Eliza de Almeida Gripp

Atrial Fibrillation in Decompensated Heart Failure: Associated Factors and In-Hospital Outcome

Background Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. Objectives To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. Methods Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. Results The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ≥ 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). Conclusions Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality.

Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation

Mailing Address: Antonio José Lagoeiro Jorge Avenida Marques de Paraná, 303. Postal Code: 24033-900, Centro, Niterói, Rio de Janeiro, RJ – Brazil. E-mail: lagoeiro@cardiol.br; lagoeiro@globo.com Severe Mitral Regurgitation by Hyperthyroidism in the Absence of Left Ventricular Dilatation Antonio José Lagoeiro Jorge, Wolney de Andrade Martins, Eliza de Almeida Gripp, Breno Macêdo de Almeida, Camila Cezário Rocha Paz Figueroa, Cíntia Lobo Sabino Hospital Universitário Antônio Pedro, Universidade Federal Fluminense (UFF), Niterói, RJ – Brazil

The Role of Three Dimensional Echocardiography in the Detection of Cardiac Metastasis from Melanoma

Melanocarcinoma, considered the most malignant of skin tumors, with enormous potential for systemic metastasis mainly through the blood, usually occurs from 30 to 60 years of age. Its incidence increases progressively, affecting 4% to 8% of the white population2. Until recently, cardiac involvement was rarely diagnosed3. The limitations of imaging methods associated with nonspecific clinical symptoms made this diagnosis a challenge. Positron emission tomography (PET scan), together with the 3D TTE, plays an important role in palliative surgical planning, when recommended, as it provides detailed information of the tumor, such as size and invasion of adjacent structures. This case report describes the use of three-dimensional echocardiography for diagnosing cardiac neoplastic involvement due to melanoma, confirmed by PETscan, in a female patient with nonspecific symptoms.

Echocardiographic Reverse Flow Pattern Seen in the Distal Segment of Left Anterior Descending Coronary Artery: An Important Finding in Anomalous Left Coronary Artery from Pulmonary Artery Syndrome

Correspondencia: Eliza de Almeida Gripp • Rua Belisario Tavora, 302 /101 Bl 2, Laranjeiras, 22245-070, Rio de Janeiro, Brasil. E-mail: elizagripp@yahoo.com.br Artigo recebido em 10/09/2013; revisado em 14/10/2013; aceito em 03/02/2014. Introducao A origem anomala da arteria coronariana esquerda a partir do tronco da arteria pulmonar e uma doenca rara, entretanto, uma importante anomalia congenita coronariana. O curso clinico depende da formacao e desenvolvimento de colaterais. A fisiopatologia e explicada pela baixa pressao no sistema arterial pulmonar, com a arteria coronariana direita enchendo a arteria coronariana esquerda de forma retrograda, atraves de colaterais, funcionando como um fenomeno do roubo de fluxo coronariano. Sera relatado um caso em que foi observado outro achado: o padrao do fluxo na arteria coronariana esquerda em seu segmento distal, avaliado pelo Doppler pulsado, corrobora o diagnostico, que foi ratificado pela angiotomografia.