Roque Aras Junior

Effects of neuromuscular electrostimulation in patients with heart failure admitted to ward.

BackgroundNeuromuscular electrostimulation has become a promising issue in cardiovascular rehabilitation. However there are few articles published in the literature regarding neuromuscular electrostimulation in patients with heart failure during hospital stay.MethodsThis is a randomized controlled pilot trial that aimed to investigate the effect of neuromuscular electrostimulation in the walked distance by the six-minute walking test in 30 patients admitted to ward for heart failure treatment in a tertiary cardiology hospital. Patients in the intervention group performed a conventional rehabilitation and neuromuscular electrostimulation. Patients underwent 60 minutes of electrostimulation (wave frequency was 20 Hz, pulse duration of 20 us) two times a day for consecutive days until hospital discharge.ResultsThe walked distance in the six-minute walking test improved 75% in the electrostimulation group (from 379.7 ± 43.5 to 372.9 ± 46.9 meters to controls and from 372.9 ± 62.4 to 500 ± 68 meters to electrostimulation, p<0.001). On the other hand, the walked distance in the control group did not change.ConclusionThe neuromuscular electrostimulation group showed greater improvement in the walked distance in the six-minute walking test in patients admitted to ward for compensation of heart failure.

Prevalência de anemia e insuficiência renal em portadores de insuficiência cardíaca não-hospitalizados

BACKGROUND Heart Failure (HF) is a common disease with a high rate of mortality. Anemia and renal failure (RF) are often found in patients with HF associated with higher severity of the heart disease and a worse prognosis. OBJECTIVE To evaluate the prevalence of anemia and RF, as well as the association between these two conditions, in non-hospitalized patients with HF. METHODS Patients treated at the HF Outpatient Clinic of a university hospital were followed from July 2003 to November 2006. Anemia was defined as hemoglobin levels < 13 mg/dl for men and 12 mg/dl for women. Renal function was assessed by the glomerular filtration rate (GFR), calculated by the simplified formula of the MDRD (Modification of Diet in Renal Disease) study. RESULTS Of the 345 patients included in this study, 26.4% (n = 91) had anemia and 29.6% had moderate to severe renal failure (GFR < 60 ml/min). The association between anemia and a higher prevalence of renal failure was statistically significant (41.8% vs. 25.2%; p = 0.005). The patients at functional class III and IV presented a higher incidence of anemia (39.0% vs. 19.4%; p <0.001) and renal failure (38.2% vs. 24.8%; p = 0.007). No association was observed between anemia or renal failure and history of hypertension, diabetes, systolic function or etiology of HF. CONCLUSION The prevalence of anemia and renal failure was high in this population and was associated with the severity of the HF (functional classes III and IV).

Impact of socio-economic profile on the prosthesis type choice used on heart surgery.

BACKGROUND Valvar heart disease is an important public health problem, more common in developing countries, especially in younger. OBJECTIVE To evaluate the epidemiological features of patients and its influence on the prosthesis type choice used on patients who underwent valve surgery. METHODS Cross-sectional. Data such as age, sex, provenance, surgery procedure and prosthesis type were retrospectively analyzed. We reviewed 366 charts of all patients submitted to heart valve surgery during three years in a public health cardiovascular treatment center. RESULTS 52% of patients were female. The age range was from 5 to 82, the median was 41 years old. In regards 37.7% of patients came from Salvador (Bahia, Brazil) and 62.3% from countryside. Valve replacement was performed in 73% of patients, whereas 7.38% underwent valvuloplasty and 18.3% underwent valve repair and replacement. Regarding type of prosthesis, 70.0% received bioprosthesis and 30.0% received metal prosthesis. On note bioprosthesis were more used in younger (P<0,001). CONCLUSION Biological prostheses were used predominantly in younger. This might be possible due to a low social-economic status, avoiding metal valve implantation and the consequent anticoagulation therapy.

Addition of non-invasive ventilatory support to combined aerobic and resistance training improves dyspnea and quality of life in heart failure patients: a randomized controlled trial:

Objective: To test the hypothesis that combined aerobic and resistance training and non-invasive ventilatory support result in additional benefits compared with combined aerobic and resistance training alone in heart failure patients. Design: A randomized, single-blind, controlled study. Setting: Cardiac rehabilitation center. Participants: A total of 46 patients with New York Heart Association class II/III heart failure were randomly assigned to a 10-week program of combined aerobic and resistance training, plus non-invasive ventilatory support (n = 23) or combined aerobic and resistance training alone (n = 23). Methods: Before and after intervention, results for the following were obtained: 6-minute walk test, forced vital capacity, forced expiratory volume at one second, maximal inspiratory muscle pressure, and maximal expiratory muscle pressure, with evaluation of dyspnea by the London Chest Activity of Daily Living scale, and quality of life with the Minnesota Living With Heart Failure questionnaire. Results: Of the 46 included patients, 40 completed the protocol. The combined aerobic and resistance training plus non-invasive ventilatory support, as compared with combined aerobic and resistance training alone, resulted in significantly greater benefit for dyspnea (mean change: 4.8 vs. 1.3, p = 0.004), and quality of life (mean change: 19.3 vs. 6.8, p = 0.017). In both groups, the 6-minute walk test improved significantly (mean change: 45.7 vs. 44.1, p = 0.924), but without a statistically significant difference. Conclusion: Non-invasive ventilatory support combined with combined aerobic and resistance training provides additional benefits for dyspnea and quality of life in moderate heart failure patients. Trial registration: ClinicalTrials.gov identifier: NCT02384798. Registered 03 April 2015.

Evaluation of variables responsible for hospital mortality in patients with rheumatic heart disease undergoing double valve replacement

Objective To describe the hospital mortality and associated clinical and echocardiographic variables in patients with rheumatic disease who underwent double valve replacement surgery. Methods This is a cross sectional descriptive study of mortality, performed in a referral hospital in Salvador, Bahia. Records from patients with rheumatic disease who underwent double valve replacement surgery during the years 2007-2011 were analyzed. Results The studied sample comprises 104 patients and 60 (57.7%) were male. The mean age was 38.04±14.45. Sixty five bioprostheses and 38 mechanical prostheses were used in these patients at the time of surgery. There were statistically significant differences between the two groups, when we analyzed the following variables: the mean age (36.30±13.03 vs. 45.35±17.8 years-old, P=0.011), mean hemoglobin (11.10±2.19 vs. 9.22±2.26 g/dL, P=0.002), mean hematocrit (34.22±5.86 vs. 28.44±6.62%, P<0.001). New York Heart Association functional class III and IV (NYHA) (P=0.022) was statistically associated with mortality. Conclusion We concluded that the mean hemoglobin/hematocrit level and the NYHA functional class was the major variables associated to the mortality among these patients. Based on these data one may concern about the patient best moment for surgery and the patient hemoglobin level.

Influência do gênero no valor prognóstico da troponina I após angioplastia coronariana eletiva

OBJECTIVE To evaluate the association between troponin I concentrations (TnI) in patients submitted to elective percutaneous coronary interventions (PCI) and adverse coronary events (ACE) during a six month follow-up period. METHODS One hundred and eleven patients who had been submitted to an elective PCI were consecutively selected during a one year timeframe. The patients had stable angina (SA), unstable angina (UA) or silent ischemia (SI) and were asymptomatic for at least 72 hours before the procedure. TnI concentrations were measured between 8 and 24 hours after the PCI. Each patient was contacted by telephone six months later and interviewed regarding ACE which were defined as death, myocardial infarction, new revascularization and recurrent ischemia. RESULTS Twenty-four patients showed elevated concentrations of TnI (21.6%) after the PCI regardless of clinical characteristics or procedure complications. Those who presented elevated TnI concentrations had higher event rates: 66.7 vs. 42.5% (RR=1.57; CI 95%=1.08-2.28). This risk seems to be higher in the subgroups of females and patients with a previous diagnosis of unstable angina. Multivariate analysis confirmed that gender was the only effect modifying co-variable associated with ACE risk, which is higher for females with elevated TnI concentrations (OR=7.22; CI 95%=1.4 -36.9) and unaltered for males (OR=1.26; CI 95%=0.35-4.55). CONCLUSION Elevated TnI concentrations were a common occurrence after PCI and is a factor related to the development of ACE in the mid term. However, when adjusted for other variables, this effect is only maintained in female patients.

Expansion Pulmonary Therapy in Blood Oxygenation and Lactate Serum Level in Postoperative Cardiac Surgery

Mailing Address: Silvana Souza Oliveira Rua Desembargador Gilberto Andrade, 256, Edf. Santo Inácio, apt. 201. Code Postal: 40155200, Chame Chame, Salvador, BA – Brazil. E-mail: silvanaso@oi.com.br Expansion Pulmonary Therapy in Blood Oxygenation and Lactate Serum Level in Postoperative Cardiac Surgery Silvana Souza Oliveira, Mansueto Neto, Roque Aras Junior Programa de Pós-graduação em Medicina e Saúde da Universidade Federal da Bahia, Salvador, BA – Brazil

Assessment of Right Ventricle Function and Myocardial Fibrosis by Cardiovascular Magnetic Resonance in Patients with Inferior Wall Myocardial Infarction

Fundamentos: Disfuncao do ventriculo direito (VD) e observada em 30-50% dos pacientes com infarto do miocardio na parede inferior (IM-I) e e fator preditor de mortalidade precoce. A fibrose miocardica esta associada com disfuncao ventricular progressiva e prognostico grave. Nesses pacientes, a ressonância magnetica cardiaca (RMC) e um importante metodo de estratificacao de risco. Objetivos: Avaliar a associacao entre disfuncao do VD e fibrose miocardica em pacientes com IM-I por RMC. Metodos: Estudo coorte realizado em um centro de cardiologia de referencia. Quarenta individuos com IM-I foram incluidos no estudo. RMC foi realizada durante a internacao para estimar funcao do VD e quantificar fibrose miocardica pela tecnica de realce tardio com gadolinio (TRT). Os pacientes foram estratificados quanto a funcao ventricular, e caracteristicas clinicas foram comparadas entre os grupos. Resultados: Quarenta pacientes foram incluidos no estudo, 75% eram homens e 43% idosos (idade ≥ 60 anos). Entre os fatores de risco cardiovasculares, hipertensao (45%) e tabagismo (33%) foram os mais prevalentes. A disfuncao do VD estava presente em 33% dos pacientes. A massa de fibrose media foi 22 ± 12g nos pacientes com disfuncao do VD e 15 ± 8 g nos pacientes com funcao ventricular preservada (p = 0,051). Conclusoes: Os resultados deste estudo indicam uma possivel associacao entre disfuncao do VD e fibrose miocardica nos pacientes com IM-I. No entanto, outros estudos envolvendo um maior numero de pacientes sao necessarios para confirmar nossos achados.

Predictors of major amputation

Chronic critical ischemia of the lower limbs with respective functional loss continues to be a major public health problem, particularly in developing countries and patients with diabetes. Despite advances in diagnostic methods and innovations in endovascular treatment, amputation is still common, with great psychosocial impact. This study aims to identify possible predictor factors of major amputations in these patients. Diabetes mellitus (DM) is a disease with growing prevalence, and is a major cause of amputations [1–3]. Numerous variables are involved in its etiology and complications. The long duration of the disease and poor metabolic control [4, 5] demonstrated by the high glycated hemoglobin and fasting glycemic levels in the amputee groups, reinforce the higher risk of amputation in these patients, as well of the higher frequency of fatal cardiovascular events. According to the International Consensus on the Diabetic Foot, patients with previous amputation should be followed up every 1–3 months, and should have at least one foot examination per year, or more frequently if the risk of complications is high, and worsening of the diabetic foot is inevitable despite preventative measures and early diagnosis. Lack of access to health services, despite the increased coverage of basic health care in the last decade in Brazil, and low compliance with treatment, despite the development of educational practices in the management for diabetic foot, increases the risk of amputation seen in this population. It is important that the population at risk is educated on health and DM. Public policies which guarantee access to basic medical care (preventive medicine) to make early diagnoses provide health education and facilitate referral to specialized services are encouraged, where necessary. Various factors are associated with the risk of amputation. The profile of severity of the patients studied is multifactorial, and some variables did not remain in the final model of regression logistics. In our population, arterial aneurysms (AA) and coronary artery disease (CAD) were predictors of amputation, possibly due to embolization of aneurysms to the distal arterial bed and the already known coronariopathy in the selected cases. A possible explanation is that in the presence of both, they lose their intensity, e.g., age, infection, trophic lesion and ankle braquial index (ABI). However, they generally behave like risk factors when compared with the others in the population. Several authors agree that patients with higher mean ages and anemia have a higher risk of amputation, especially in those with diabetes. Anemia is an independent risk factor for amputation and mortality in hospitalized patients with peripheral artery disease (PAD). It is emphasized that the amputees group presents higher rates of infection, with some evolving to gangrene and more severe obstructive arterial lesions characterized by transatlantic intersociety consesus (TASC) C and D, which may have contributed to the outcome of the amputation, even when revascularization was attempted. & Wagner Ramos Borges wagner2076@bol.com.br

Subclinical Atherosclerosis in Non-dialysis Chronic Renal Patients

Background: Nowadays cardiovascular diseases are the main cause of morbid-mortality. Atherosclerosis is one of the most important in this class of diseases. Aim: Identifying subclinical atherosclerosis in a population of non-dialytic patients with chronic kidney disease. Methods: From November 2012 to December 2013, we selected 40 patients with stage 3 or 4 of CKD (Chronic kidney disease) who did not need hemodialysis. CACS (coronary artery calcium score) and MTCA (miointimal tichness carotid artery) were calculated and their mean and standard deviation, median and quartiles. To verify the association between the variables we used the Fisher exact test and the Spearman correlation (p<0.05). Results: The distribution of the CACS was not as expected and the median increased with age groups. The CACS was null in : 50% of the sample in all patients below 45 years of age, 50% of those between 45-49 years of age and 50-54 years of age, 53.8% in those 55-59 years of age and 25% of those 60-65 years of age, however p value=0.102. The median MTCA was 0.9 mm with interquartile range of 0.7-1.2 mm. In percentil75 for age and sex were : 80% of 45 year olds, 25% of 45-49 year olds, 66.7% of 50-54 year olds, 69.2% of 55-59 year olds and 50% of 60-65 year olds, though p value was 0.602. We found a moderate positive correlation between age and CACS (r=0.458 p=0.03) and between age and MTCA weak (r=0.346 p=0.029) when performed correlation of age with the values of CACS and MTCA. The correlation between MTCA and CACS was strong(r=0.807) p<0.001. Conclusion: Non-invasive tests in CKD non-dialytic patients can identify subclinical atherosclerosis through the CACS and MTCA. This may change the clinical management, evolution and prognosis.