Moacir Fernandes de Godoy

Sensitivity, specificity and predictive values of linear and nonlinear indices of heart rate variability in stable angina patients

Background Decreased heart rate variability (HRV) is related to higher morbidity and mortality. In this study we evaluated the linear and nonlinear indices of the HRV in stable angina patients submitted to coronary angiography. Methods We studied 77 unselected patients for elective coronary angiography, which were divided into two groups: coronary artery disease (CAD) and non-CAD groups. For analysis of HRV indices, HRV was recorded beat by beat with the volunteers in the supine position for 40 minutes. We analyzed the linear indices in the time (SDNN [standard deviation of normal to normal], NN50 [total number of adjacent RR intervals with a difference of duration greater than 50ms] and RMSSD [root-mean square of differences]) and frequency domains ultra-low frequency (ULF) ≤ 0,003 Hz, very low frequency (VLF) 0,003 – 0,04 Hz, low frequency (LF) (0.04–0.15 Hz), and high frequency (HF) (0.15–0.40 Hz) as well as the ratio between LF and HF components (LF/HF). In relation to the nonlinear indices we evaluated SD1, SD2, SD1/SD2, approximate entropy (−ApEn), α1, α2, Lyapunov Exponent, Hurst Exponent, autocorrelation and dimension correlation. The definition of the cutoff point of the variables for predictive tests was obtained by the Receiver Operating Characteristic curve (ROC). The area under the ROC curve was calculated by the extended trapezoidal rule, assuming as relevant areas under the curve ≥ 0.650. Results Coronary arterial disease patients presented reduced values of SDNN, RMSSD, NN50, HF, SD1, SD2 and -ApEn. HF ≤ 66 ms2, RMSSD ≤ 23.9 ms, ApEn ≤−0.296 and NN50 ≤ 16 presented the best discriminatory power for the presence of significant coronary obstruction. Conclusion We suggest the use of Heart Rate Variability Analysis in linear and nonlinear domains, for prognostic purposes in patients with stable angina pectoris, in view of their overall impairment.

A ecocardiografia com contraste no diagnóstico de dilatações vasculares intrapulmonares em candidatos ao transplante hepático

OBJECTIVEnTo determine the importance of contrast echocardiography in the diagnosis of intrapulmonary vascular dilations (PVD) in patients with severe hepatic diseases, eligible for transplantation.nnnMETHODSnTransthoracic echocardiography (TTE) with second harmonic imaging was performed in 76 patients, among them 32 patients were consecutively undergone to a transesophageal study (ETE). Echocardiographic contrast was obtained from microbubbles derived from the injection of agitated saline solution, in venous peripheral access. Abnormal presence of contrast in the left cardiac chambers was considered positive, with a delay of 4 to 6 cardiac cycles, after initial opacification of the right cardiac chambers.nnnRESULTSnPVD diagnosis was performed in 53.9% of the patients (41/76). Sensibility, specificity, positive predictive value, negative predictive value, and accuracy of the TTE in relation to the ETE was 75%, 100%, 100%, 80% and 87.5%, respectively. Echocardiography was positive in 37 (55.2%) of 67 nonhypoxemic patients, and in 4 (44.4%) hypoxemic ones. No cardiologic hemodynamic repercussions from intrapulmonary shunt were observed.nnnCONCLUSIONnThe contrast echocardiography is efficient, easy to be used, and safe in the search for and identification of intrapulmonary vascular alterations in patients eligible for hepatic transplantation.OBJECTIVE: To determine the importance of contrast echocardiography in the diagnosis of intrapulmonary vascular dilations (PVD) in patients with severe hepatic diseases, eligible for transplantation. METHODS: Transthoracic ecocardiography (TTE) with second harmonic imaging was performed in 76 patients, among them 32 patients were consecutively undergone to a transesophageal study (ETE). Echocardiographic contrast was obtained from microbubbles derived from the injection of agitated saline solution, in venous peripheral access. Abnormal presence of contrast in the left cardiac chambers was considered positive, with a delay of 4 to 6 cardiac cycles , after initial opacicification of the right cardiac chambers. RESULTS: PVD diagnosis was performed in 53.9% of the patients (41/76). Sensibility, specificity, positive predictive value, negative predictive value, and accuracy of the TTE in relation to the ETE was 75%, 100%, 100%, 80% e 87.5%, respectively. Echocardiography was positive in 37 (55.2%) of 67 nonhypoxemic patients, and in 4 (44.4%) hypoxemic ones. No cardiologic hemodynamic repercussions from intrapulmonar shunt were observed. CONCLUSION: The contrast echocardiography is efficient, easy to be used, and safe in the search for and identification of intrapulmonary vascular alterations in patients eligible for hepatic transplantation

CCR5 chemokine receptor gene variants in chronic Chagas' disease

a Laboratorio de Imunogenetica, Departamento de Biologia Molecular, Faculdade de Medicina de Sao Jose do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 Sao Jose do Rio Preto, SP, Brazil b Departamento de Cardiologia e Cirurgia Cardiovascular, Faculdade de Medicina de Sao Jose do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 Sao Jose do Rio Preto, SP, Brazil c Centro de Investigacao de Microrganismos, Departamento de Doencas Dermatologicas, Infecciosas e Parasitarias, Faculdade de Medicina de Sao Jose do Rio Preto, Avenida Brigadeiro Faria Lima, 5416, 15090-000 Sao Jose do Rio Preto, SP, Brazil d Departamento de Cardiologia e Cirurgia Cardiovascular, Hospital de Base da Fundacao Faculdade Regional de Medicina, Sao Jose do Rio Preto, SP, Brazil

Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária

Objective: To describe the adverse effects that occur during and after percutaneous transluminal coronary angioplasty (PTCA) possibly related to the reuse of medical equipment. An additional objective is to quantify and identify the reasons of discard in respect to the brand-new and reuse of medical equipment. Method: Sixty patients were studied (48.3% with unstable angina, 45% with acute myocardial infarction and 6.7% with other diagnoses). During the procedure and stay in the Intensive Coronary Unit, the occurrence of fever, hypotension or hypertension, chills, sudoresis, bleeding, nausea and vomits were observed. Seven products were evaluated: catheter introducer, catheter guides (0.35 and 0.014), catheter balloons for angioplasty, indeflator inflation device and manifolds. In total, 76 brand-new and 410 reused apparatuses were studied to verify the occurrence of discard, whether this happened before or during the procedure and for what reason. P-values = 0.05 were considered significant. Results: Twenty-six patients presented adverse effects. Hypotension was the most common seen in 11 (18.3%) cases. There was no significant association between this adverse effect and reuse or not of the equipment. Three brand-new products and 55 of the reused products were discarded as they were incomplete. Conclusion: The adverse effects presented by patients submitted to coronary vessel angioplasty were not associated to the reuse of medical equipment. The integrity and functionality were the main reasons of discard.

Contrast Echocardiography in the Diagnosis of Intrapulmonary Vascular Dilations in Candidates for Liver Transplantation

OBJECTIVEnTo determine the importance of contrast echocardiography in the diagnosis of intrapulmonary vascular dilations in patients with severe liver disease, who are candidates for liver transplantation.nnnMETHODSnThe study comprised 76 patients with chronic liver disease and no evidence of intrinsic pulmonary disease, heart failure, or congenital heart disease with intracardiac communications, who underwent transthoracic echocardiography with second harmonic imaging. Thirty-two of them underwent consecutive transesophageal study. The result of contrast echocardiography was considered positive when the presence of contrast was detected in the left cardiac chambers with a delay of 4 to 6 cardiac cycles after initial opacification of the right cardiac chambers.nnnRESULTSnThe prevalence of intrapulmonary vascular dilations was 53.9% (41/76 patients). The sensitivity, specificity, positive and negative predictive values, and accuracy of transthoracic echocardiography as compared with those of transesophageal echocardiography for confirming pulmonary vascular abnormalities in patients with liver disease were, respectively, 75%, 100%, 100%, 80%, and 87.5%. The degree of arterial oxygenation showed no correlation with the occurrence of a positive echocardiographic study. Arterial hypoxemia (PaO2 < 70 mm Hg) was observed in 9 (15.9%) of the 76 patients. The echocardiographic study was positive in 37 (55.2%) of the 67 nonhypoxemic patients and in 4 (44.4%) of the 9 hypoxemic ones.nnnCONCLUSIONnContrast echocardiography proved to be effective, easy, and safe to use in candidates for liver transplantation. Transthoracic echocardiography may be used in the diagnostic routine of intrapulmonary vascular dilations, the transesophageal study being reserved for inconclusive cases with clinical suspicion.

Late Diagnosis of Anomalous Aortic Origin of a Coronary Artery from the Inappropriate Sinus of Valsalva during Investigation of Chest Pain

In this work are reported two cases of anomalous aortic origin of a coronary artery (AAOCA), with the left main coronary artery (LMCA) arising at the right sinus of Valsalva in a 77-year-old woman and in a 79-year-old man submitted to angiography after positive ischemic tests. The origin of the LMCA or the left descendant artery (LDA) from the right sinus of Valsalva has a prevalence of 0.2%, the origin of the circumflex artery (CXA) from the right sinus 0.5%, and the origin of the right coronary artery (RCA) from the left sinus of Valsalva has a prevalence of 0.3%. It is the subgroup of the coronary anomalies that has the greatest potential for clinical repercussions, especially the sudden cardiac death (SCD). We discuss the diagnostic methods and treatment options for this kind of coronary anomaly in symptomatic cases.

Bloqueio atrioventricular avançando no hiperparatireoidismo: uma complicação rara e irreversível

1. Membro titular da Sociedade Brasileira de Cardiologia, médico residente em Hemodinâmica e Cardiologia Invasiva pela Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto, SP, Brasil. 2. Livre-docente em Cirurgia Cardiovascular, professor adjunto do Departamento de Cardiologia e Cirurgia Cardiovascular da FAMERP, São José do Rio Preto, SP, Brasil. 3. Médico cardiologista, residente em Ecocardiografia pela FAMERP, São José do Rio Preto, SP, Brasil. 4. Membro titular da Sociedade Brasileira de Cardiologia, residente em Ecocardiografia pela FAMERP, São José do Rio Preto, SP, Brasil. 5. Doutor em Ciências da Saúde, professor assistente da FAMERP, São José do Rio Preto, SP, Brasil. Correspondência: Júlio César Queiroz de França Avenida Brigadeiro Faria Lima, 5.416 – Vila São Pedro São José do Rio Preto, SP, Brasil – CEP 15090-000 E-mail: jucequdefr@hotmail.com Artigo submetido em 5/2017. Artigo publicado em 12/2017. RESUMO Hiperparatireoidismo associado a hipercalcemia causando bradicardia significativa é uma combinação rara. Relatamos o caso de uma paciente de 62 anos de idade em pré-operatório de paratireoidectomia total decorrente de hiperparatireoidismo primário sintomático, que evoluiu com bloqueio atrioventricular avançado percebido durante a internação. A paciente necessitou de implante de marcapasso definitivo, pois permaneceu com bloqueio cardíaco avançado mesmo após correção da hipercalcemia. DESCRITORES: Bradicardia; Hipercalcemia; Hiperparatireoidismo. ABSTRACT The combination of hyperparathyroidism and hypercalcemia leading to significant bradycardia is rare. Here we report the case of a 62-year -old female patient in the preoperatory of a total parathyroidectomy due to symptomatic primary hyperparathyroidism, which evolved with an advanced atrioventricular block during hospitalization. The patient required a definitive pacemaker implantation, since the advanced heart block persisted after the correction of hypercalcemia.

Endocarditis Caused by Enterococcus Leading to Spondylodiscitis: Case Report and Literature Review

Spondylodiscitis (SD) is rarely observed as a complication of infective endocarditis (IE) and the frequency of this association may range from 0.6 to 2.2%. IE patients were screened for SD and 15% were diagnosed with such spinal impairment, according to the literature.1 The symptoms of SD associated with endocarditis can be as mild as back pain and myalgia or as severe as septic arthritis. The most feared complication of SD is disability due to residual neurological injury or severe pain that can occur in up to one third of the cases. Differential diagnosis with chronic rheumatic diseases is often difficult.1,2