Luiz Felipe P. Moreira

The archives and the publication of its first impact factor

Mailing address: Luiz Felipe P. Moreira • Av. Dr. Enéas Carvalho Aguiar, 44 2o andar, Bloco 2, Sala 13 Cerqueira César 05403-000 São Paulo, SP Brazil E-mail: lfelipe@cardiol.br The Arquivos Brasileiros de Cardiologia (Brazilian Archives of Cardiology) have been, for more than 60 years, one of the main means of dissemination of scientific research in the area of cardiovascular diseases in our country. Included in all main international databases and published in three language providing free access to its entire content through the Scientific Electronic Library Online (Scielo), the journal currently offers wide distribution and visibility to the scientific articles that it publishes.Correspondencia: Luiz Felipe P. Moreira • Av. Dr. Eneas Carvalho Aguiar, 44 2o andar, Bloco 2, Sala 13 Cerqueira Cesar 05403-000 Sao Paulo, SP Brasil Email: lfelipe@cardiol.br Los Arquivos Brasileiros de Cardiologia han sido a lo largo de mas de 60 anos uno de los principales medios de divulgacion de las investigaciones cientificas en el area de las enfermedades cardiovasculares en nuestro Pais. Figurando en todas las principales bases de datos internacionales y siendo vehiculado en tres idiomas con acceso libre a su contenido integral a traves de la plataforma Scielo (Scientific Electronic Library Online), el periodico proporciona actualmente amplia divulgacion y visibilidad a los articulos cientificos publicados. Con la reciente divulgacion de su primer Factor de Impacto por el Journal of Citation Report de la Thompson Reuters, responsable por la Base de Datos del Institute for Scientific Information (ISI), obtuvimos la confirmacion del grado de relevancia cientifica y del alcance de las investigaciones brasilenas y de centros extranjeros publicadas en nuestra revista. El Factor de Impacto de 1,316 fue calculado en relacion a los dos primeros anos de indexacion, teniendo en cuenta el numero de articulos publicados y el numero de veces que estos articulos fueron citados en el ano 2009. La puntuacion obtenida coloca a los Arquivos al frente o en el mismo nivel de mas de 40% de los 95 periodicos internacionales indexados en la Base de Datos ISI en el area de Cardiologia. Nuestra revista se destaca tambien en relacion a las principales revistas publicadas por sociedades nacionales de Cardiologia en el hemisferio norte y como el unico periodico publicado en America Latina y en el hemisferio sur con un impacto relevante en esta area de actuacion. La divulgacion del Factor de Impacto de los Arquivos Brasileiros de Cardiologia representa, sin duda, un gran incentivo para los investigadores brasilenos y latinoamericanos, que pueden contar con un periodico regional de gran visibilidad para la publicacion de sus investigaciones. El nivel alcanzado por este parametro bibliometrico abre tambien nuevas perspectivas para la mejor calificacion de los Programas de Post Grado brasilenos con lineas de investigacion en el campo de la Cardiologia, frente a las agencias gubernamentales, pasando a ser considerado por la Coordinacion de Perfeccionamiento de Personal de Nivel Superior (Capes) del Ministerio de Educacion como un periodico Qualis B1 o B2, de acuerdo con el Area de Evaluacion considerada.

Multicenter trial of dynamic cardiomyoplasty for chronic heart failure

OBJECTIVES The purpose of this study was to prospectively assess the effect of dynamic cardiomyoplasty in patients with symptomatic chronic heart failure. BACKGROUND Since the first procedure was performed in 1985, dynamic cardiomyoplasty has been developed for use in patients with chronic heart failure. The aging population in developed countries has made heart failure a growing public health concern. Heart transplantation is appropriate or available for only a small proportion of these patients because of limited donor supply. Effective alternatives to transplantation are needed. METHODS Eight centers in North and South America performed 68 cardiomyoplasty procedures between May 1991 and September 1993. Data were prospectively collected every 6 months and compared with preoperative values using paired t tests, chi-square tests and actuarial survival analyses. RESULTS Patients had a mean (+/- SD) age of 57 +/- 1 years and were predominantly male (53 [78%] of 68). Heart failure etiology was classified as idiopathic in 47 (69%) of 68 patients and ischemic in 21 (31%). The in-hospital mortality rate was 12% (8 of 68), and the survival rate at 6 and 12 months was 75 +/- 5% and 68 +/- 6%, respectively. Objective improvements were seen at 6 months (n = 49) in left ventricular ejection fraction (23 +/- 1% vs. 25 +/- 1%, p = 0.05), stroke volume (50 +/- 2 vs. 56 +/- 3 ml/beat, p = 0.02) and left ventricular stroke work index (26 +/- 1 vs 30 +/- 2 g/m2 per beat, p = 0.01). Improvements in mean New York Heart Association functional class (3 +/- 0.04 vs. 1.8 +/- 0.1, p = 0.0001) and activity of daily living score (59 +/- 3 vs. 80 +/- 2, p = 0.0001) were also observed. There were no significant changes at 6 months in peak oxygen consumption (15 +/- 1 vs. 16 +/- 1 ml/kg per min), cardiac index (2.26 +/- 0.08 vs. 2.33 +/- 0.08 liters/min per m2), pulmonary capillary wedge pressure (19 +/- 2 vs. 18 +/- 1 mm Hg) or heart rate (87 +/- 2 vs. 82 +/- 3 beats/min). CONCLUSIONS These data suggest that dynamic cardiomyoplasty improves ventricular systolic function, reduces symptoms of heart failure and improves objective measures of quality of life in patients with congestive heart failure. This improvement occurred without changes in peak exercise capacity, ventricular filling pressure or actuarial survival.

Partial left ventriculectomy with mitral valve preservation in the treatment of patients with dilated cardiomyopathy.

OBJECTIVE This study reports initial results of partial left ventriculectomy performed with preservation of the mitral valve in the treatment of 27 patients with idiopathic dilated cardiomyopathy. METHODS Patients were in New York Heart Association class III or IV. Partial ventriculectomy was performed as an isolated procedure in four patients and associated with mitral annuloplasty in 23 patients. There were four hospital deaths (14.8%) and the remaining patients were followed for 11.2 +/- 6 months. RESULTS Decrease of left ventricular diastolic diameter (81.8 +/- 8.7 to 68.5 +/- 7.6 mm, p < 0.001) and improvement of left ventricular wall shortening (12% +/- 3.1% to 18.1% +/- 3.9%, p < 0.001) were demonstrated by echocardiography after the operation. Left ventricular radioisotopic angiography showed reduction of diastolic volume (495 +/- 124 ml to 352 +/- 108 ml, p < 0.001) and increase of ejection fraction (17.7% +/- 4.6% to 23.7% +/- 8.8%, p < 0.001). Right-sided heart catheterization demonstrated improvement of stroke index (24.3 +/- 7.7 ml/m2 to 28.3 +/- 7.6 ml/m2, p < 0.01) and decrease of pulmonary wedge pressure (23.2 +/- 8.8 mm Hg to 17 +/- 7 mm Hg, p < 0.01). Similar results were documented at 6 and 12 months of follow-up. Functional class improved from 3.6 +/- 0.5 to 1.4 +/- 0.6 (p < 0.001). However, seven patients died at midterm follow-up because of heart failure progression or arrhythmia-related events, and survival rate was 59.2% +/- 9.4% from 6 to 24 months of follow-up. CONCLUSIONS Partial left ventriculectomy performed with preservation of the mitral valve improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy. Nevertheless, the high incidences of heart failure progression and arrhythmia-related deaths observed after this procedure preclude its wide clinical application.

Clinical and left ventricular function outcomes up to five years after dynamic cardiomyoplasty.

Improvement in congestive heart failure and left ventricular function after dynamic cardiomyoplasty has been reported in patients with severe cardiomyopathies, but the long-term effects of this procedure remain unclear. In this investigation 31 patients undergoing cardiomyoplasty for treatment of idiopathic dilated cardiomyopathy were annually investigated with radionuclide scintigraphy, Doppler echocardiography, and right-sided heart catheterization. They were in New York Heart Association functional class III or IV before the operation. No hospital deaths occurred, but one patient with progressive heart failure required urgent heart transplantation 42 days after cardiomyoplasty. The other patients were followed up from 6 to 70 months (mean 25.6 months) and 12 patients died at late follow-up. Actuarial survivals were 86% at 1 year, 61.4% at 2 years, and 42.5% at 3 to 5 years of follow-up. Multivariate analysis of factors influencing outcome showed that long-term survival was significantly affected by preoperative functional class and pulmonary vascular resistance. Functional class improved from 3.2 +/- 0.4 to 1.7 +/- 0.7 in the surviving patients (p < 0.01). Furthermore, left ventricular ejection fraction improved from 19.8% +/- 3% to 23.9% +/- 7.2% (p < 0.01), and significant changes in stroke index, arterial pressure, pulmonary wedge pressure, and left ventricular stroke work index were also found at 6 months of follow-up. In the late postoperative period, the left ventricular ejection fraction tended to decrease and returned to preoperative levels at 5 years, whereas hemodynamic variables did not change significantly. Thus, despite the tendency of the left ventricular ejection fraction to decrease at late follow-up, the long-term course of these patients seems to be characterized by the maintenance of hemodynamic improvement. However, long-term survival after cardiomyoplasty is limited by the severity of the patients condition before the operation.

Determinants of midterm outcome of partial left ventriculectomy in dilated cardiomyopathy

BACKGROUND Partial left ventriculectomy has been proposed for treatment of severe cardiomyopathies. This study reports midterm results of this procedure in 37 patients with dilated cardiomyopathy. METHODS All patients were in New York Heart Association class III (16) or IV (21). Partial ventriculectomy was associated with mitral annuloplasty in 27 patients and with mitral replacement in 2. RESULTS There were seven operative deaths (18.9%). During a mean follow-up of 18.2+/-9.3 months, 9 more patients died. Actuarial survival was 56.7%+/-8.1% at 6 and 24 months. Analysis of factors influencing outcome showed that midterm survival was significantly affected only by myocardial cell diameter. Otherwise, functional class improved from 3.5+/-0.5 to 1.8+/-0.9 in the survivors (p < 0.001). Furthermore, left ventricular diastolic volume decreased from 523+/-207 to 380+/-148 mL (p < 0.001), and left ventricular ejection fraction increased from 17.1%+/-4.6% to 23%+/-8% (p < 0.001), whereas significant changes in cardiac index, stroke index, and pulmonary pressures were found at 1 month of follow-up. Although left ventricular diastolic volume tended to increase in the late postoperative period, left ventricular ejection fraction and hemodynamic variables did not change significantly. CONCLUSIONS Partial ventriculectomy improves left ventricular function and congestive heart failure in patients with dilated cardiomyopathy for up to 24 months of follow-up. Nevertheless, this procedures clinical application is limited by the high mortality observed in the first postoperative months. Otherwise, new perspectives may be advised by the identification that partial ventriculectomy results seem to be influenced by compromised myocardial cells.

Long-term outcome, survival analysis, and risk stratification of dynamic cardiomyoplasty

METHODS To analyze the long-term outcome of dynamic cardiomyoplasty, we retrospectively studied 127 consecutive patients who underwent this procedure in Paris, France (n = 76), São Paulo, Brazil (n = 37), and Portland, Oregon (n = 14). Preoperative data were collected for patients operated on between January 1985 and June 1994 and examined with respect to effect on long-term survival. Patients had a mean age of 50 +/- 13 years and were predominantly male (82%). In 46% the cause of disease was ischemic. Concomitant operations were performed in 22 patients. RESULTS Operative mortality was 12% (15/127). Kaplan-Meier survival +/- standard error at 1 through 5 years was 73% +/- 4%, 57% +/- 5%, 49% +/- 6%, 44% +/- 6%, and 40% +/- 7%, respectively. There was a distinct improvement at 6 months in New York Heart Association functional class (3.2 +/- 0.05 vs 1.7 +/- 0.07, p < 0.0001) and a small but significant increase in left ventricular ejection fraction (20% +/- 0.8% vs 23% +/- 1.5%, p = 0.04). Ninety-day mortality was associated with low right ventricular ejection fraction, a blunted hemodynamic response to exercise testing, and requirement for an intraaortic balloon pump at the time of the operation. Using a stepwise Cox regression method of multivariable survival analysis (n = 101), we determined that atrial fibrillation, New York Heart Association class IV, high pulmonary capillary wedge pressure, and balloon pump use were independent variables simultaneously associated with poor overall survival. When metabolic testing variables were added to this model, peak oxygen consumption eliminated both pulmonary capillary wedge pressure and functional class from the model, albeit with fewer (n = 74) patients. CONCLUSION Dynamic cardiomyoplasty is an evolving therapy for symptomatic congestive heart failure, the results of which may be enhanced by intelligent, risk-sensitive patient selection.

Current expectations in dynamic cardiomyoplasty

Dynamic cardiomyoplasty has been evaluated in the treatment of severe cardiomyopathies. This report outlines the results of this procedure in 21 patients with dilated or ischemic cardiomyopathy who were in New York Heart Association class III or IV before operation. There were no operative deaths. Patients were followed up for a mean of 17.6 months. Eight patients died during late follow-up, and actuarial survival rates were 73.2% at 1 year and 65.9% at 2 years of follow-up. Functional class improvement was documented in the surviving patients. Furthermore, significant improvement in left ventricular function was demonstrated by radioisotopic angiography and by heart catheterization for more than 2 years after the operation. These studies documented that left ventricular ejection fraction increased as a result of global improvement in regional wall motion. Absence of clinical and hemodynamic improvement after cardiomyoplasty seems to be related to muscle flap ischemic compromise, whereas the patients condition before operation seems to influence the long-term outcome of cardiomyoplasty.

Mychophenolate Mofetil Increased Chagas Disease Reactivation in Heart Transplanted Patients: Comparison Between Two Different Protocols

Heart transplantation (HT) remains the treatment of choice for advanced chagasic cardiomyopathy. New immunosuppression protocols have provided better control of rejection (RJ) and cardiac allograft vasculopathy. However, their influence on infection and Chagas disease reactivation (CDR) is not well established. The aim of this study was to compare the CDR rate in patients under two different immunosuppression protocols. We studied 39 chagasic patients who had undergone orthotopic HT between April, 1987 and June, 2004. They were divided into two groups, one taking azathioprine (group 1 = 24 patients) and the other taking mycophenolate mofetil (group 2 = 15 patients), in the standard doses (2 mg/kg/day and 2 g/day, respectively), beside prednisone and cyclosporine, in equivalent doses. The number of CDR and RJ episodes were analyzed in the first and second years after HT. CDR rates were 8%± 5% at 1 year and 12%± 6% at 2 years of follow‐up in group 1. Otherwise, patients in group 2 presented CDR rates of 75%± 10% and 81%± 9% at the same periods, respectively (p < 0.0001, hazard ratio = 6.06). When comparing RJ rates in the first year after HT, both groups had similar behavior under both immunosuppression protocols (p = 0.88). These data show that current prescribed doses of mycophenolate mofetil increase the early risk of CDR without changing RJ incidence in this period.

Conventional Versus Biventricular Pacing in Heart Failure and Bradyarrhythmia: The COMBAT Study

BACKGROUND Worsening in clinical and cardiac status has been noted after chronic right ventricular pacing, but it is uncertain whether atriobiventricular (BiVP) is preferable to atrio-right ventricular pacing (RVP). Conventional versus Multisite Pacing for BradyArrhythmia Therapy study (COMBAT) sought to compare BiVP versus RVP in patients with symptomatic heart failure (HF) and atrioventricular (AV) block. METHODS AND RESULTS COMBAT is a prospective multicenter randomized double blind crossover study. Patients with New York Heart Association functional class (FC) II-IV, left ventricular ejection fraction (LVEF) <40%, and AV block as an indication for pacing were enrolled. All patients underwent biventricular system implantation and then were randomized to receive successively (group A) RVP-BiVP-RVP, or (group B) BiVP-RVP-BiVP. At the end of each 3-month crossover period, patients were evaluated according to Quality of Life (QoL), FC, echocardiographic parameters, 6-Minute Walk Test (6MWT), and peak oxygen consumption (VO(2 max)). Sixty patients were enrolled, and the mean follow-up period was 17.5 +/- 10.7 months. There were significant improvements in QoL, FC, LVEF, and left ventricular end-systolic volume with BiVP compared with RVP. The effects of pacing mode on 6MWT and VO(2 max) were not significantly different. Death occurred more frequently with RVP. CONCLUSION In patients with systolic HF and AV block requiring permanent ventricular pacing, BiVP is superior to RVP and should be considered the preferred pacing mode.

Conflict of interest policies and disclosure requirements among European Society of Cardiology National Cardiovascular Journals

Disclosure of potential conflicts of interest (COIs) is used by biomedical journals to guarantee credibility and transparency of the scientific process. Conflict of interest disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into the current COI policies and practices among European Society of Cardiology National Cardiovascular Journals, as derived from a cross-sectional survey using a standardized questionnaire, are discussed.