Cristiano Ricardo Bastos de Macedo

Meta‐analysis about efficacy of anti‐resorptive drugs in post‐menopausal osteoporosis

Objective: The purpose of this study was to compare the effect of three groups of anti‐resorptive drugs in post‐menopausal osteoporosis. Data sources: We collected data covering the period between 1983 and 1995, by first using MEDLINE. References retrieved were scanned further to identify additional papers. Study selection: Only randomized studies evaluating bone mass by means of dual‐photon or dual energy densitometry over a period of 1 year were accepted. Data extraction: Studies were arranged into three drug groups. We used densitometry results after 1 year in all treatment or control groups. Factors which might interfere with the results were recorded for subsequent separate analysis. Data synthesis: The MEDLINE search identified almost 25,000 studies. On reading the abstracts, 275 trials appeared to be controlled trials and original copies were retrieved for detailed analysis. A total of 31 articles which satisfied the inclusion criteria were identified. The first meta‐analysis included studies which compared oestrogens and placebo, and the global effect‐size was 0·54 (95% CI 0·34, 0·73). The second meta‐analysis compared calcitonins with placebo and produced an effect‐size of 0·41 (95% CI 0·21, 0·61) The third analysis compared bisphosphonates and placebo and showed an effect‐size of 0·87 (95% CI 0·68, 1·07). Only oestrogen dose affected the results found. Conclusions: Bisphosphonates had the greatest effect on bone mass in post‐menopausal osteoporosis.

Stroke History and Chagas Disease Are Independent Predictors of Silent Cerebral Microembolism in Patients with Congestive Heart Failure

Background: Chagas disease is endemic in South and Central America, where 18 million individuals are infected by Trypanosoma cruzi, causing congestive heart failure (CHF) and cardioembolic stroke. Transcranial Doppler (TCD) is able to detect real-time microembolic signals (MES) to the brain vessels and may represent a surrogate marker of stroke risk. We aimed to determine predictors of MES in a population of patients with CHF. Methods: Consecutive CHF patients from a university-based cardiomyopathy clinic underwent TCD recording of the middle cerebral artery for 60 min by a single investigator who was blinded to all clinical data including cardiomyopathy etiology. Predictors of MES were sought by multivariable logistic regression analysis. Results: From April 2004 to February 2009, 144 patients were studied, including 62 (44.6%) patients with Chagas disease. MES were detected in 9 (6.2%) patients and were more frequent in patients with Chagas disease than in patients with other causes of CHF (12.9 vs. 1.2%, p = 0.005). In multivariate analysis corrected for age and left-ventricular ejection fraction, predictors of MES were Chagas disease (odds ratio = 1.15, 95% confidence interval = 1.05–1.26, p = 0.004) and stroke history (odds ratio = 1.27, 95% confidence interval = 1.08–1.50, p = 0.005). Conclusions: Chagas disease and stroke history are risk factors for MES independent of cardiac disease severity. Other mechanisms besides structural cardiac disease may be operative, increasing embolic risk in Chagas disease.

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.

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.

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.