated hypertensive postmenopausal women

EFFECT OF HORMONE REPLACEMENT THERAPY AND RALOXIFENE ON EXERCISE TESTING AND DISPERSION OF VENTRICULAR REPOLARIZATION IN TREATED HYPERTENSIVE POSTMENOPAUSAL WOMEN Lı́lian S Costa, Monica A Oliveira, Valeria M Rubim, João Carlos Tress, Jose M Aldrighi, Mauricio Wajngarten, Cantidio Drumond Neto, Otavio E Gebara. Cardiology, Rio de Janeiro Santa Casa de Misericordia Hospital, Rio de Janeiro, RJ, Brazil; Cardiogeriatry, INCOR Sao Paulo Heart Institute, Sao Paulo, SP, Brazil.

P-266: The effect of hormone replacement therapy on vascular compliance in postmenopausal women

Abstract P-266 Key Words: Postmenopausal, Pulse Wave Velocity, Ambulatory Blood Pressure Monitoring

The effect of accupril on circadian blood pressure patterns in hypertensive subjects with left ventricle hypertrophy

Abstract P-190 Key Words: Ambulatory Blood Pressure Monitoring, Left Ventricular Hypertrophy, Pharmacology Therapy

Avaliaçäo do perfil arritmogênico ventricular de pacientes com miocardiopatia dilatada e fraçäo de ejeçäo diminuída

PURPOSE: To evaluate the arrhythmogenic profile of patients with dilated cardiomyopathy of low ejection fraction and its prognostic significance. METHODS: Data from 40 patients (30 males; mean age: 52±13 years) were analysed including ventricular arrhythmias (24h - Holter monitoring), autonomic balance from heart rate variability in time domain (rMSSD and pNN50 indexes), ventricular late potentials (signal averaged electrocardiogram (ECG)) and dispersion of ventricular repolarization measured from 12-lead ECG. RESULTS: There was a high prevalence of ventricular arrhythmias with at least one episode of nonsustained ventricular tachycardia (VT) in 60% of the patients. Depressed vagal activity was observed in more than half of the patients. In only 30% of the patients the signal-averaged ECG was positive. The dispersion of ventricular repolarization ranged from 20 to 100ms. The presence of >30 ventricular premature beats or nonsustained VT on Holter monitoring was the most significant predictor of cardiac death and sudden cardiac death with a relative risk of 1.9 and 3.2, respectively (p= 0.01 and 0.000). CONCLUSION: In this study population it was noted that patients with dilated cardiomyopathy and low ejection fraction had an abnormal electrical and autonomic cardiac behaviour. These findings could represent risk factors for the ocurrence of life-threatening arrhythmias or fatal events.