Rodrigo Citton Padilha Reis

Spatial repolarization heterogeneity and survival in Chagas disease

OBJECTIVES We investigated if cardiac spatial repolarization heterogeneity might be associated with an increased risk of death in patients with chronic Chagas disease. METHODS Repolarization heterogeneity was assessed using the V-index, a recently introduced metric founded on a biophysical model of the ECG. This metric provides an estimate of the standard deviation of the repolarization times across the heart. We analyzed 113 patients (aged 21- 67 years) enrolled between 1998 and 1999 who had a known serological status showing positive reactions to Trypanosoma cruzi. Fourteen subjects died during a 10-year follow-up period. RESULTS The V-index was significantly lower in survivor (S) than in non-survivor (NS) subjects (S: 31.2 ± 13.3 ms vs NS: 41.2 ± 18.6 ms, single-tail t-test: p = 0.009, single-tail Wilcoxon rank sum test: p = 0.029). A V-index larger than 36.3 ms was related to a significantly higher risk of death in a univariate Cox proportional-hazards analysis (hazard ratio, HR = 5.34, p = 0.0046). In addition, V-index > 36.3 ms retained its prognostic value in a multivariate Cox proportional-hazards analysis after adjustment for other three clinical variables (left ventricular ejection factor < 0.50, QRS duration > 133 ms, ventricular tachycardia during stress testing or 24 hours Holter) and for T-wave amplitude variability > 30 μV, even using shrinkage, a statistical procedure that protects against over-fitting due to small sample size. CONCLUSIONS The study showed that an increased dispersion of repolarization times in patients with Chagas disease, as measured by the V-index, is significantly correlated with the risk of death in a univariate survival analysis. The V-index captures prognostic information not immediately available from the analysis of other established risk factors.

Inconsistency of Association between Coffee Consumption and Cognitive Function in Adults and Elderly in a Cross-Sectional Study (ELSA-Brasil)

Background: Coffee is one of the most consumed beverages worldwide and the effect on cognition appears to be task specific and vary by age. Method: In cohort of 14,563 public service workers (35–74 years old) we assessed coffee consumption habits and examined cognitive function using standardized neuropsychological test battery. By linear regression and generalize linear regression with logarithmic link and gamma distribution we investigated the relation of coffee consumption (never/almost never, ≤1 cup/day, 2–3 cups/day, ≥3 cups/day) in the last 12 months to performance on specific domains of cognition for adults and elderly separately. Results: Among elderly, after adjustments, coffee consumption was associated only with an increase in the mean words remembered on learning, recall, and word recognition tests when comparing the 2–3 cups/day to never/almost never category (arithmetic mean ratio (AMR): 1.03; 95% Confidence Interval (CI): 1.00 to 1.07), and to an increase in the mean words pronounced in semantic verbal fluency test when comparing the ≥3 cups/day to never/almost never category (difference of the mean: 1.23; 95% CI: 0.16 to 2.29). However, coffee consumption was not associated with any cognitive function tests in adults and also was not associated with the phonemic verbal fluency test and trail-making test B in elderly. Conclusions: Results suggest that coffee consumption might be slightly beneficial to memory in elderly but lacks a dose response relationship. Longitudinal analyses are needed to investigate possible, even if subtle, positive effects of coffee drinking on specific cognitive domains in elderly.

Effect of pacing-induced ventricular dyssynchrony on right ventricular function.

Background: Asynchronous electrical activation induced by right ventricular (RV) pacing can cause several abnormalities in left ventricular (LV) function. However, the effect of ventricular pacing on RV function has not been well established. We evaluated RV function in patients undergoing long‐term RV pacing.

Life course socioeconomic adversities and 10-year risk of cardiovascular disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health

ObjectivesTo investigate whether life course exposure to adverse socioeconomic positions (SEP) as well as maintaining a low SEP or decreasing the SEP intra- and intergeneration was associated with an increased 10-year cardiovascular disease (CVD) risk predicted by the Framingham Risk Score.MethodsThis is a cross-sectional analysis of baseline data (2008–2010) of 13,544 active workers from ELSA-Brasil cohort. Maternal education, leg length, social class of first occupation and education were used to evaluate childhood, youth and adulthood SEP.ResultsAfter considering adulthood SEP, exposure to early-life low SEP remained associated with an increased 10-year CVD risk. The 10-year CVD risk also rose as the number of exposures to low SEP throughout life increased. Compared to individuals in high-stable intragenerational trajectory, those in upward, downward, or stable low trajectory presented higher 10-year CVD risk. Increasing individuals’ SEP over generation showed no increased risk of 10-year CVD risk compared to individuals in high-stable trajectory.ConclusionsChildhood may be a critical period for exposures to social adversities. Life course low SEP may also affect the 10-year CVD risk via accumulation of risk and social mobility.

Platelet volume is associated with the Framingham risk score for cardiovascular disease in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Abstract Background: Platelet volume indices (PVI), an easy and inexpensive surrogate measure of platelet function, have been associated with cardiovascular diseases (CVD) and their risk factors. However, results are conflicting because of the lack of standardized procedures. The purpose of this study is to investigate the relationship of PVI with the Framingham risk score (FRS). Methods: Baseline data (2008–2010) of 3115 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were used. PVI measurements were strictly controlled. The cohort was distributed according to risk factors and the general FRS was estimated. Multiple linear regression analysis was used to estimate the association between PVI and FRS. Results: Mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) independently correlated (p≤0.01) with FRS after adjustment for confounding variables. One unit increase in MPV, PDW, or P-LCR increased the FRS by 0.59%, 0.40%, and 0.08%, respectively. Diabetics had higher (p≤0.004) MPV, PDW, and P-LCR, and hypertensive individuals had higher (p≤0.045) PDW and P-LCR. Conclusions: Increased PVI was independently correlated with higher CVD risk based on the FRS, diabetes, and systolic hypertension. Prospective follow up of this cohort is warranted to confirm that PVI is associated with the development of CVD.

Net atrioventricular compliance is an independent predictor of cardiovascular death in mitral stenosis

Objectives Rheumatic mitral stenosis (MS) is a progressive disease, and risk of death may persist despite relief of the obstruction. Net atrioventricular compliance (Cn) modulates the overall haemodynamic burden of the MS and may be useful in predicting cardiovascular death after percutaneous mitral valvuloplasty (PMV). Methods A total of 427 patients (mean age 50±16 years, 84% female) with severe MS undergoing PMV were enrolled. Doppler-derived Cn was estimated at baseline using a previously validated equation. The primary endpoint was late cardiovascular death, and the secondary endpoint was a composite of all-cause mortality, mitral valve (MV) replacement or repeat PMV over a median follow-up of 31 months (IQR: 7.8–49.2 months). Results At baseline, 209 patients (49%) were in New York Heart Association (NYHA) functional class III or IV. During follow-up, 49 patients died (41 cardiovascular deaths), 50 underwent MV replacement and 12 required repeat PMV, with an overall incidence of cardiac mortality and adverse events of 4.1 deaths and 11.1 events per 100 patient-years, respectively. Low baseline Cn was a strong predictor of both cardiac death (adjusted HR 0.70, 95% CI 0.49 to 0.86) and composite endpoint (adjusted HR 0.81, 95% CI 0.67 to 0.91) after adjusting for clinical factors, baseline pulmonary artery pressure, tricuspid regurgitation severity, right ventricular function and immediate procedural haemodynamic data. The inclusion of Cn in a model with conventional parameters resulted in improvement in 5-year cardiovascular mortality risk prediction. Conclusions Baseline Cn is a strong predictor of cardiovascular death in patients with MS undergoing PMV, independent of other prognostic markers of decreased survival in MS, including baseline patient characteristics and postprocedural data. Cn assessment therefore has potential value in evaluation of cardiovascular mortality risk in the setting of MS.

Outcomes of infective endocarditis in the current era: Early predictors of a poor prognosis

BACKGROUND The early identification of patients at risk of complications of infective endocarditis (IE) using parameters obtained as part of routine practice is essential for guiding clinical decision-making. This study aimed to identify a parameter at hospital admission that predicts the outcome, adding value to other well-known factors of a poor prognosis in IE. METHODS Two hundred and three patients with IE were included in this study. Clinical evaluation, echocardiography, blood cultures, and routine laboratory tests were performed at hospital admission. The endpoint was in-hospital mortality. RESULTS The mean age of the patients was 48.2±16.6 years; 62% were male and 38% had rheumatic heart disease. During treatment, cardiac surgery was performed in 111 patients (55%), and the overall in-hospital mortality rate was 32%. In the multivariable analysis, the independent predictors of death were age (odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02-1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04-1.21), length of the vegetation at diagnosis (OR 1.15, 95% CI 1.03-1.28), development of heart failure (OR 6.43, 95% CI 2.14-19.33), and embolic events during antimicrobial therapy (OR 12.14, 95% CI 2.11-71.89). CONCLUSIONS An elevated CRP level at hospital admission and vegetation length at diagnosis were strong predictors of in-hospital mortality in IE, independent of other prognostic parameters, specifically taking into account patient characteristics and complications during therapy.

A radiografia do joelho em flexão fixa utilizando um novo posicionador produziu medidas da largura do espaço articular com alta repetibilidade: estudo ELSA‐Brasil Musculoesquelético (ELSA‐Brasil ME)

OBJECTIVE To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in ELSA-Brasil MSK. MATERIAL AND METHODS A test-retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations. RESULTS Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5mm and ≤1.7mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference=1.08; coefficient of variation (%CV)=54.68%; intraclass correlation coefficient (ICC) (95%CI)=0.59 (0.34-0.77)]; JSW [SD of mean difference=0.34 - 0.61; %CV=4.48% - 9.80%; ICC (95%CI)=0.74 (0.55-0.85) - 0.94 (0.87-0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively. CONCLUSIONS Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10mm from the medial extremity of the medial tibial plateu. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.

Fixed-flexion knee radiography using a new positioning device produced highly repeatable measurements of joint space width: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK)

OBJECTIVE To describe the performance of a non-fluoroscopic fixed-flexion PA radiographic protocol with a new positioning device, developed for the assessment of knee osteoarthritis (OA) in Brazilian Longitudinal Study of Adult Health Musculoskeletal Study (ELSA-Brasil MSK). MATERIAL AND METHODS A test-retest design including 19 adults (38 knee images) was conducted. Feasibility of the radiographic protocol was assessed by image quality parameters and presence of radioanatomic alignment according to intermargin distance (IMD) values. Repeatability was assessed for IMD and joint space width (JSW) measured at three different locations. RESULTS Approximately 90% of knee images presented excellent quality. Frequencies of nearly perfect radioanatomic alignment (IMD ≤1mm) ranged from 29% to 50%, and satisfactory alignment was found in up to 71% and 76% of the images (IMD ≤1.5mm and ≤1.7mm, respectively). Repeatability analyses yielded the following results: IMD [SD of mean difference=1.08; coefficient of variation (%CV)=54.68%; intraclass correlation coefficient (ICC) (95%CI)=0.59 (0.34-0.77)]; JSW [SD of mean difference=0.34-0.61; %CV=4.48%-9.80%; ICC (95%CI)=0.74 (0.55-0.85)-0.94 (0.87-0.97)]. Adequately reproducible measurements of IMD and JSW were found in 68% and 87% of the images, respectively. CONCLUSIONS Despite the difficulty in achieving consistent radioanatomic alignment between subsequent radiographs in terms of IMD, the protocol produced highly repeatable JSW measurements when these were taken at midpoint and 10mm from the medial extremity of the medial tibial plateau. Therefore, measurements of JSW at these locations can be considered adequate for the assessment of knee OA in ELSA-Brasil MSK.