Artigos e Materiais de Revistas Científicas - HC/InCor

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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First Evaluation of the Brazilian Advanced Life Support Training (TECA A)
(2023) FURTADO, Fabrício Nogueira; CARVALHO, Antonio Carlos de Camargo; GONÇALVES JUNIOR, Iran; CANESIN, Manoel Fernandes; TIMERMAN, Sergio; GONÇALVES, Rodrigo Marques; ALFIERI, Daniela Frizon; ALMEIDA, Dirceu
Abstract Background Cardiac arrest (CA) is a common condition associated with high mortality. The Brazilian advanced life support training TECA A (Treinamento em Emergências Cardiovasculares Avançado — Advanced Cardiovascular Emergency Training) was created to train healthcare professionals in the management of CA. However, there are no studies evaluating the effectiveness of TECA A. Objective To assess the impact of TECA A on the management of CA using a simulated CA situation. Methods Fifty-six students underwent a simulated case of CA in a manikin. The students’ performance in the management of CA was assessed for the time to first chest compression and defibrillation and for a global assessment score using a structured tool. These items were assessed and compared before and after the TECA A. Exclusion criteria were previous participation in CA trainings and absence from class. Categorical variables were compared using the McNemar test and quantitative variables using the Wilcoxon test. All tests were two-tailed, and statistical significance was set at p < 0.05. Results Compared with before TECA A, median global assessment scores were higher after TECA A (pre-training: 4.0 points [2.0-5.0] vs. 10 points [9.0-10.0]; p<0.001), the time to start chest compressions was shorter (pre-training: 25 seconds [15-34] vs. 19 seconds [16.2-23.0]; p=0.002) and so was the time to defibrillation (pre-training: 82.5 seconds [65.0-108.0] vs. 48 seconds [39.0-53.0]; p<0.001). Conclusions The TECA A promoted a higher adherence to cardiopulmonary resuscitation (CPR) guidelines and a reduction in the time elapsed from CA to first chest compression and defibrillation.
Bentall-De Bono Reoperation Associated With Pseudoaneurysm and Infectious Endocarditis
(2023) RABELATO, Janayna; ANTONIO, Iuri Betuel Gomes; MAIA, Adnaldo da Silveira; DANTAS, Daniel Chagas; ALMEIDA, Antonio Flávio de; ISSA, Mario
Abstract We present the case of a 55-year-old patient who underwent the Bentall-De Bono procedure with mechanical prosthesis in 2005 and was admitted to the emergency department in July 2020 with mixed shock. Complementary exams showed an abscess involving the prosthetic tube, two thirds of the aortic valve circumference and the left ventricle, with a neocavity of about 45 mm in diameter from the aortic sinus to the ascending aorta. The patient underwent surgical repair, with a new procedure using the Bentall-De Bono technique, now associated with coronary artery bypass grafting with a great saphenous vein graft between the aorta and the anterior descending artery. Culture of samples collected intraoperatively showed Staphylococcus epidermidis. The patient received antibiotic therapy for 30 days, evolving favorably, and is under regular outpatient follow-up.
Has the Natural History of Primary Heart Tumors in Children Been Modified Recently?
(2024) AIELLO, Vera Demarchi
Functional recovery of chronically critically ill patients in the first days after discharge from the intensive care unit: Feasibility of the 6-minute step test
(2023) GAIA, Viviane Roccasecca Sampaio; COSTA, Eduardo Leite Vieira; YAMAGUTI, Wellington Pereira; FRANCISCO, Davi de Souza; FUMIS, Renata Rego Lins
Background Survivors of chronic critical illness often experience weakness and functional dependence to various degrees after their intensive care unit (ICU) stay. Evaluating their functional status with the traditional six-minute walk test is challenging due to space constraints or patient intolerance. Objective Our aim was to evaluate the feasibility of using the six-minute step test (6MST) as a measure of functional capacity in chronically critically ill patients early after ICU discharge. Methods This prospective study was undertaken in a private Brazilian hospital. From July 2019 to July 2020, all chronically critically ill patients were asked to participate 48 hours after ICU discharge. On the day of study inclusion and a week later, those who consented underwent functional assessment comprised of the 6MST, peripheral muscle strength using handgrip strength (HGS), and mobility using the ICU mobility scale (IMS). Results A total of 40 patients were included. The 6MST was feasible in 40% on the first evaluation and 57% on the second. The median 6MST was 0 [0-5] on the first evaluation and 3.5 [0-7.75] on the second (P = 0.005). The median HGS increased from 11.50 [9.25-18] on the first evaluation to 14.5 [10-20] on the second (P = 0.006). The median IMS was 4.5 [3.25-7] on the first evaluation and 6 [3.25-7] on the second (P<0.001). Despite the significant improvement, all parameters measured remained well below normal. Conclusion The 6MST was a feasible measure of functional capacity in chronically critically ill patients early after ICU discharge. Patients had functional capacity well below predicted values.
How Can COVID-19 Influence the Evolution of Patients with Acute Coronary Syndromes?
(2024) SOEIRO, Alexandre de Matos
Burnout, satisfaction and compassion fatigue: relationship with quality of care and patient safety
(2024) GARZIN, Ana Claudia Alcantara; FERRARI, Carla Maria Maluf; PEREIRA, Giovana Caldas; DUARTE, Kawany de Oliveira Rodrigues; RODRIGUES, Samara Gomes; KOWALSKI, Ivonete Sanches Giacometti
2023 HRS expert consensus statement on the management of arrhythmias during pregnancy
(2023) JOGLAR, Jose A.; KAPA, Suraj; SAAREL, Elizabeth V.; DUBIN, Anne M.; GORENEK, Bulent; HAMEED, Afshan B.; MELO, Sissy Lara de; LEAL, Miguel A.; MONDESERT, Blandine; PACHECO, Luis D.; ROBINSON, Melissa R.; SARKOZY, Andrea; SILVERSIDES, Candice K.; SPEARS, Danna; SRINIVAS, Sindhu K.; STRASBURGER, Janette F.; TEDROW, Usha B.; WRIGHT, Jennifer M.; ZELOP, Carolyn M.; ZENTNER, Dominica
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady-and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease-and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
Myocardial Injury Progression after Radiofrequency Ablation in School-Age Children
(2024) MELO, Sissy Lara de; FERRAZ, Alberto Pereira; LEMOUCHE, Stephanie Ondracek; DEVIDO, Marcela Santana; SOUSA, Gabriela Liberato de; ROCHITTE, Carlos E.; PISANI, Cristiano Faria; HACHUL, Denise Tessariol; SCANAVACCA, Mauricio
Background: The past decades have seen the rapid development of the invasive treatment of arrhythmias by catheter ablation procedures. Despite its safety and efficacy being well-established in adults, to date there has been little data in pediatric scenarios. One of the main concerns is the possible expansion of the ablation procedure scar in this population and its consequences over the years. Objectives: This study aimed to analyze the risk of myocardial injury progression after radiofrequency catheter ablation in pediatric patients. Methods: This is a retrospective study of 20 pediatric patients with previous ablation for treatment of supraventricular arrhythmia that underwent cardiac magnetic resonance and coronary angiography for evaluation of myocardial fibrosis and the integrity of the coronary arteries during follow-up. Results: The median age at ablation procedure was 15.1 years (Q1 12.9, Q3 16.6) and 21 years (Q1 20, Q3 23) when the cardiac magnetic resonance was performed. Fourteen of them were women. Nodal reentry tachycardia and WolfParkinson-White Syndrome were the main diagnosis (19 patients), with one patient with atrial tachycardia. Three patients had ventricular myocardial fibrosis, but with a volume < 0.6 cm(3) . None of them developed ventricular dysfunction and no patient had coronary lesions on angiography. Conclusion: Radiofrequency catheter ablation did not show to increase the risk of myocardial injury progression or coronary artery lesions.
Staring us in the face: resumption of CPAP therapy
(2024) JOOSTEN, Simon A.; GENTA, Pedro R.
The Exometabolome of Xylella fastidiosa in Contact with Paraburkholderia phytofirmans Supernatant Reveals Changes in Nicotinamide, Amino Acids, Biotin, and Plant Hormones
(2024) FEITOSA-JUNIOR, Oseias R.; LUBBE, Andrea; KOSINA, Suzanne M.; MARTINS-JUNIOR, Joaquim; BARBOSA, Deibs; BACCARI, Clelia; ZAINI, Paulo A.; BOWEN, Benjamin P.; NORTHEN, Trent R.; LINDOW, Steven E.; SILVA, Aline M. da
Microbial competition within plant tissues affects invading pathogens' fitness. Metabolomics is a great tool for studying their biochemical interactions by identifying accumulated metabolites. Xylella fastidiosa, a Gram-negative bacterium causing Pierce's disease (PD) in grapevines, secretes various virulence factors including cell wall-degrading enzymes, adhesion proteins, and quorum-sensing molecules. These factors, along with outer membrane vesicles, contribute to its pathogenicity. Previous studies demonstrated that co-inoculating X. fastidiosa with the Paraburkholderia phytofirmans strain PsJN suppressed PD symptoms. Here, we further investigated the interaction between the phytopathogen and the endophyte by analyzing the exometabolome of wild-type X. fastidiosa and a diffusible signaling factor (DSF) mutant lacking quorum sensing, cultivated with 20% P. phytofirmans spent media. Liquid chromatography-mass spectrometry (LC-MS) and the Method for Metabolite Annotation and Gene Integration (MAGI) were used to detect and map metabolites to genomes, revealing a total of 121 metabolites, of which 25 were further investigated. These metabolites potentially relate to host adaptation, virulence, and pathogenicity. Notably, this study presents the first comprehensive profile of X. fastidiosa in the presence of a P. phytofirmans spent media. The results highlight that P. phytofirmans and the absence of functional quorum sensing affect the ratios of glutamine to glutamate (Gln:Glu) in X. fastidiosa. Additionally, two compounds with plant metabolism and growth properties, 2-aminoisobutyric acid and gibberellic acid, were downregulated when X. fastidiosa interacted with P. phytofirmans. These findings suggest that P. phytofirmans-mediated disease suppression involves modulation of the exometabolome of X. fastidiosa, impacting plant immunity.
Cardiac Remodeling in Subclinical Hypertrophic CardiomyopathyThe VANISH Randomized Clinical Trial
(2023) VISSING, Christoffer Rasmus; RAJA, Anna Axelsson; DAY, Sharlene M.; RUSSELL, Mark W.; ZAHKA, Kenneth; LEVER, Harry M.; PEREIRA, Alexandre C.; COLAN, Steven D.; MARGOSSIAN, Renee; MURPHY, Anne M.; CANTER, Charles; BACH, Richard G.; WHEELER, Matthew T.; ROSSANO, Joseph W.; OWENS, Anjali T.; BENSON, Lee; MESTRONI, Luisa; TAYLOR, Matthew R. G.; PATEL, Amit R.; WILMOT, Ivan; THRUSH, Philip; SOSLOW, Jonathan H.; BECKER, Jason R.; SEIDMAN, Christine E.; LAKDAWALA, Neal K.; CIRINO, Allison L.; MCMURRAY, John J. V.; MACRAE, Calum A.; SOLOMON, Scott D.; BUNDGAARD, Henning; ORAV, E. John; HO, Carolyn Y.
Importance Valsartan has shown promise in attenuating cardiac remodeling in patients with early-stage sarcomeric hypertrophic cardiomyopathy (HCM). Genetic testing can identify individuals at risk of HCM in a subclinical stage who could benefit from therapies that prevent disease progression.Objective To explore the potential for valsartan to modify disease development, and to characterize short-term phenotypic progression in subclinical HCM.Design, Setting, and Participants The multicenter, double-blind, placebo-controlled Valsartan for Attenuating Disease Evolution in Early Sarcomeric Hypertrophic Cardiomyopathy (VANISH) randomized clinical trial was conducted from April 2014 to July 2019 at 17 sites in 4 countries (Brazil, Canada, Denmark, and the US), with 2 years of follow-up. The prespecified exploratory VANISH cohort studied here included sarcomere variant carriers with subclinical HCM and early phenotypic manifestations (reduced E ' velocity, electrocardiographic abnormalities, or an increased left ventricular [LV] wall thickness [LVWT] to cavity diameter ratio) but no LV hypertrophy (LVH). Data were analyzed between March and December 2022.Interventions Treatment with placebo or valsartan (80 mg/d for children weighing <35 kg, 160 mg/d for children weighing >= 35 kg, or 320 mg/d for adults aged >= 18 years).Main Outcomes and Measures The primary outcome was a composite z score incorporating changes in 9 parameters of cardiac remodeling (LV cavity volume, LVWT, and LV mass; left atrial [LA] volume; E ' velocity and S ' velocity; and serum troponin and N-terminal prohormone of brain natriuretic peptide levels).Results This study included 34 participants, with a mean (SD) age of 16 (5) years (all were White). A total of 18 participants (8 female [44%] and 10 male [56%]) were randomized to valsartan and 16 (9 female [56%] and 7 male [44%]) were randomized to placebo. No statistically significant effects of valsartan on cardiac remodeling were detected (mean change in composite z score compared with placebo: -0.01 [95% CI, -0.29 to 0.26]; P = .92). Overall, 2-year phenotypic progression was modest, with only a mild increase in LA volume detected (increased by 3.5 mL/m(2) [95% CI, 1.4-6.0 mL/m(2)]; P = .002). Nine participants (26%) had increased LVWT, including 6 (18%) who developed clinically overt HCM. Baseline LA volume index (LAVI; 35 vs 28 mL/m(2); P = .01) and average interventricular septum thickness (8.5 vs 7.0 mm; P = .009) were higher in participants who developed HCM.Conclusions and Relevance In this exploratory cohort, valsartan was not proven to slow progression of subclinical HCM. Minimal changes in markers of cardiac remodeling were observed, although nearly one-fifth of patients developed clinically overt HCM. Transition to disease was associated with greater baseline interventricular septum thickness and LAVI. These findings highlight the importance of following sarcomere variant carriers longitudinally and the critical need to improve understanding of factors that drive disease penetrance and progression.
A BEAT-PCD consensus statement: a core outcome set for pulmonary disease interventions in primary ciliary dyskinesia
(2024) KOS, Renate; GOUTAKI, Myrofora; KOBBERNAGEL, Helene E.; RUBBO, Bruna; SHOEMARK, Amelia; ALIBERTI, Stefano; ALTENBURG, Josje; ANAGNOSTOPOULOU, Pinelopi; ATHANAZIO, Rodrigo A.; BEYDON, Nicole; DELL, Sharon D.; EMIRALIOGLU, Nagehan; FERKOL, Thomas W.; LOEBINGER, Michael R.; LORENT, Natalie; MAITRE, Bernard; MARTHIN, June; MORGAN, Lucy C.; NIELSEN, Kim G.; RINGSHAUSEN, Felix C.; SHTEINBERG, Michal; TIDDENS, Harm A. W. M.; ZEE, Anke H. Maitland-Van der; CHALMERS, James D.; LUCAS, Jane S. A.; HAARMAN, Eric G.
Background Consistent use of reliable and clinically appropriate outcome measures is a priority for clinical trials, with clear definitions to allow comparability. We aimed to develop a core outcome set (COS) for pulmonary disease interventions in primary ciliary dyskinesia (PCD). Methods A multidisciplinary international PCD expert panel was set up. A list of outcomes was created based on published literature. Using a modified three-round e-Delphi technique, the panel was asked to decide on relevant end-points related to pulmonary disease interventions and how they should be reported. First, inclusion of an outcome in the COS was determined. Second, the minimum information that should be reported per outcome. The third round finalised statements. Consensus was defined as >= 80% agreement among experts. Results During the first round, experts reached consensus on four out of 24 outcomes to be included in the COS. Five additional outcomes were discussed in subsequent rounds for their use in different subsettings. Consensus on standardised methods of reporting for the COS was reached. Spirometry, health-related quality-of-life scores, microbiology and exacerbations were included in the final COS. Conclusion This expert consensus resulted in a COS for clinical trials on pulmonary health among people with PCD.
Racial Inequities in the Control of Hypertension and the Explanatory Role of Residential Segregation: a Decomposition Analysis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)
(2024) GUIMARAES, Joanna M. N.; JACKSON, John W.; BARBER, Sharrelle; GRIEP, Rosane H.; FONSECA, Maria de J. M. da; CAMELO, Lidyane V.; BARRETO, Sandhi M.; SCHMIDT, Maria Ines; DUNCAN, Bruce B.; CARDOSO, Leticia de O.; PEREIRA, Alexandre C.; CHOR, Dora
The mechanisms underlying racial inequities in uncontrolled hypertension have been limited to individual factors. We investigated racial inequities in uncontrolled hypertension and the explanatory role of economic segregation in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). All 3897 baseline participants with hypertension (2008-2010) were included. Uncontrolled hypertension (SBP >= 140 mmHg or DBP >= 90 mmHg), self-reported race (White/Brown/Black people), and neighborhood economic segregation (low/medium/high) were analyzed cross-sectionally. We used decomposition analysis, which describes how much a disparity would change (disparity reduction; explained portion) and remain (disparity residual; unexplained portion) upon removing racial differences in economic segregation (i.e., if Black people had the distribution of segregation of White people, how much we would expect uncontrolled hypertension to decrease among Black people). Age- and gender-adjusted prevalence of uncontrolled hypertension (39.0%, 52.6%, and 54.2% for White, Brown, and Black participants, respectively) remained higher for Black and Brown vs White participants, regardless of economic segregation. Uncontrolled hypertension showed a dose-response pattern with increasing segregation levels for White but not for Black and Brown participants. After adjusting for age, gender, education, and study center, unexplained portion (disparity residual) of race on uncontrolled hypertension was 18.2% (95% CI 13.4%; 22.9%) for Black vs White participants and 12.6% (8.2%; 17.1%) for Brown vs White participants. However, explained portion (disparity reduction) through economic segregation was - 2.1% (- 5.1%; 1.3%) for Black vs White and 0.5% (- 1.7%; 2.8%) for Brown vs White participants. Although uncontrolled hypertension was greater for Black and Brown vs White people, racial inequities in uncontrolled hypertension were not explained by economic segregation.
SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device
(2024) KIM, Daniel; COLLINS, Jeremy D.; WHITE, James A.; HANNEMAN, Kate; LEE, Daniel C.; PATEL, Amit R.; HU, Peng; LITT, Harold; WEINSAFT, Jonathan W.; DAVIDS, Rachel; MUKAI, Kanae; NG, Ming -Yen; LUETKENS, Julian A.; ROGUIN, Ariel; ROCHITTE, Carlos E.; WOODARD, Pamela K.; MANISTY, Charlotte; ZAREBA, Karolina M.; MONT, Lluis; BOGUN, Frank; ENNIS, Daniel B.; NAZARIAN, Saman; WEBSTER, Gregory; STOJANOVSKA, Jadranka
Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk -benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced -based decision -making regarding the risk -benefit ratio of CMR for patients with CIEDs.
Intraoperative individualization of positive-end-expiratory pressure through electrical impedance tomography or esophageal pressure assessment: a systematic review and meta-analysis of randomized controlled trials
(2024) ESPOSITO, Teresa; FREGONESE, Martina; MORETTINI, Giulio; CARBONI, Paloma; TARDIOLI, Cecilia; MESSINA, Antonio; VASCHETTO, Rosanna; CORTE, Francesco Della; VETRUGNO, Luigi; NAVALESI, Paolo; ROBERTIS, Edoardo De; AZZOLINA, Danila; PIRIYAPATSOM, Annop; TUCCI, Mauro R.; WRIGGE, Hermann; SIMON, Philipp; BIGNAMI, Elena; MAGGIORE, Salvatore M.; SIMONTE, Rachele; CAMMAROTA, Gianmaria
Purpose This systematic review of randomized-controlled trials (RCTs) with meta-analyses aimed to compare the effects on intraoperative arterial oxygen tension to inspired oxygen fraction ratio (PaO2/FiO2), exerted by positive end-expiratory pressure (PEEP) individualized trough electrical impedance tomography (EIT) or esophageal pressure (Pes) assessment (intervention) vs. PEEP not tailored on EIT or Pes (control), in patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach.Methods PUBMED (R), EMBASE (R), and Cochrane Controlled Clinical trials register were searched for observational studies and RCTs from inception to the end of August 2022. Inclusion criteria were: RCTs comparing PEEP titrated on EIT/Pes assessment vs. PEEP not individualized on EIT/Pes and reporting intraoperative PaO2/FiO(2). Two authors independently extracted data from the enrolled investigations. Data are reported as mean difference and 95% confidence interval (CI).Results Six RCTs were included for a total of 240 patients undergoing general anesthesia for surgery, of whom 117 subjects in the intervention group and 123 subjects in the control group. The intraoperative mean PaO2/FiO(2) was 69.6 (95%CI 32.-106.4 ) mmHg higher in the intervention group as compared with the control group with 81.4% between-study heterogeneity (p < 0.01). However, at meta-regression, the between-study heterogeneity diminished to 44.96% when data were moderated for body mass index (estimate 3.45, 95%CI 0.78-6.11, p = 0.011).Conclusions In patients undergoing abdominal or pelvic surgery with an open or laparoscopic/robotic approach, PEEP personalized by EIT or Pes allowed the achievement of a better intraoperative oxygenation compared to PEEP not individualized through EIT or Pes.
Nonstructural Genetic Cardiac Disease as the Most Common Cause of Sudden Cardiac Death in the Young Athlete: Is This True?
(2023) STEIN, Ricardo; FERRARI, Filipe; BEUREN, Thais M. A.; SILVEIRA, Anderson D. D. da; SACILOTTO, Luciana
Purpose of reviewThis review is aimed at summarizing and discussing the primary causes of sudden cardiac death (SCD) in young athletes.Recent findingsSCD in young athletes is a dramatic event, with an incidence rate that can reach 13 deaths per 100,000 athletes. Occasionally, exercise can trigger SCD, and unfortunately, this event may be the first manifestation of an underlying and silent cardiac condition. In the USA, hypertrophic cardiomyopathy is reported as the leading cause of SCD among young athletes, whereas arrhythmogenic right ventricular cardiomyopathy has been reported as the main cause in the Veneto region of Italy. However, emerging evidence has demonstrated that in many cases, athletes who experience sudden death have a seemingly normal cardiac structure, suggesting the possibility of sudden arrhythmic death syndrome. In recent decades, it has been possible to determine the causes of many SCDs that occur in the presence of nonstructural cardiac diseases. It is worth noting that routinely used cardiovascular screening methods, such as electrocardiogram and echocardiogram, may fail to detect nonstructural genetic cardiac diseases. In turn, in some circumstances, genetic testing may play a role in identifying individuals at risk of SCD due to these conditions.Understanding the underlying causes of SCD in young athletes is noteworthy for developing effective prevention and screening strategies. A multidisciplinary approach involving cardiologists, clinical sports physicians, pathologists, and geneticists collaborating represents an opportunity to enhance and optimize patient care and can play a crucial role in the prevention of SCD among young athletes.
Prevalence and clinical characteristics of oral lesions in heart transplant patients induced by sirolimus and everolimus: a systematic review and meta-analysis on a global scale
(2024) MOURA, Anne Evelyn Oliveira; BESSELER, Mariana Oliveira; PEREZ-DE-OLIVEIRA, Maria Eduarda; NORMANDO, Ana Gabriela Costa; NEVES, Itamara Lucia Itagiba; NEVES, Ricardo Simoes; VARGAS, Pablo Agustin; AZEKA, Estela; SANTOS-SILVA, Alan Roger; MONTANO, Tania Cristina Pedroso
Objective. Sirolimus (SRL) and everolimus (EVL) are increasingly included in immunosuppressive protocols after heart transplantation. They present some side effects, including the appearance of painful lesions in the oral cavity. Therefore, this systematic review aimed to verify the global prevalence and clinical characteristics of oral lesions induced by SRL and EVL in heart transplant patients.Study Design. A systematic review was performed using 5 main electronic databases (Medline/PubMed, SCOPUS, EMBASE, Web of Science, and LILACS), in addition to the gray literature. Studies were independently assessed by 2 reviewers based on established eligibility criteria. The risk of bias was assessed using the Joanna Briggs Institute appraisal tools, and the certainty of evidence was evaluated through GRADE assessment.Results. Seventeen studies (860 patients) were included in the qualitative analysis. Of these, 11 studies were pooled in a metaanalysis of prevalence. The worldwide prevalence of oral lesions induced by SRL and EVL in heart transplant patients was 10.0%, and most lesions were described as ulcers >1.0 cm, related to significant pain.Conclusions. Oral lesions induced by SRL and/or EVL, although not very prevalent, have a relevant impact on patient's lives and the continuity of treatment.
Comprehensive vasodilatation in women with acute heart failure: Novel insights from the GALACTIC randomized controlled trial
(2023) WUSSLER, Desiree; BELKIN, Maria; MAEDER, Micha T.; WALTER, Joan; SHRESTHA, Samyut; KUPSKA, Karolina; STIERLI, Michelle; FLORES, Dayana; KOZHUHAROV, Nikola; GUALANDRO, Danielle Menosi; OLIVEIRA JUNIOR, Mucio Tavares de; SABTI, Zaid; NOVEANU, Markus; SOCRATES, Thenral; BAYES-GENIS, Antoni; SIONIS, Alessandro; SIMON, Patrick; MICHOU, Eleni; GUJER, Samuel; GORI, Tommaso; WENZEL, Philip; PFISTER, Otmar; ARENJA, Nisha; KOBZA, Richard; RICKLI, Hans; BREIDTHARDT, Tobias; MUENZEL, Thomas; MUELLER, Christian; GALACTIC Investigators
Aims Sex-specific differences in acute heart failure (AHF) are both relevant and underappreciated. Therefore, it is crucial to evaluate the risk/benefit ratio and the implementation of novel AHF therapies in women and men separately.Methods and results We performed a pre-defined sex-specific analysis in AHF patients randomized to a strategy of early intensive and sustained vasodilatation versus usual care in an international, multicentre, open-label, blinded endpoint trial. Inclusion criteria were AHF with increased plasma concentrations of natriuretic peptides, systolic blood pressure >= 100 mmHg, and plan for treatment in a general ward. Among 781 eligible patients, 288 (37%) were women. Women were older (median 83 vs. 76 years), had a lower body weight (median 64.5 vs. 77.6 kg) and lower estimated glomerular filtration rate (median 48 vs. 54 ml/min/1.73 m(2)). The primary endpoint, a composite of all-cause mortality or rehospitalization for AHF at 180 days, showed a significant interaction of treatment strategy and sex (p for interaction = 0.03; hazard ratio adjusted for female sex 1.62, 95% confidence interval 1.05-2.50; p = 0.03). The combined endpoint occurred in 53 women (38%) in the intervention group and in 35 (24%) in the usual care group. The implementation of rapid up-titration of renin-angiotensin-aldosterone system (RAAS) inhibitors was less successful in women versus men in the overall cohort and in patients with heart failure with reduced ejection fraction (median discharge % target dose in patients randomized to intervention: 50% in women vs. 75% in men).Conclusion Rapid up-titration of RAAS inhibitors was less successfully implemented in women possibly explaining their higher rate of all-cause mortality and rehospitalization for AHF.
Effect of Tafamidis on Cardiac Function in Patients With Transthyretin Amyloid Cardiomyopathy A Post Hoc Analysis of the ATTR-ACT Randomized Clinical Trial
(2024) SHAH, Sanjiv J.; FINE, Nowell; GARCIA-PAVIA, Pablo; KLEIN, Allan L.; FERNANDES, Fabio; WEISSMAN, Neil J.; MAURER, Mathew S.; BOMAN, Kurt; GUNDAPANENI, Balarama; SULTAN, Marla B.; ELLIOTT, Perry
Importance Tafamidis has been shown to improve survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared with placebo. However, its effect on cardiac function has not been fully characterized.Objective To examine the effect of tafamidis on cardiac function in patients with ATTR-CM.Design, Setting, and Participants This was an exploratory, post hoc analysis of the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), a multicenter, international, double-blind, placebo-controlled phase 3 randomized clinical trial conducted from December 2013 to February 2018. The ATTR-ACT included 48 sites in 13 counties and enrolled patients aged 18 to 90 years with ATTR-CM. Data were analyzed from July 2018 to September 2023.Intervention Patients were randomized to tafamidis meglumine, 80 mg or 20 mg, or placebo for 30 months.Main Outcomes and Measures Patients were categorized based on left ventricular (LV) ejection fraction at enrollment as having heart failure with preserved ejection fraction (>= 50%), mildly reduced ejection fraction (41% to 49%), or reduced ejection fraction (<= 40%). Changes from baseline to month 30 in LV ejection fraction, LV stroke volume, LV global longitudinal strain, and the ratio of early mitral inflow velocity to septal and lateral early diastolic mitral annular velocity (E/e ') were compared in patients receiving tafamidis, 80 mg, vs placebo.Results A total of 441 patients were randomized in ATTR-ACT, and 436 patients had available echocardiographic data. Of 436 included patients, 393 (90.1%) were male, and the mean (SD) age was 74 (7) years. A total of 220 (50.5%), 119 (27.3%), and 97 (22.2%) had heart failure with preserved, mildly reduced, and reduced LV ejection fraction, respectively. Over 30 months, there was less pronounced worsening in 4 of the echocardiographic measures in patients receiving tafamidis, 80 mg (n = 176), vs placebo (n = 177) (least squares mean difference: LV stroke volume, 7.02 mL; 95% CI, 2.55-11.49; P = .002; LV global longitudinal strain, -1.02%; 95% CI, -1.73 to -0.31; P = .005; septal E/e ', -3.11; 95% CI, -5.50 to -0.72; P = .01; lateral E/e ', -2.35; 95% CI, -4.01 to -0.69; P = .006).Conclusions and Relevance Compared with placebo, tafamidis, 80 mg, attenuated the decline of LV systolic and diastolic function over 30 months in patients with ATTR-CM. Approximately half of patients had mildly reduced or reduced LV ejection fraction at enrollment, suggesting that ATTR-CM should be considered as a possible diagnosis in patients with heart failure regardless of underlying LV ejection fraction.Trial Registration ClinicalTrials.gov Identifier: NCT01994889
Primary results of the brazilian registry of atherothrombotic disease (NEAT)
(2024) SILVA, Pedro G. M.; NASCIMENTO, Charlene Troiani do; PEDROSA, Rodrigo Pinto; NAKAZONE, Marcelo Arruda; NASCIMENTO, Michel Ulloffo do; MELO, Leiliandry de Araujo; JUNIOR, Osvaldo Lourenco Silva; ZIMMERMANN, Sergio Luiz; MELO, Rodrigo Morel Vieira de; BERGO, Ricardo Reinaldo; PRECOMA, Dalton Bertolim; TRAMUJAS, Lucas; LIMA, Eduardo Gomes; DANTAS, Joao Miguel Malta; BARUZZI, Antonio Claudio do Amaral; FLUMIGNAN, Ronald Luiz Gomes; PAIVA, Maria Sanali Moura de Oliveira; GOWDAK, Luis Henrique Wolff; CARVALHO, Priscila Nasser de; FIGUEIREDO NETO, Jose Albuquerque de; SILVESTRE, Odilson Marcos; FIORANELLI, Alexandre; VIEIRA, Ricardo D. 'Oliveira; HORAK, Ana Clara Peneluppi; MIYADA, Debora Harumi Kodama; KOJIMA, Flavia Cristina Soares; OLIVEIRA, Julia Souza de; SILVA, Leila de Oliveira; PAVANELLO, Ricardo; RAMACCIOTTI, Eduardo; LOPES, Renato D.; NASCIMENTO, Charlene Troiani do; PEDROSA, Rodrigo Pinto; NAKAZONE, Marcelo Arruda; NASCIMENTO, Michel Ulloffo do; MELO, Leiliandry de Araujo; JUNIOR, Osvaldo Lourenco Silva; ZIMMERMANN, Sergio Luiz; MELO, Rodrigo Morel Vieira de; BERGO, Ricardo Reinaldo; PRECOMA, Dalton Bertolim; TRAMUJAS, Lucas; DANTAS, Joao Miguel Malta; BARUZZI, Antonio Claudio do Amaral; FLUMIGNAN, Ronald Luiz Gomes; PAIVA, Maria Sanali Moura de Oliveira; CARVALHO, Priscila Nasser de; FIGUEIREDO NETO, Jose Albuquerque de; SILVESTRE, Odilson Marcos; FIORANELLI, Alexandre; VIEIRA, Ricardo D. 'Oliveira; FORTES, Jose Augusto Ribas; RITT, Luiz Eduardo Fonteles; REQUIAO-MOURA, Lucio R.; BORGES, Fabricio Assami; BERNOCHE, Claudia; POMPILIO, Mauricio Antonio
There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America. The Network to control atherothrombosis (NEAT) registry is a national prospective observational study of patients with known coronary (CAD) and/or peripheral arterial disease (PAD) in Brazil. A total of 2,005 patients were enrolled among 25 sites from September 2020 to March 2022. Patient characteristics, medications and laboratorial data were collected. Primary objective was to assess the proportion of patients who, at the initial visit, were in accordance with good medical practices (domains) for reducing cardiovascular risk in atherothrombotic disease. From the total of patients enrolled, 2 were excluded since they did not meet eligibility criteria. Among the 2,003 subjects included in the analysis, 55.6% had isolated CAD, 28.7% exclusive PAD and 15.7% had both diagnoses. Overall mean age was 66.3 (+/- 10.5) years and 65.7% were male patients. Regarding evidence-based therapies (EBTs), 4% were not using any antithrombotic drug and only 1.5% were using vascular dose of rivaroxaban (2.5 mg bid). Only 0.3% of the patients satisfied all the domains of secondary prevention, including prescription of EBTs and targets of body-mass index, blood pressure, LDL-cholesterol, and adherence of lifestyle recommendations. The main barrier for prescription of EBTs was medical judgement. Our findings highlight that the contemporary practice does not reflect a comprehensive approach for secondary prevention and had very low incorporation of new therapies in Brazil. Large-scale populational interventions addressing these gaps are warranted to improve the use of evidence-based therapies and reduce the burden of atherothrombotic disease.ClinicalTrials.gov NCT04677725

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