Demóstenes Ribeiro

Ressincronização ventricular: comparando os marcapassos biventriculares com os marcapassos bifocais de ventrículo direito

OBJECTIVE To analyze the conventional biventricular pacing (BV) and the bifocal (BF) right ventricular (RV) pacing, and to perform a comparative analysis of these two techniques in relation to clinical, functional and echocardiographic parameters in a population without the exclusion criteria of the major studies. METHODS A prospective non-randomized analysis of 36 patients undergoing surgery for multisite pacemaker implantation due to QRS > or =130 ms, severe left ventricular dysfunction, and NYHA functional class III or ambulatory class IV congestive heart failure was performed. RESULTS Favorable results of resynchronization were obtained with both techniques, with no significant differences in the comparison of the two groups, except for a higher QRS narrowing in the BV group, and a trend of a lower number or hospital admissions in the BV group. When the groups were analyzed separately and compared before and after the procedures, we observed that improvement was much more significant in the biventricular group, as were the more statistically relevant rates. CONCLUSION Cardiac resynchronization therapy proved to be an efficient therapy in both groups analyzed, although with more significant outcomes in the biventricular group.

Diretriz de interpretação de eletrocardiograma de repouso

Jose Alves Pinho (BA), Mario Sergio de Carvalho Bacellar (BA),Demostenes G. Lima Ribeiro (CE), Rubens Nassar Darwich (MG),Antonio Luiz Pinho Ribeiro (MG), Marcelo Marcos Eloy Dunda (PB),Helio Germiniani (PR), Francisco Faustino Franca (PE),Laurindo Saraiva (PE), Clebia Maria Rios Ribeiro (PE),Paulo Ginefra (RJ), Iseu Gus (RS), Eney Fernandes (SC),Andres Riera (SC), Anisio Pedrosa (SP),Antonio Americo Friedman (SP), Antonio Carlos Firmiani (SP),Cesar Grupi (SP), Claudio Pinho (SP),Eduardo Vilaca Lima (SP), Elisabeth Kaiser (SP),Fabio Sandoli Brito (SP), Gilberto Luiz Castro Vinhas (SP),Helio Schwartz (SP), Jose Grindler (SP), Jose Luiz Aziz (SP),Marcio Figueiredo (SP), Marcos S. Molina (SP),Martino Martinelli (SP), Nancy Tobias (SP),Paulo Cesar R. Sanches (SP), Paulo Jorge Moffa (SP),Severino Attanes Neto (SP), Silvana Nishioka (SP)

Endocardite infecciosa valvar submetida a tratamento cirúrgico: análise de 64 casos

OBJECTIVE: To identify some aspects of the infective valve endocarditis treated by heart surgery, as well as antibiotic therapy, in a public hospital, in the city of Fortaleza, Ceara state, Brazil, from1988 to 2003. METHOD: A retrospective and observational study of 64 patients with Infective Valve Endocarditis who required aortic and/or mitral valve replacement, tricuspid vegectomy and repair or pulmonary valve valvulectomy, as well as antibiotic therapy, during their in-hospital stay. They were analyzed in respect to gender, age, time elapsed from hospital admission to the surgery, time elapsed from hospital admission to hospital discharge, valve lesion, blood culture result, surgical treatment and mortality. RESULTS: Infective valve endocarditis treated with heart surgery was more frequent in the third decade of life. Most of patients (81.2%) were males. The patients who died spent a shorter time from hospital admission to the surgery than the patients who survived. The aortic valve was affected in 65% of cases. Positivity blood culture were seen in 42% and Staphylococcus aureus was isolated in 52.4% of these cases. Valve replacement was necessary in 93.7% of cases. The in-hospital mortality rate was 14.1% which was not influenced by the age of the patient or the blood culture result. CONCLUSION: Infective valve endocarditis treated by heart surgery was more frequent in men and in the third decade of life. It mostly affected the aortic valve. Staphylococcus aureus was the more common pathogen found. Almost all the patients needed replacement of the infected valve and the in-hospital mortality rate was 14.1%.

Reumatic fever: it is still among us

Medical Science Institute - Paulo Marcelo Martins Rodrigues. MedicalSchool, Federal University of Ceara. Fortaleza, CE, Brazil.Correspondence address: Demostenes G. L. Ribeiro. Rua DeputadoMoreira da Rocha, 655 / 202. Aldeota Fortaleza, Ceara, Brazil. CEP:60.160-060. Phone: (85) 248-3009.E-mail:ricardop@ultranet.com.br

Clinical correlation between N-terminal pro-b-type natriuretic peptide and angiographic coronary atherosclerosis

OBJECTIVES: This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors. METHODS: In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries) or group B (patients with angiographic coronary atherosclerosis). The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide. RESULTS: Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ≥250 pg/mL, fibrinogen levels >500 mg/dL and ≥501 monocytes/mm3 compared with group A patients (p<0.05). Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ≥250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction. CONCLUSIONS: An N-terminal pro-B-type natriuretic peptide plasma concentration of ≥250 pg/mL is an independent predictor of angiographic coronary atherosclerosis.