Marco Antonio de Mattos

Age influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery

OBJECTIVE To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients >70 years-old in comparison to patients <70 years-old. METHODS Patients undergoing isolated CABG were selected for the study. The patients were grouped in G1 (age > 70 years-old) and G2 (age <70 years-old). The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, reexploration for bleeding, intra-aortic balloon for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB). RESULTS 1,033 patients were included, 257 (24.8%) in G1 and 776 (75.2%) in G2. Patients in G1 were more likely to have in-hospital mortality than G2 (8.9% vs. 3.6%, respectively; P=0.001), while the incidence of AMI was similar (5.8% vs. 5.5%; P=0.87) than G2. More patients in G1 had re-exploration for bleeding (12.1% vs. 6.1%; P=0.003). G1 had more incidence of respiratory complications (21.4% vs. 9.1%; P<0.001), mediastinitis (5.1% vs. 1.9%; P=0.013), stroke (3.9% vs. 1.3%; P=0.016), acute renal failure (7.8% vs. 1.3%; P<0.001), sepsis (3.9% vs. 1.9%;P=0.003), atrial fibrillation (15.6% vs. 9.8%; P=0.016), and CAVB (3.5% vs. 1.2%; P=0.023) than G2. There was no significant difference in the use of intra-aortic balloon. In the forward stepwise multivariate logistic regression analysis age > 70-year-old was an independent predictive factor for higher in-hospital mortality (P=0.004), reexploration for bleeding (P=0.002), sepsis (P=0.002), respiratory complications (P<0.001), mediastinitis (P=0.016), stroke (P=0.029), acute renal failure (P<0.001), atrial fibrillation (P=0.021) and CAVB (P=0.031). CONCLUSION This study suggests that patients > 70 years-old were at increased risk of death and other complications in the CABGs postoperative period in comparison to younger patients.

Efeito da dieta e do ciclismo indoor sobre a composição corporal e nível sérico lipídico

BACKGROUND Indoor cycling is an aerobic exercise that employs large muscle groups of the lower limbs, lacking osteoarticular impact and high energy expenditure, which makes it interesting to generate a non-pharmacological strategy. OBJECTIVE To assess body composition and lipid profile in overweight women after twelve weeks of low-calorie diet and indoor cycling training. METHODS We randomly assigned 40 women (23.90 ± 3.10 years), divided into four groups: control (C), indoor cycling (CI), indoor cycling combined with low-calorie diet (CD) and low-calorie diet (D). The variables were: height and body mass, BMI, fat percentage, lean body mass, triglycerides, cholesterol and lipoproteins (HDL, LDL, VLDL). The indoor cycling training consisted of three weekly sessions of 45 minutes each and an energy restriction of about 1,200 kcal. The study lasted 12 weeks. We used descriptive statistics (mean and standard deviation) and inferential statistics (Students t test). The level of significance was p < 0.05. RESULTS The groups CI, CD and D significantly reduced the mean anthropometric variables after 12 weeks of intervention (body mass, fat percentage and body mass index), and serum levels of total cholesterol and triglycerides. HDL cholesterol increased significantly for groups CI and CD. CONCLUSION According to the results, the indoor cycling and the low-calorie diet helped fight overweight and control serum lipids.

Uso da radiofrequência bipolar para o tratamento da fibrilação atrial durante cirurgia cardíaca

FUNDAMENTO: O tratamento da fibrilacao atrial com dispositivo de ablacao de tecidos por radiofrequencia bipolar em concomitância a cirurgia cardiaca tem se mostrado metodo eficaz no tratamento desta arritmia. OBJETIVO: Descrever a experiencia inicial do Instituto Nacional de Cardiologia no tratamento cirurgico da fibrilacao atrial com uso de dispositivo de radiofrequencia bipolar em pacientes submetidos a cirurgia cardiaca, relatando o resultado de acompanhamento pos-operatorio de um ano. METODOS: Entre janeiro de 2008 e marco de 2009, 47 pacientes (36 mulheres) consecutivos, com idade media de 53,7 ± 10,6 anos, apresentando fibrilacao atrial por um periodo medio de 34,6 meses (3 a 192 meses) foram submetidos a ablacao cirurgica desta arritmia, por radiofrequencia bipolar, durante o procedimento que motivou a indicacao da cirurgia. Oito apresentavam fibrilacao atrial intermitente e 39, continua. Oitenta e um por cento foram submetidos a cirurgia valvar como procedimento principal. Esta e uma analise retrospectiva, observacional, com avaliacao de um ano de pos-operatorio das variaveis clinicas e de Holter 24 h. RESULTADOS: Dos 47 pacientes, 40 sobreviveram um ano. Desses, 33 foram submetidos a Holter 24 h, em um intervalo medio de 401 dias apos a cirurgia. Encontrou-se a seguinte distribuicao de ritmos: 24 (73%) sinusal, 5 (15%) fibrilacao atrial, tres (9%) Flutter atrial e um (3%) ritmo juncional. Foram observados dois acidentes vasculares encefalicos, sendo um associado a arritmia supraventricular. CONCLUSAO: A ablacao cirurgica de fibrilacao atrial com dispositivo de radiofrequencia bipolar concomitante a cirurgia cardiaca e metodo eficaz para o tratamento desta arritmia.BACKGROUND Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction with cardiac surgery has proven to be an effective method to treat this arrhythmia. OBJECTIVE Describe the initial experience of the Instituto Nacional de Cardiologia in the surgical treatment of atrial fibrillation using bipolar radiofrequency device in patients undergoing cardiac surgery, reporting the results of postoperative follow-up of one year. METHODS Between January 2008 and March 2009, 47 consecutive patients (36 women), with mean age of 53.7 ± 10.6 years, with atrial fibrillation for a mean period of 34.6 months (3-192 months) underwent surgical ablation of this arrhythmia, through bipolar radiofrequency during the procedure which led to the indication of surgery. Eight of them showed intermittent atrial fibrillation and 39, continued. Eighty-one percent underwent valve surgery as the main procedure. This is a one-year postoperative retrospective, observational evaluation of clinical variables and 24-h Holter. RESULTS Out of the 47 patients, 40 survived one year. Out of these, 33 underwent 24 h Holter, at an average interval of 401 days after the surgery. The following rhythm distribution was found: 24 (73.0%) sinus, five (15.0%) atrial fibrillation, three (9.0%) atrial Flutter and one (3.0%) junctional rhythm. Two cerebrovascular accidents were observed, one of which was associated with supraventricular arrhythmia. CONCLUSION Surgical ablation of atrial fibrillation with bipolar radiofrequency device concomitant with cardiac surgery is an effective method for treating this arrhythmia.

Tendência temporal de letalidade hospitalar por infarto agudo do miocárdio: 1994-2003

OBJECTIVE To analyze the temporal tendency of lethality due to acute myocardial infarction (AMI) and if the change in behavior directly interfered in such lethality. METHODS 1055 non-selected patients, who were hospitalized in coronary unit from 1994 to 2003, were assessed. Clinical and therapeutic profile-related variables were analyzed. The statistic analysis used the exponential damping of temporal series and other techniques, such as the logistic linear regression. RESULTS The average lethality was 10.8%, being 12% in 1994 and 7% in 2002 (p=0.000), a relative reduction of 58%. There was no significant variation in the risk profile of the patients. There were 67.4% of men and 32.4% of women, with an average age of 60.93 and 64.84 years old, respectively. It was observed a significant increase in the percentage of cardiac catheterization (from 14% to 51%), in the angioplasty carried out 24 hours after the infarction (from 2% to 33%), in the surgery for myocardial revascularization (from 4% to 7%) and in the primary angioplasty (from 4% to 11%) with p=0.000, p=0.021, p=0.000 and p=0.000, respectively, for linear tendency. In the first 24 hours there was an increase of the use of aspirin and beta-blockers, from 78% to 100% and, from 33% to 76% (p=0.003 and p=0.004, respectively) along the years. After the analysis, the myocardial reperfusion therapy, the use of aspirin and beta-blocker in the first 24 hours of the AMI (p=0.010, p=0.024 and p=0.035, respectively) kept on being lethality determiners. CONCLUSION There was a decrease in lethality and the change of behavior in the treatment of AMI along the years was responsible for the reduction of lethality in that temporal series.

Avaliação da pressão arterial em bombeiros militares filhos de hipertensos através da monitorização ambulatorial da pressão arterial

OBJETIVO: Avaliar a influencia do antecedente familiar de hipertensao arterial sistemica (HASF) sobre o efeito do estresse do trabalho em bombeiros militares comunicantes (BMC), atraves da monitorizacao ambulatorial da pressao arterial (MAPA). METODOS: Estudo prospectivo caso-controle. Foi realizada a MAPA em 66 BMC saudaveis, durante 12 horas de trabalho na central de comunicacoes (CC), sendo 34 filhos de hipertensos (grupo 1) e 32 filhos de normotensos (grupo 2). RESULTADOS: O grupo 1 diferiu do grupo 2, pois apresentou, no trabalho, maiores medias sistolicas (134,1 ± 9,9 mmHg X 120,8 ± 9,9 mmHg p < 0,0001) e diatolicas (83,8 ± 8,3 mmHg X 72,9 ± 8,6 mmHg p < 0,001) e maiores cargas sistolicas (31,4 ± 25,6 % X 9,4 ± 9,4 % p = 0,0001) e diastolicas (28,3 ± 26,6 % X 6,1 ± 8,9 % p = 0,0001). A prevalencia de hipertensao arterial sistemica (HAS) no grupo 1, no trabalho, foi de 32,3 %. Estes individuos, monitorados fora do trabalho, normalizaram a pressao arterial (hipertensos funcionais). O grupo 2 revelou pressao arterial (PA) normal no trabalho. CONCLUSAO: A pressao arterial mais elevada em BMC filhos de hipertensos e explicada de maneira independente pela HASF e aqueles que desenvolveram HAS durante o turno de trabalho na CC, podem ser considerados hipertensos funcionais, enquanto, os BMC filhos de normotensos, submetidos ao estresse psicologico, estao livres de alteracoes na pressao arterial.

Use of bipolar radiofrequency for the treatment of atrial fibrillation during cardiac surgery

FUNDAMENTO: O tratamento da fibrilacao atrial com dispositivo de ablacao de tecidos por radiofrequencia bipolar em concomitância a cirurgia cardiaca tem se mostrado metodo eficaz no tratamento desta arritmia. OBJETIVO: Descrever a experiencia inicial do Instituto Nacional de Cardiologia no tratamento cirurgico da fibrilacao atrial com uso de dispositivo de radiofrequencia bipolar em pacientes submetidos a cirurgia cardiaca, relatando o resultado de acompanhamento pos-operatorio de um ano. METODOS: Entre janeiro de 2008 e marco de 2009, 47 pacientes (36 mulheres) consecutivos, com idade media de 53,7 ± 10,6 anos, apresentando fibrilacao atrial por um periodo medio de 34,6 meses (3 a 192 meses) foram submetidos a ablacao cirurgica desta arritmia, por radiofrequencia bipolar, durante o procedimento que motivou a indicacao da cirurgia. Oito apresentavam fibrilacao atrial intermitente e 39, continua. Oitenta e um por cento foram submetidos a cirurgia valvar como procedimento principal. Esta e uma analise retrospectiva, observacional, com avaliacao de um ano de pos-operatorio das variaveis clinicas e de Holter 24 h. RESULTADOS: Dos 47 pacientes, 40 sobreviveram um ano. Desses, 33 foram submetidos a Holter 24 h, em um intervalo medio de 401 dias apos a cirurgia. Encontrou-se a seguinte distribuicao de ritmos: 24 (73%) sinusal, 5 (15%) fibrilacao atrial, tres (9%) Flutter atrial e um (3%) ritmo juncional. Foram observados dois acidentes vasculares encefalicos, sendo um associado a arritmia supraventricular. CONCLUSAO: A ablacao cirurgica de fibrilacao atrial com dispositivo de radiofrequencia bipolar concomitante a cirurgia cardiaca e metodo eficaz para o tratamento desta arritmia.BACKGROUND Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction with cardiac surgery has proven to be an effective method to treat this arrhythmia. OBJECTIVE Describe the initial experience of the Instituto Nacional de Cardiologia in the surgical treatment of atrial fibrillation using bipolar radiofrequency device in patients undergoing cardiac surgery, reporting the results of postoperative follow-up of one year. METHODS Between January 2008 and March 2009, 47 consecutive patients (36 women), with mean age of 53.7 ± 10.6 years, with atrial fibrillation for a mean period of 34.6 months (3-192 months) underwent surgical ablation of this arrhythmia, through bipolar radiofrequency during the procedure which led to the indication of surgery. Eight of them showed intermittent atrial fibrillation and 39, continued. Eighty-one percent underwent valve surgery as the main procedure. This is a one-year postoperative retrospective, observational evaluation of clinical variables and 24-h Holter. RESULTS Out of the 47 patients, 40 survived one year. Out of these, 33 underwent 24 h Holter, at an average interval of 401 days after the surgery. The following rhythm distribution was found: 24 (73.0%) sinus, five (15.0%) atrial fibrillation, three (9.0%) atrial Flutter and one (3.0%) junctional rhythm. Two cerebrovascular accidents were observed, one of which was associated with supraventricular arrhythmia. CONCLUSION Surgical ablation of atrial fibrillation with bipolar radiofrequency device concomitant with cardiac surgery is an effective method for treating this arrhythmia.

Mortality from coronary artery disease during dengue epidemics

Background: The possibility of increased mortality from coronary artery disease (CAD) during dengue epidemics is frequently taken into account to create extra cardiologic beds. Objective: Describe a possible association between the mortality from CAD and the reported cases of dengue virus infections in the state of Rio de Janeiro. Methods: Two time series were developed. The first series of CAD mortality comprised 313,503 patients between January 1996 and December 2010. The disease codes used were all from I20 to I25 (ICD-10). The second series comprised 275,227 cases of dengue fever reported between January 1994 and December 2010. The Box-Jenkins methodology was employed for modeling the series; and both cross correlation and intervention analysis were used to evaluate such association. Results: The time series of CAD mortality best fits into the model SARIMA (1,1,1) x (1,0,1)365, where annual seasonality is reflected by an increase in the number of cases in winter months. The intervention analysis showed absence of influence of cases of dengue fever in CAD mortality with a correlation coefficient of 0.0018. Conclusions: There is no correlation between CAD mortality and the number of dengue fever cases. CAD mortality is higher in winter.

Uso de la radiofrecuencia bipolar para el tratamiento de la fibrilación atrial durante cirugía cardíaca

FUNDAMENTO: O tratamento da fibrilacao atrial com dispositivo de ablacao de tecidos por radiofrequencia bipolar em concomitância a cirurgia cardiaca tem se mostrado metodo eficaz no tratamento desta arritmia. OBJETIVO: Descrever a experiencia inicial do Instituto Nacional de Cardiologia no tratamento cirurgico da fibrilacao atrial com uso de dispositivo de radiofrequencia bipolar em pacientes submetidos a cirurgia cardiaca, relatando o resultado de acompanhamento pos-operatorio de um ano. METODOS: Entre janeiro de 2008 e marco de 2009, 47 pacientes (36 mulheres) consecutivos, com idade media de 53,7 ± 10,6 anos, apresentando fibrilacao atrial por um periodo medio de 34,6 meses (3 a 192 meses) foram submetidos a ablacao cirurgica desta arritmia, por radiofrequencia bipolar, durante o procedimento que motivou a indicacao da cirurgia. Oito apresentavam fibrilacao atrial intermitente e 39, continua. Oitenta e um por cento foram submetidos a cirurgia valvar como procedimento principal. Esta e uma analise retrospectiva, observacional, com avaliacao de um ano de pos-operatorio das variaveis clinicas e de Holter 24 h. RESULTADOS: Dos 47 pacientes, 40 sobreviveram um ano. Desses, 33 foram submetidos a Holter 24 h, em um intervalo medio de 401 dias apos a cirurgia. Encontrou-se a seguinte distribuicao de ritmos: 24 (73%) sinusal, 5 (15%) fibrilacao atrial, tres (9%) Flutter atrial e um (3%) ritmo juncional. Foram observados dois acidentes vasculares encefalicos, sendo um associado a arritmia supraventricular. CONCLUSAO: A ablacao cirurgica de fibrilacao atrial com dispositivo de radiofrequencia bipolar concomitante a cirurgia cardiaca e metodo eficaz para o tratamento desta arritmia.BACKGROUND Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction with cardiac surgery has proven to be an effective method to treat this arrhythmia. OBJECTIVE Describe the initial experience of the Instituto Nacional de Cardiologia in the surgical treatment of atrial fibrillation using bipolar radiofrequency device in patients undergoing cardiac surgery, reporting the results of postoperative follow-up of one year. METHODS Between January 2008 and March 2009, 47 consecutive patients (36 women), with mean age of 53.7 ± 10.6 years, with atrial fibrillation for a mean period of 34.6 months (3-192 months) underwent surgical ablation of this arrhythmia, through bipolar radiofrequency during the procedure which led to the indication of surgery. Eight of them showed intermittent atrial fibrillation and 39, continued. Eighty-one percent underwent valve surgery as the main procedure. This is a one-year postoperative retrospective, observational evaluation of clinical variables and 24-h Holter. RESULTS Out of the 47 patients, 40 survived one year. Out of these, 33 underwent 24 h Holter, at an average interval of 401 days after the surgery. The following rhythm distribution was found: 24 (73.0%) sinus, five (15.0%) atrial fibrillation, three (9.0%) atrial Flutter and one (3.0%) junctional rhythm. Two cerebrovascular accidents were observed, one of which was associated with supraventricular arrhythmia. CONCLUSION Surgical ablation of atrial fibrillation with bipolar radiofrequency device concomitant with cardiac surgery is an effective method for treating this arrhythmia.