Leticia W. Ribeiro

Does serum ferritin correlate with coronary angiography findings

BACKGROUND A number of epidemiological studies have described a positive relationship between serum ferritin levels and coronary heart disease. In this prospective study, we evaluated the association between serum ferritin levels and the angiographic extent of coronary atherosclerosis. METHOD We studied 307 consecutive patients (60.9% male, age 60.1+/-11.0 years) referred for diagnostic coronary angiography. Risk factors for coronary artery disease, lipids and ferritin levels, as well clinical characteristics were recorded from all patients. Two experienced cardiologists blinded for clinical and laboratory data reviewed the cinefilms. Angiographic significant coronary artery disease (CAD) was defined as any more than a 50% diameter stenosis. RESULTS From the 307 patients, 196 (63.8%) were found to have angiographic significant CAD. The presence of significant CAD was associated with ferritin levels (P=0.015) as well as patient age (P<0.001), male sex (P<0.001), smoking (P<0.002), and cholesterol levels (P=0.028). By multivariate analysis, however, ferritin level was not an independent risk factor for CAD (P=0.27), while the association with all the other factors remained significant. CONCLUSION In patients referred for coronary angiography no independent relationship was found between angiographic significant coronary artery disease and serum ferritin levels.

Effect of nitrate withdrawal on quality of life and adherence to treatment in patients with stable angina: evidence from a randomized clinical trial.

BackgroundLong-term nitrate treatment of stable angina is associated with side effects that can interfere with health-related quality of life (HRQoL) and medication adherence. The aim of the present study was to compare HRQoL and adherence to treatment in patients with stable angina undergoing nitrate withdrawal or maintenance. MethodsThis study is a randomized clinical trial. Patients were allocated to an intervention group (nitrate withdrawal followed by introduction of placebo) or a control group (nitrate maintenance). The assessments were made at baseline and 30 and 120 days using the Short Form Health Survey and the Seattle Angina Questionnaire. Treatment adherence was measured on the basis of the Morisky scale and pill count. ResultsA total of 105 patients with stable angina were randomized for replacement of nitrate with placebo (n=51) and for maintenance of treatment with nitrate (n=54). After 4 months, Short Form Health Survey scores increased for bodily pain (P=0.005) and general health (P=0.004) in the nitrate maintenance group. Decreased Seattle Angina Questionnaire scores were also noted for physical limitations (P=0.039) and angina frequency (P=0.011) in the nitrate maintenance group. However, the effect size was small (⩽0.44) when the intervention and control groups were compared. At the end of the study, adherence was significantly higher in the placebo group (P=0.041), but no difference was detected between the groups with the pill count method. ConclusionHRQoL was similar in patients with stable angina using nitrate regularly as compared with patients undergoing nitrate withdrawal. However, adherence to treatment was lower in nitrate users according to the Morisky scale.

Evaluation of strategies of care in the secondary prevention of heart disease: critical appraisal of a cluster randomized trial

Evaluation of: Murphy AW, Cupples ME, Smith SM, Byrne M, Myrne MC, Newell J; for the SPHERE study team: Effect of tailored practice and patients care plans on secondary prevention of heart disease in general practice: cluster randomized controlled trial. BMJ 339, B4220 (2009). Coronary heart disease is the main cause of morbidity/mortality in developed countries and the costs of this epidemic are a major concern and a focus of public health policies. The cornerstone in controlling the incidence of coronary heart disease is the management of risk factors and an evaluation of the best strategy is of the greatest importance. Murphy et al. conducted a cluster randomized trial to evaluate the strategies of tailored practice and patient care plans on secondary prevention of heart disease in general practice. The study found that at 18 months of follow-up, there were no significant differences between intervention and control groups in the proportion of patients above the recommended limits of systolic blood pressure, diastolic blood pressure and total cholesterol concentrations. The number of patients admitted to hospital significantly decreased in the intervention group. Although secondary prevention programs have positive impacts on the process of care, the benefit was clear after a longer period of follow-up in many studies. The practice of preventive cardiology in patients with coronary heart disease is difficult to achieve, particularly when the population already had a lower prevalence of uncontrolled risk factors, as Murphy et al. found in their study. It is possible that the patients included in this and other studies were at a sufficiently low risk that the likelihood of detecting a beneficial effect in a short period of time was small. There is good evidence that healthcare professionals can help patients; nonetheless, they also need guidance and programs to help them. Some questions regarding these multidisciplinary programs also remain to be answered, and their cost-effectiveness remains unclear. The incremental benefit of secondary prevention programs may be very small in the settings in which those trials were performed, but they certainly will be beneficial in settings where usual care is less optimal; these scenarios are often found around the world.

Comparação da aterosclerose coronária em pacientes com infarto do miocárdio e angina do peito

Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.Objetivo - Comparar a gravidade da doenca coronaria e a presenca de fatores de risco cardiovasculares entre pacientes com angina e infarto do miocardio (IM). Metodos - Estudaram-se 62 pacientes com IM e 129 com angina, atraves de cineangiocoronariografia, avaliando-se a oclusao (lesao de 99% ou 100%), a severidade (escore de 0 a 5 de acordo com o numero de vasos afetados) e a extensao (3 grupos com diferentes graus de estenose). Dois observadores experientes interpretaram cegamente os angiogramas. Resultados - Os pacientes com IM tiveram maior oclusao (50% vs 13,2% [p<0,01]), maior severidade (79% vs 54,3% com mais de 90% de estenose [p<0,02]) e maior extensao (2,0 vs 0,87 [p<0,001]), mesmo quando controlados para os fatores de risco coronarios classicos e para o tempo de doenca. O tabagismo foi o unico fator de risco independente correlacionado com IM (P<0,01). Conclusao - Entre os pacientes estudados, a doenca coronaria foi maior no grupo IM, bem como a prevalencia de tabagismo.

Comparative study for the identification of myocardial ischemia by contrast ventriculography under the effect of isosorbide mononitrate and by perfusional myocardial scintigraphy in patients with ischemic heart disease

OBJECTIVE To evaluate and compare the usefulness of cineventriculographies, before and after nitrate use, to technetium-99m sestamibi scintigraphy for the identification of myocardial ischemia. METHODS Twenty-six patients were studied at basal conditions and 5 minutes after intravenous administration of isosorbide mononitrate (0.3 mg/kg), to evaluate the performance and regional wall motion of the left ventricle (LV). The results were compared too those obtained with technetium-99m sestamibi scintigraphy. RESULTS Before nitrate, contrast ventriculography identified 30 normal segments, 62 hypokinetic segments, 28 dyskinetic segments, and 14 akinetic segments. After drug administration, 99 segments were normal, 11 hypokinetic, 11 dyskinetic, and 13 akinetic. Myocardial scintigraphy revealed 110 ischemic segments and 18 fibrotic segments (p < 0.005). After drug administration, the ventriculography showed increase in the velocity of circumferential fiber shortening (p = 0.0142), the ejection fraction (p = 0.0462), decrease in the end-systolic volume (p = 0.0031) and no change in end-diastolic volume. CONCLUSION Contrast ventriculography using nitrate proved to be similar to perfusional myocardial scintigraphy in the identification of myocardial ischemia.