Ivan Romero Rivera

Prevalência de pressão arterial elevada em escolares e adolescentes de Maceió

OBJECTIVES: To define the prevalence of high blood pressure in a representative sample of children and adolescents from the city of Maceio, state of Alagoas, Brazil, and to investigate the association of high blood pressure with age, sex and nutritional status. METHODS: This cross-sectional study was carried out from May 2000 to September 2002. Individuals between 7 and 17 years of age were selected among all the 185,702 students from public and private schools. The size of the sample was defined based on the expected prevalence of hypertension for the age group. After randomization, data were collected through a questionnaire. Blood pressure was measured twice. Weight and height were also measured. High blood pressure was defined as systolic and/or diastolic blood pressure over the 95th percentile in one or in both measures. RESULTS: The final sample included 1,253 students (706 females). One hundred and eighteen students had high blood pressure (mean age 13 years; 44% males). Risk of being overweight and excess weight were identified, respectively, in 9.3 and 4.5% of the students. These variables were significantly associated with high blood pressure. CONCLUSIONS: The prevalence of high blood pressure was 9.4%. High blood pressure was significantly more frequent among overweight students and among those at risk for being overweight.

Medida da pressão arterial em crianças e adolescentes: recomendações das diretrizes de hipertensão arterial e prática médica atual

OBJECTIVE To determine, in a school-based sample of children and adolescents, aged from 7 to 17 years, of both gender, in public and private schools, the frequency of students already submitted to blood pressure measure. METHODS A cross-sectional study was carried out, sampling from a population pool of elementary and middle schools, randomly selected. The sample was calculated based on the expected prevalence of hypertension for the age group. Data were collected through a questionnaire. Blood pressure was measured twice and hypertension was defined as mean systolic and/or diastolic blood pressure over the 95th percentile. Independent variables studied: sex; age groups; economic status; public/private school. RESULTS The final sample included 1253 students. The response rate was 97%: 1215 students; 531 males; mean age 12,4 +/- 3 years (236 from 7 to 9 years; 638 from 10 to 14 years; 341 from 15 to 17 years). Prevalence of hypertension was 7.7%; 348 students (29%) were already submitted to blood pressure measures (54% once; 35% 2 to 4 times; 11% 5 or more times). High economic status, private school and adolescent group were significantly associated to previous blood pressure measure. CONCLUSION Despite of pediatric consensus statements and guidelines recommendations about importance of blood pressure measure at every examination after age 3 years, there is a very low frequency of this practice (29%) in children and adolescents.

Multiple arterial anomalies in the newborn infant. Echocardiographic and angiographic diagnosis

Multiple arterial anomalies characterized by tortuosity and rolling of the pulmonary arteries and aorta were diagnosed on echocardiography in an asymptomatic newborn infant with a phenotype suggesting Ehlers-Danlos syndrome. These changes were later confirmed on angiography, which also showed peripheral vascular abnormalities. The electrocardiogram showed a probable hemiblock of the left anterosuperior branch, and the chest x-ray showed an excavated pulmonary trunk with normal pulmonary flow.

Electrocardiography in the diagnosis of ventricular hypertrophy in patients with chronic renal disease.

BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 + or - 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearsons linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > or = 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterizacion y prevalencia en la enfermedad renal cronica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnostico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiograficos, correlacionandolos al indice de masa del ventriculo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. METODOS: Estudio transversal que incluyo a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 anos) con ERC de todas las etiologias, desde hace al menos 6 meses en hemodialisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el termino de las sesiones de HD. RESULTADOS: La HVI se detecto en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estandar concentrico y 27 (32,6%) el estandar excentrico de HVI. Todos los metodos electrocardiograficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnosticas superiores al 50%. Mediante la correlacion lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presento coeficiente > 0,50. Sin embargo, el calculo de la razon de verosimilitud evidencio que el ECG tiene poder discriminatorio para diagnostico de HVI en la poblacion estudiada, con enfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlacion entre IMVI con el QTc y su dispersion. CONCLUSION: El ECG es un metodo util, eficaz y de alta reproductibilidad en el diagnostico de HVI de los pacientes en HD. En esa poblacion, el criterio de Producto de Cornell fue mas fiable para la deteccion de HVI.

Left Ventricular Diastolic Function in Essential Hypertensive Patients. Influence of Age and Left Ventricular Geometry

PURPOSE To evaluate diastolic dysfunction (DD) in essential hypertension and the influence of age and cardiac geometry on this parameter. METHODS Four hundred sixty essential hypertensive patients (HT) underwent Doppler echocardiography to obtain E/A wave ratio (E/A), atrial deceleration time (ADT), and isovolumetric relaxation time (IRT). All patients were grouped according to cardiac geometric patterns (NG - normal geometry; CR - concentric remodeling; CH- concentric hypertrophy; EH - eccentric hypertrophy) and to age (<40; 40 - 60; >60 years). One hundred six normotensives (NT) persons were also evaluated. RESULTS A worsening of diastolic function in the HT compared with the NT, including HT with NG (E/A: NT - 1.38+/-0.03 vs HT - 1.27+/-0.02, p<0.01), was observed. A higher prevalence of DD occurred parallel to age and cardiac geometry also in the prehypertrophic groups (CR). Multiple regression analysis identified age as the most important predictor of DD (r2=0.30, p<0.01). CONCLUSION DD was prevalent in this hypertensive population, being highly affected by age and less by heart structural parameters. DD is observed in incipient stages of hypertensive heart disease, and thus its early detection may help in the risk stratification of hypertensive patients.

Association of pulmonary atresia with intact ventricular septum and aortic valve stenosis. Prenatal diagnosis

A rare association of pulmonary atresia with an intact septum was diagnosed through echocardiography in a fetus 32 weeks of gestational age. The diagnosis was later confirmed by echocardiography of the newborn infant and further on autopsy. The aortic valve was bicuspid with a pressure gradient of 81 mmHg, and the right ventricle was hypoplastic, as were the pulmonary trunk and arteries, and the blood flow was totally dependent on the ductus arteriosus.

Doppler-derived myocardial performance index in patients with impaired left ventricular relaxation and preserved systolic function.

Background: The Doppler‐derived myocardial performance index (MPI) has been used in the evaluation of left ventricular (LV) function in several diseases. In patients with isolated diastolic dysfunction, the diagnostic utility of this index remains unclear. The aim of this study was to determine the diagnostic utility of MPI in patients with systemic hypertension, impaired LV relaxation, and normal ejection fraction. Methods: Thirty hypertensive patients with impaired LV relaxation were compared to 30 control subjects. MPI and its components, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and the ejection time (ET), were measured from LV outflow and mitral inflow Doppler velocity profiles. Results: MPI was higher in patients than in control subjects (0.45 ± 0.13 vs 0.37 ± 0.07 P < 0.0029). The increase in MPI was due to the prolongation of IRT without significant change of ICT and ET. MPI cutoff value of ≥0.40 identified impaired LV relaxation with a sensitivity of 63% and specificity of 70% while an IRT >94 ms had a sensitivity of 67% and specificity of 80%. Multivariate analysis identified relative wall thickness, mitral early filling wave velocity (E), and systolic myocardial velocity (Sm) as independent predictors of MPI in patients with hypertension. Conclusions: MPI was increase in patients with hypertension, diastolic dysfunction, and normal ejection fraction but was not superior to IRT to detect impaired LV relaxation.

Pulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation

There is no definitive and reliable echocardiographic method for estimating the pulmonary vascular resistance (PVR) to differentiate persistent vascular disease from dynamic pulmonary hypertension. The aim of this study was to analyze the relationship between the pulmonary venous blood flow velocity‐time integral (VTIpv) and PVR.

O eletrocardiograma no diagnóstico da hipertrofia ventricular de pacientes com doença renal crônica

BACKGROUND Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular risk, and its characterization and prevalence in chronic renal disease (CRD) should be further studied. OBJECTIVE To establish the diagnosis of LVH in patients with stage-5 CRD using six different electrocardiographic criteria, and to correlate them with left ventricular mass index (LVMI) as obtained by echocardiography. METHODS Cross-sectional study including 100 patients (58 men and 42 women, mean age 46.2 + or - 14.0 years) with CRD of all causes undergoing hemodialysis (HD) for at least six months. Electrocardiography (ECG) and echocardiography were performed in all patients, always up to one hour after the end of the HD sessions. RESULTS LVH was detected in 83 patients (83%), of whom 56 (67.4%) had the concentric pattern and 27 (32.6%) the eccentric pattern of LVH. Diagnostic sensitivity, specificity and accuracy of all the electrocardiographic methods studied were higher than 50%. Using Pearsons linear correlation for LVMI, only the Sokolow-Lyon voltage criterion did not show a > or = 0.50 coefficient. Calculation of the likelihood ratio, in turn, showed that ECG has a discriminatory power for the diagnosis of LVH in the population studied, with emphasis on the Cornell-product and Romhilt-Estes criteria. No correlation was observed between LVMI and QTc and QTc dispersion. CONCLUSION ECG is a useful, efficient, and highly reproducible method for the diagnosis of LVH in HD patients. In this population, the Cornell-product proved to be the most reliable criterion for the detection of LVH.FUNDAMENTO: La hipertrofia ventricular izquierda (HVI) es un factor predictor independiente de riesgo cardiovascular y su caracterizacion y prevalencia en la enfermedad renal cronica (ERC) carecen de mejor estudio. OBJETIVO: Establecer el diagnostico de HVI en pacientes con ERC en estadio 5 por seis diferentes criterios electrocardiograficos, correlacionandolos al indice de masa del ventriculo izquierdo (IMVI) que se obtuvo mediante el ecocardiograma. METODOS: Estudio transversal que incluyo a 100 pacientes (58 varones y 42 mujeres, edad de 46,2 ± 14,0 anos) con ERC de todas las etiologias, desde hace al menos 6 meses en hemodialisis (HD). Se obtuvieron electrocardiograma (ECG) y ecocardiograma de los pacientes, siempre hasta una hora tras el termino de las sesiones de HD. RESULTADOS: La HVI se detecto en 83 pacientes (83%), de los que 56 (67,4%) presentaban el estandar concentrico y 27 (32,6%) el estandar excentrico de HVI. Todos los metodos electrocardiograficos estudiados tuvieron sensibilidad, especificidad y exactitud diagnosticas superiores al 50%. Mediante la correlacion lineal de Pearson con el IMVI, solamente el criterio de Sokolow-Lyon voltaje no presento coeficiente > 0,50. Sin embargo, el calculo de la razon de verosimilitud evidencio que el ECG tiene poder discriminatorio para diagnostico de HVI en la poblacion estudiada, con enfasis para los criterios de Producto de Cornell y Romhilt-Estes. No hubo correlacion entre IMVI con el QTc y su dispersion. CONCLUSION: El ECG es un metodo util, eficaz y de alta reproductibilidad en el diagnostico de HVI de los pacientes en HD. En esa poblacion, el criterio de Producto de Cornell fue mas fiable para la deteccion de HVI.

Circulação coronária dependente do ventrículo direito na atresia pulmonar com septo interventricular íntegro. Ausência da origem das artérias coronárias da aorta

This report describes the clinical, echocardiographic and angiographic aspects of a five-day old boy with pulmonary atresia and intact ventricular septum. Both the echocardiogram and the aortography did not show any coronary arteries arising from the aorta. Two-dimensional echocardiography was able to identify the coronary arteries originating from the right ventricle and so did the right ventricular angiogram. No retrograde flow into the aorta or pulmonary trunk was identified after opacification of the coronary arteries. As far as we know this is the first case diagnosed by echocardiography, and is a vivid example of the necessity of identifying the coronary arteries in patients with pulmonary atresia and intact ventricular septum.