Leonardo Roever

Cardiovascular Disease Burden: Evolving Knowledge of Risk Factors in Myocardial Infarction and Stroke through Population-Based Research and Perspectives in Global Prevention.

Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.e., ischemic heart disease and cerebrovascular diseases have developed rapidly. In fact, until recently, the evidence describing the incidence of acute myocardial infarction, the underlying risk factors, and the clinical outcomes of those who have this acute ischemic coronary event has largely been based on studies conducted in developed countries, with limited data for women and usually of low-ethnic diversity. Recent reports by the WHO have provided striking public health information, i.e., the global burden of cardiovascular mortality for the next decades is expected to predominantly occur among developing countries. Therefore, multiethnic population-based research including prospective cohorts and, when appropriate, case–control studies, is warranted. These studies should be specifically designed to ascertain key public health measures, such as geographic variations in non-communicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention (both primary and secondary) and specific treatments. As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology study, which is the largest global initiative of nearly 200,000 adults aged 35–70 years, looking at environmental, societal, and biological influences on obesity and chronic health conditions, such as ischemic heart disease, stroke, and cancer among urban and rural communities in low-, middle-, and high-income countries, with national, community, household, and individual-level data. Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity and mortality.

Avaliação da reprodutibilidade ultrassonográfica como método para medida da gordura abdominal e visceral

OBJETIVO: O objetivo deste estudo e avaliar a variabilidade interobservador do metodo ultrassonografico para medida da gordura subcutânea, visceral e perirrenal por meio de tecnica padronizada. MATERIAIS E METODOS: Foram avaliados 50 pacientes entre novembro de 2006 e janeiro de 2007. A medida da espessura subcutânea foi realizada com transdutor linear de 7,5 MHz posicionado transversalmente a 1 cm acima da cicatriz umbilical. Para a gordura visceral foi utilizado transdutor de 3,5 MHz posicionado 1 cm acima da cicatriz umbilical, considerando-se a medida entre a face interna do musculo reto abdominal e a parede posterior da aorta na linha media do abdome. A gordura perirrenal foi medida no terco medio do rim direito, com transdutor posicionado na linha axilar media. RESULTADOS: A reprodutibilidade interobservador foi analisada por meio do teste t de Student, com significância de 95%. Nao houve diferenca significativa entre as medias das medidas das gorduras subcutânea, visceral e perirrenal, com p = 0,7141, 0,7286 e 0,6368, respectivamente. As medias encontradas, com seus respectivos desvios-padrao, foram: 2,64 ± 1,37 para a espessura subcutânea, 6,84 ± 2,38 para a espessura visceral e 4,89 ± 2,6 para a espessura perirrenal. CONCLUSAO: A ultrassonografia apresentou boa reprodutibilidade interobservador para avaliacao da gordura abdominal por meio das medidas das espessuras subcutânea, visceral e perirrenal. Unitermos: Gordura abdominal; Ultrassom; Sindrome metabolica.

Non-HDL-C vs. LDL-C in Predicting the Severity of Coronary Atherosclerosis

Atherosclerosis is a complex process involving multiple interfaces among inflammation, hypertension, age, ectopic obesity, diabetes, metabolic syndrome, dyslipidaemias, poor diet, smoking, sedentary lifestyle, impaired immune system, endothelial, vascular, hormonal and coagulation [1–3]. Dyslipidaemia is a risk factor for coronary artery disease (CAD), stroke, metabolic syndrome (MetS) peripheral artery disease. Early diagnosis and management are key factors in the prevention of atherosclerotic disease and development of cardiovascular events [4,5]. Several guidelines have recommended using the low-density lipoprotein (LDL-C) treatment goal as the marker for patients with dyslipidaemia. Recently, non-high-density lipoprotein cholesterol (non-HDL-C) has been recognised as a target marker in the treatment of patients with hypertriglyceridaemia or cardiometabolic abnormalities. NonHDL-C is the amount of cholesterol carried by apoB particles including the cholesterol carried by LDL and VLDL particles [6–10]. However, whether non-HDL-C or LDL-C is the better marker reflecting the atherogenic coronary risk remains controversial. The LDL-C measures the mass of cholesterol within LDL particles, and the non-HDL-C indicates the mass of cholesterol within all the apolipoprotein B (apoB) particles including LDL and very low-density lipoprotein (VLDL) [11].

Network Meta-analysis to Synthesize Evidence for Decision Making in Cardiovascular Research

Clinical decision-making requires synthesis of evidence from literature reviews focused on a specific theme. Evidence synthesis is performed with qualitative assessments and systematic reviews of randomized clinical trials, typically covering statistical pooling with pairwise meta-analyses. These methods include adjusted indirect comparison meta-analysis, network meta-analysis, and mixed-treatment comparison. These tools allow synthesis of evidence and comparison of effectiveness in cardiovascular research.

Genotype‐guided warfarin dosing vs. conventional dosing strategies: a systematic review and meta‐analysis of randomized controlled trials

Previous trials on the effectiveness of genotype‐guided warfarin dosing vs. conventional dosing have been inconclusive. We conducted a systematic review and meta‐analysis of randomized trials comparing genotype‐guided to conventional dosing strategies.

Usefulness and Safety of Rivaroxaban in Patients Following Isolated Mitral Valve Replacement With a Mechanical Prosthesis

Rivaroxaban has previously been tested in experimental and animal models with encouraging results. We prospectively selected seven patients between May 2017 and January 2018 who underwent isolated mitral valve replacement with a mechanical prosthesis and had unstable INR control at least 3 months after surgery. An intervention of rivaroxaban 15mg was then administered twice daily for a period of 90days. No patient presented intracardiac thrombus, reversible ischemic neurological deficit, ischemic or hemorrhagic stroke, and hospitalization or death during 3 months of follow-up. Two patients eradicated the presence of spontaneous echo contrast. Mean and peak pressure gradients, peak velocity, effective orifice area, and PHT were similar before and after the intervention. In conclusion, the use of rivaroxaban for 90days in seven patients after replacement of mitral valve with the mechanical prosthesis did not present thromboembolic or bleeding events (NCT02894307).

Endovascular Stent Grafting of a Deep Femoral Artery Pseudoaneurysm

Introduction Pseudoaneurysms (PSAs) are uncommon, but can occur as a complication of orthopedic procedures, usually associated with femur surgery. This report describes successful management of a PSA of the deep femoral artery (DFA) with an endovascular stent graft. Report This case reports an injury that presented as a false aneurysm secondary to a fractured neck of femur, which was initially confused with hematoma. Imaging confirmed the diagnosis of PSA, and the decision was taken to implant an endovascular stent graft. Discussion The endovascular stent graft was implanted based on radiological, anatomical, and clinical parameters. This case supports the feasibility, safety, and efficacy of stenting for PSA of the DFA.

Cerebral hemorrhage following thrombolytic therapy for stroke Are neutrophils really neutral

An ideal biomarker can accurately predict disease risk stratification. The longstanding link between inflammatory responses and atherosclerotic disease and vascular events suggests great promise for inflammatory measures as biomarkers in stroke and other vascular disease. Recent studies across multiple areas and disciplines have suggested that leukocytes, as an inflammatory marker, and specifically neutrophils, may hold promise in predicting poor outcomes in various cardiovascular diseases (e.g., heart failure, acute coronary syndromes, stable coronary artery disease), including stroke, as well as in neoplasms, infections, and inflammation.1–7 The neutrophil count and neutrophil to lymphocyte ratio (NLR) are readily available, inexpensive, and calculated from a complete peripheral blood count with differential. The NLR combines 2 different immune pathways: neutrophils (much quicker response) and lymphocytes (more adaptive long-term response).

The association of left ventricular mass with coronary atherosclerosis and myocardial ischemia: cause and effect or simple association?

Lima and colleagues1 describe a parallel independent association of the presence of coronary artery atherosclerosis, myocardial infarction, and left ventricular mass (LVM). Previous publications reporter2–5 similar findings in somewhat different subsets of patients and they support the potential role of higher LVM as an independent predictor of adverse events in addition to coronary atherosclerosis and myocardial ischaemia. The current paper contributes to an expanding body of evidence that emphasizes the independent risk associated with the presence of higher LVM and intriguingly shows a strong relationship in patients with previous myocardial infarction. They also found that LVM and concentric remodelling are associated with a greater degree of …

Cardiac Tumors: A Brief Commentary

Patients with cardiac tumors may present with cardiovascular related or constitutional symptoms, but more often than not a cardiac mass is discovered incidentally during an imaging examination performed for an unrelated indication. Cardiac myxoma is generally considered to be a surgical emergency. Echocardiography, including the transesophageal approach, is the most important means of diagnosis; computed tomography and magnetic resonance imaging. The clinical presentation has changed, and the management of cardiac myxoma now needs to be reviewed.