Dario Sobral | Universidade de Pernambuco - UPE (Brasil) (original) (raw)

Papers by Dario Sobral

IJC Heart & Vasculature, Dec 1, 2019

Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) ... more Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients in endemic areas is unknown, but can be estimated using predictive equations. Methods: We retrospectively analyzed all consecutive patients diagnosed with Sch-PAH referred to the Pronto SocorroCardiologico de Pernambuco between 2004 and 2010 using specific therapy and measured laboratory, diagnostic imaging, and baseline hemodynamic parameters. Observed and predicted survivals according to the National Institutes of Health (NIH) and Pulmonary Hypertension Connection (PHC) registry equations were compared by the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results: Sixty-eight patients (47 [69.1%] women) observed for a mean of 3.1 years (range, 7-72 months), median survival was 74 months, and 42 (61.7%) survived. The sex and age distributions were similar for functional class I/II and III/IV patients. Hemodynamic abnormalities were severe: mean right atrial pressure, 12.6 ± 6.2 mmHg; mean pulmonary artery pressure, 60.3 ± 13.69 mmHg; pulmonary vascular resistance, 14.62 ± 7.04 Wood units; and cardiac index, 2.3 ± 0.8 L/min/m 2. The usual idiopathic PAH predictors were not prognostic in Sch-PAH patients. The 1-, 3-and 5-year survival rates were 92.1%, 75.2%, and 50.8%, respectively, and those estimatedby the NIH and PHC registry equations were 68%, 45% and 32% (p = 0.001), and 93%, 79% and 68% (p = 0.340), respectively. Conclusions: Sch-PAH patients in endemic areas have severe hemodynamic profiles and reduced long-term survivaldespite treatment. The PHC registry equation may be a useful tool to estimate survival in Sch-PAH.

Revista portuguesa de cardiologia, 2015

Background: Impaired heart rate (HR) recovery after exercise testing is considered a predictor of... more Background: Impaired heart rate (HR) recovery after exercise testing is considered a predictor of cardiovascular mortality as it reflects vagus nerve dysfunction. Objective: To assess the relationship between body mass index (BMI) and HR recovery after exercise. Methods: We analyzed the records of 2443 patients of both sexes, aged between 20 and 59 years, in sinus rhythm, not using negative chronotropic agents and with no myocardial ischemic response to exercise testing carried out at a specialist clinic, between 2005 and 2011. BMI was categorized as normal (18.5-<25 kg/m 2), overweight (25-≤30 kg/m 2) or obese (>30 kg/m 2). The different BMI groups were compared in terms of HR recovery after exercise, which was calculated as the difference between maximum HR during exercise and in the first minute of recovery. Recovery was considered impaired when the difference was ≤12 bpm. Results: Eighty-seven (3.6%) patients presented impaired recovery, which was three times more prevalent in the obese group and twice as prevalent in the overweight group compared with the normal group (p<0.001 and p=0.010, respectively). Obese patients presented higher basal HR and lower maximum HR, as well as reduced chronotropic reserve (p<0.001). In multivariate analysis, impaired HR recovery was associated with overweight (relative risk [RR]=1.8; p=0.035), obesity (RR=2; p=0.016), number of metabolic equivalents (RR=0.82; p<0.001) and resting HR (RR=1.05; p<0.001). The hazard ratio for hypertension was 2 (p=0.083, NS). Conclusion: Impaired HR recovery was associated with higher BMI, demonstrating that obese individuals present vagus nerve dysfunction.

Objective: Platelet activation and consumption are common in critically ill patients and are asso... more Objective: Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Inflammatory and thrombotic conditions may alter platelet size, which can be detected on routine blood cell analysis by evaluation of mean platelet volume. The aim of the present study was to investigate the evaluation of platelet parameters as a predictor of all-cause mortality in cardiac intensive care unit (ICU) patients. Methods: Platelet count and mean platelet volume were measured daily in cardiac ICU and were classified in three categories of thrombocytopenia, according to the average value of platelet count during hospitalization: mild (100-149 X 109/L), moderate (50-99 X 109/L) and severe (<50 X 109/L). We excluded patients younger than 18 years, pregnant women, with cancer or hematological disease, who have had previous use of steroids or chemotherapy, those that were readmitted after hospital discharge and patients who died in the first 24 hrs ...

International Journal of Cardiovascular Sciences, 2020

Acute myocardial infarction (AMI) is one of the most important cardiovascular diseases, leading t... more Acute myocardial infarction (AMI) is one of the most important cardiovascular diseases, leading to disability and death worldwide. Atherosclerosis is the main etiology of AMI, which is characterized by a series of highly specific cellular and molecular responses that can best be described, in aggregate, as an inflammatory disease.1 Risk factors such as arterial hypertension, diabetes mellitus, smoking, dyslipidemia, obesity, emotional stress and family history are not, in themselves, sufficient for in-hospital risk assessment of patients with AMI. Recently, several studies have found an association between oxidative stress, due to inflammation, and hypoxemia processes, with hematological changes and coronary arterial diseases, suggesting their usefulness in identifying the risk of death. These studies have shown the association of hematological parameters with prognostic biomarkers in patients with coronary artery disease.2-6 This issue of the International Journal of Cardiovascular...

Reblampa Rev Bras Latinoam Marcapasso Arritmia, Jun 1, 2000

The Signal-Averaged Electrocardiogram (SAECG) is a register obtained through amplifying technique... more The Signal-Averaged Electrocardiogram (SAECG) is a register obtained through amplifying techniques of high frequency and low amplitude electric signals which allow the detection of low voltage electric potentials that may occur in the terminal portion of the QRS and represent areas of slow and fractionate electric conduction. The presence of these potentials has been regarded as a foretelling factor in fatal arrhythmic events, being therefore useful in sudden death prevention, especially in ischemic heart disease where its diagnostic value is already well established. Although still under investigation, its use has been extended to heart diseases of other aetiologies and other situations such as in the pre-operative period of heart surgery, after thrombolytic therapy and in syncope investigation. This revision aims to an updated approach of the method, its clinical use and limitations. DESCRIPTORS: signal-averaged electrocardiography, late potentials, ventricular tachycardia, sudden death, syncope. Reblampa 78024-266

Journal of the American College of Cardiology, 2014

Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) ... more Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients in endemic areas is unknown, but can be estimated using predictive equations. Methods: We retrospectively analyzed all consecutive patients diagnosed with Sch-PAH referred to the Pronto SocorroCardiologico de Pernambuco between 2004 and 2010 using specific therapy and measured laboratory, diagnostic imaging, and baseline hemodynamic parameters. Observed and predicted survivals according to the National Institutes of Health (NIH) and Pulmonary Hypertension Connection (PHC) registry equations were compared by the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results: Sixty-eight patients (47 [69.1%] women) observed for a mean of 3.1 years (range, 7-72 months), median survival was 74 months, and 42 (61.7%) survived. The sex and age distributions were similar for functional class I/II and III/IV patients. Hemodynamic abnormalities were severe: mean right atrial pressure, 12.6 ± 6.2 mmHg; mean pulmonary artery pressure, 60.3 ± 13.69 mmHg; pulmonary vascular resistance, 14.62 ± 7.04 Wood units; and cardiac index, 2.3 ± 0.8 L/min/m 2. The usual idiopathic PAH predictors were not prognostic in Sch-PAH patients. The 1-, 3-and 5-year survival rates were 92.1%, 75.2%, and 50.8%, respectively, and those estimatedby the NIH and PHC registry equations were 68%, 45% and 32% (p = 0.001), and 93%, 79% and 68% (p = 0.340), respectively. Conclusions: Sch-PAH patients in endemic areas have severe hemodynamic profiles and reduced long-term survivaldespite treatment. The PHC registry equation may be a useful tool to estimate survival in Sch-PAH.

Sao Paulo Medical Journal

INTRODUCTION Coronary artery disease is a condition characterized by increased atherosclerotic pl... more INTRODUCTION Coronary artery disease is a condition characterized by increased atherosclerotic plaque in the epicardial arteries and is associated with high morbidity and mortality. Coronary artery disease accounts for nearly 360,000 events per year 1 in the United States, among which most occur in the hospital setting, and many events evolve to death before the patients are transported to the emergency room. 1 In the first six months of 2019, 137,713 hospitalizations due to coronary artery disease were recorded in Brazil, and 5.8% culminated in inhospital death. 2 Some clinical factors and complementary test markers help in the prognostic evaluation of coronary artery disease. Among these, the following can be highlighted: advanced age, male gender, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking and myocardial dysfunction. 3,4 However, the impairment of cardiac vagal activity over the first year after a diagnosis of myocardial infarction has been made is also a good indicator for identifying the development of heart disease and sudden death over the short and medium term. 5-7 Analysis on the behavior of heart rate turbulence (HRT), obtained through 24-hour Holter monitoring, is one of the easiest and most efficient means for assessing cardiac autonomic dysfunction. 8 Sade et al. 8 found that HRT was similar to the ejection fraction in an assessment of the prognosis of 128 individuals post-infarction. On the other hand, the Innovative Stratification of Arrythmic Risk-Heart Rate Turbulence (ISAR-HRT) 9 study showed that altered HRT parameters increased the risk of death almost sixfold, in a prospective analysis on 1,500 survivors of myocardial infarction analyzed over a 22-month period. This risk exceeded the risks attributed to severe ventricular dysfunction, diabetes mellitus and age over 65 years.

Current Cardiology Reviews

Obesity, a chronic disease established as a global epidemic by the World Health Organization, is ... more Obesity, a chronic disease established as a global epidemic by the World Health Organization, is considered a risk factor for atrial fibrillation (AF), the most common sustained cardiac arrhythmia, which has high morbidity and mortality. Although both obesity and AF are diseases associated with negative outcomes, studies have shown the presence of an obesity paradox, in which patients with a high body mass index (BMI) and AF have a better prognosis than patients with a normal BMI. Despite the fact that the mechanisms that lead to this paradox are still uncertain, adequate anticoagulation in obese patients seems to play an important role in reducing adverse events in this group. In this perspective article, the authors discuss the relationship between new oral anticoagulants (NOACs), namely, apixaban, edoxaban and rivaroxaban (factor Xa inhibitors) and dabigatran (direct inhibitor of thrombin), and the obesity paradox, seeking to deepen the understanding of the mechanism that leads to this paradox.

European Heart Journal - Case Reports, 2021

Arquivos Brasileiros de Cardiologia, 2019

Cardiovascular diseases (CVD) are the leading cause of death in the world, with coronary heart di... more Cardiovascular diseases (CVD) are the leading cause of death in the world, with coronary heart disease being the main etiology, accounting in 2016 for 31% of global deaths. 1 Myocardial infarction (MI) is usually due to changes in the arterial wall or thrombotic occlusion of a coronary vessel caused by the rupture of a vulnerable plaque. 1,2 Instability in the atherosclerotic plaque is the result of local and systemic oxidative stress, thus leading to platelet activation and formation of aggregates in the circulation. 3 The major function of platelets is as part of the homeostatic mechanism, halting blood loss after tissue trauma, but in oxidative conditions, they are associated with various CVD such as hypertension, heart failure, stroke, diabetes and atherosclerosis. 3

Journal of Substance Use, 2019

Objective: The aims of the present research were to determine the prevalence of the use of dietar... more Objective: The aims of the present research were to determine the prevalence of the use of dietary supplements and anabolic-androgenic steroids (AAS) without professional guidance in the countryside of Northeastern Brazil, and to compare blood pressure (BP) between nonusers of dietary supplements, thermogenic supplement users and AAS users. Methods: The sample consisted of 346 resistance training (RT) practitioners and bodybuilders. The participants answered a questionnaire on the use of dietary supplements and/or AAS. In addition, the participants underwent BP assessment. Results: 76.9% of the sample consumed dietary supplements and AAS at some point in their lives. 66.8% (95% CI: 61.5-71.7) of our sample used only food supplements without any guidance from a qualified professional. AAS and cosmetic doping was reported by 8.1% (95%CI: 5.6-11.2%) and 2.0% (95%CI: 1.0-4.2%) of the sample, respectively. Regarding BP, a significant difference was observed for systolic BP when nonusers of dietary supplements were compared to users of thermogenic supplements (126.5 ± 15.1 mmHg s. 134.7 ± 14.5 mmHg; p= .034) and when compared to AAS users (126.5 ± 15.1 mmHg vs. 136.6 ± 12.2 mmHg; p= .010). Conclusions: Our findings point to excessive consumption of dietary supplements and AAS (without professional guidance) by RT practitioners and bodybuilders. In addition, we observed high systolic blood pressure in users of thermogenic supplements and AAS users.

(SP), Goiânia (GO), Recife (PE), Brasília (DF)Belo Horizonte (MG) Objetivo-Avaliar através de ens... more (SP), Goiânia (GO), Recife (PE), Brasília (DF)Belo Horizonte (MG) Objetivo-Avaliar através de ensaio clínico prospectivo, randomizado, duplo-cego cruzado contra placebo, a eficácia do sotalol na dose oral de 320mg diários em reduzir taquiarritmias ventriculares não sustentadas (TVNS). Métodos-Foram avaliados em condições de controle (Ct), placebo (Pb) e droga (Dg), 90 portadores de um número médio 2³50 extra-sístoles horárias (EV), com ou sem respostas pareadas (RP) e TVNS, registradas no Holter. Considerou-se a droga como efetiva, frente a uma redução ³75% das EV e ³90% das RP e TVNS. Avaliaram-se os resultados globais e os observados em doenças específicas, incluindo a cardiopatia chagásica crônica, arritmias ventriculares idiopáticas e doença coronariana e hipertensiva sistêmica. Resultados-Não ocorreram diferenças significativas entre Ct e Pb. Globalmente, a droga reduziu as EV em 42% (38/90 pacientes), as RP em 48% (32/67 e as TVNS em 53% (19/36), com médias respectivas entre Pb e Dg de 11.770±13.818 para 1.043±1.554 nas EV (p<0,001); de 439±586 para 27±52 nas RP (p<0,001) e de 445±1.147 para 2,5±5,8 nas TVNS (p<0,102). Nos chagásicos, redução das EV de 33% (13/39 pacientes), das RP em 42% (14/ 34) e das TVNS em 64% (12/22). Nos idiopáticos, a redução das EV foi de 53% (17/32 pacientes), das RP de 50% (10/20) e das TVNS de 36% (4/11). Nos isquêmicos e/ou hipertensos, a redução das EV foi de 47% (7/15 pacientes) e de 73% nas RP (8/11). Conclusão-Na população estudada e na dose indicada, o sotalol mostrou ser um fármaco efetivo para controle de TVNS, apresentando mínimos efeitos colaterais.

Journal of Bodywork and Movement Therapies, 2019

BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in he... more BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in heart rate variability (HRV) with lower patient overload, and consequently reduce cardiovascular risk in renal transplant patients. The aim of this study was to evaluate the effects of a 12-week WBV training program of two weekly sessions on HRV. METHODS A double-blind, randomized controlled clinical trial with 12 kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBV Group) and training with sub-therapeutic WBV (8 Hz) (Sham Group). Variables were evaluated in time and frequency domains of HRV through the 24-h Holter monitor, heart rate (HR), blood pressure (BP) and maximum oxygen consumption (VO2max) through an exercise stress test. RESULTS The delta between Sham and WBV groups showed an increase in the low frequency (Δ = 959.05 Hz; p = 0.01) and in the high frequency (Δ = 204.42 Hz; p = 0.04) of the HRV compared to Sham group. No changes in the ergometric variables were observed for any of the groups. CONCLUSION The present study evidenced an increase in the low and high frequency of HRV in individuals who participated in the Sham WBV group. There was no improvement in the autonomic balance in the groups, in the other HRV parameters, or the exercise test after the WBV training period.

International Journal of Therapy and Rehabilitation, 2019

Background/Aims Whole body vibration is an exercise alternative that can be used in the rehabilit... more Background/Aims Whole body vibration is an exercise alternative that can be used in the rehabilitation of renal transplant recipients with the aim of reducing cardiovascular risk. The aim of this study was to evaluate the effects of whole body vibration training on heart rate variability, cardiorespiratory parameters and functional capacity on five renal transplant recipients. Methods Renal transplant recipients underwent whole body vibration exercise twice a week for a total of 12 weeks. All participants were monitored using the 24-hour Holter to evaluate the heart rate variability domains. An exercise test to evaluate maximal oxygen consumption and the distance walked in the Six-Minute Walk Test to evaluate functional capacity were also recorded. Results Overall, two of the five transplant recipients improved sympathovagal balance at the end of the study. Maximal oxygen consumption improved in three transplanted patients, and the distance walked improved for two patients. The resu...

Arquivos Brasileiros de Cardiologia, 2019

Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment ... more Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment of doctors who, in final analysis, must determine which treatments are appropriate for their patients.

International journal of innovative research in medical science, Jul 24, 2019

Marfan syndrome (MS) is an autosomal dominant inherited connective tissue disease. The systemic c... more Marfan syndrome (MS) is an autosomal dominant inherited connective tissue disease. The systemic complications of this disorder occur due to osteo-articular, cardiovascular, and ophthalmologic alterations. The cardiovascular involvement of MS is characterized mainly by aortic root and arch changes, resulting in increased susceptibility for the development of aneurysms. In the present study, we describe a case of type B abdominal aortic dissection in a patient with MS followed by spinal cord ischemia that rapidly evolved to paraplegia. Although rare, medullary ischemia is associated with a poor prognosis, as noted in the present case, wherein the patient died.

ABC Imagem Cardiovascular, 2018

International journal of innovative research in medical science, Oct 21, 2019

Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardia... more Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction, which occurs in about 0.2 to 0.3% of patients with myocardial ischemia. If early therapy is not initiated, 90% of patients with VSR will die within the first month. This study aimed to evaluate the epidemiological and clinical characteristics of patients with VSR as a mechanical complication of acute myocardial infarction. Methods: A prospective study was conducted among nine patients who presented to the Cardiovascular Emergency Room of Pernambuco with acute coronary syndrome with ST segment elevation and VSR complications. Results: There were five women and 4 men, and the mean age of the patients was 72.5 years. The median time from the onset of the symptoms of acute coronary syndrome with ST segment elevation to the diagnosis of VSR was 3.5 days. Among the nine patients included in the study, three were treated surgically. Of all the patients, including those who underwent corrective surgery, eight patients died, 44.4% (N = 4), in the first four days after AMI. Conclusion: VSR occurs more frequently among elderly patients with multi-arterial involvement, lower wall infarction, and involvement of the right coronary artery. The prognosis is extremely limited, especially in patients who are already admitted to the cardiac emergency room with Killip IV, with > 24 hours of clinical evolution, and do not require surgical correction.

IJC Heart & Vasculature, Dec 1, 2019

Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) ... more Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients in endemic areas is unknown, but can be estimated using predictive equations. Methods: We retrospectively analyzed all consecutive patients diagnosed with Sch-PAH referred to the Pronto SocorroCardiologico de Pernambuco between 2004 and 2010 using specific therapy and measured laboratory, diagnostic imaging, and baseline hemodynamic parameters. Observed and predicted survivals according to the National Institutes of Health (NIH) and Pulmonary Hypertension Connection (PHC) registry equations were compared by the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results: Sixty-eight patients (47 [69.1%] women) observed for a mean of 3.1 years (range, 7-72 months), median survival was 74 months, and 42 (61.7%) survived. The sex and age distributions were similar for functional class I/II and III/IV patients. Hemodynamic abnormalities were severe: mean right atrial pressure, 12.6 ± 6.2 mmHg; mean pulmonary artery pressure, 60.3 ± 13.69 mmHg; pulmonary vascular resistance, 14.62 ± 7.04 Wood units; and cardiac index, 2.3 ± 0.8 L/min/m 2. The usual idiopathic PAH predictors were not prognostic in Sch-PAH patients. The 1-, 3-and 5-year survival rates were 92.1%, 75.2%, and 50.8%, respectively, and those estimatedby the NIH and PHC registry equations were 68%, 45% and 32% (p = 0.001), and 93%, 79% and 68% (p = 0.340), respectively. Conclusions: Sch-PAH patients in endemic areas have severe hemodynamic profiles and reduced long-term survivaldespite treatment. The PHC registry equation may be a useful tool to estimate survival in Sch-PAH.

Revista portuguesa de cardiologia, 2015

Background: Impaired heart rate (HR) recovery after exercise testing is considered a predictor of... more Background: Impaired heart rate (HR) recovery after exercise testing is considered a predictor of cardiovascular mortality as it reflects vagus nerve dysfunction. Objective: To assess the relationship between body mass index (BMI) and HR recovery after exercise. Methods: We analyzed the records of 2443 patients of both sexes, aged between 20 and 59 years, in sinus rhythm, not using negative chronotropic agents and with no myocardial ischemic response to exercise testing carried out at a specialist clinic, between 2005 and 2011. BMI was categorized as normal (18.5-<25 kg/m 2), overweight (25-≤30 kg/m 2) or obese (>30 kg/m 2). The different BMI groups were compared in terms of HR recovery after exercise, which was calculated as the difference between maximum HR during exercise and in the first minute of recovery. Recovery was considered impaired when the difference was ≤12 bpm. Results: Eighty-seven (3.6%) patients presented impaired recovery, which was three times more prevalent in the obese group and twice as prevalent in the overweight group compared with the normal group (p<0.001 and p=0.010, respectively). Obese patients presented higher basal HR and lower maximum HR, as well as reduced chronotropic reserve (p<0.001). In multivariate analysis, impaired HR recovery was associated with overweight (relative risk [RR]=1.8; p=0.035), obesity (RR=2; p=0.016), number of metabolic equivalents (RR=0.82; p<0.001) and resting HR (RR=1.05; p<0.001). The hazard ratio for hypertension was 2 (p=0.083, NS). Conclusion: Impaired HR recovery was associated with higher BMI, demonstrating that obese individuals present vagus nerve dysfunction.

Objective: Platelet activation and consumption are common in critically ill patients and are asso... more Objective: Platelet activation and consumption are common in critically ill patients and are associated with poorer prognosis. Inflammatory and thrombotic conditions may alter platelet size, which can be detected on routine blood cell analysis by evaluation of mean platelet volume. The aim of the present study was to investigate the evaluation of platelet parameters as a predictor of all-cause mortality in cardiac intensive care unit (ICU) patients. Methods: Platelet count and mean platelet volume were measured daily in cardiac ICU and were classified in three categories of thrombocytopenia, according to the average value of platelet count during hospitalization: mild (100-149 X 109/L), moderate (50-99 X 109/L) and severe (<50 X 109/L). We excluded patients younger than 18 years, pregnant women, with cancer or hematological disease, who have had previous use of steroids or chemotherapy, those that were readmitted after hospital discharge and patients who died in the first 24 hrs ...

International Journal of Cardiovascular Sciences, 2020

Acute myocardial infarction (AMI) is one of the most important cardiovascular diseases, leading t... more Acute myocardial infarction (AMI) is one of the most important cardiovascular diseases, leading to disability and death worldwide. Atherosclerosis is the main etiology of AMI, which is characterized by a series of highly specific cellular and molecular responses that can best be described, in aggregate, as an inflammatory disease.1 Risk factors such as arterial hypertension, diabetes mellitus, smoking, dyslipidemia, obesity, emotional stress and family history are not, in themselves, sufficient for in-hospital risk assessment of patients with AMI. Recently, several studies have found an association between oxidative stress, due to inflammation, and hypoxemia processes, with hematological changes and coronary arterial diseases, suggesting their usefulness in identifying the risk of death. These studies have shown the association of hematological parameters with prognostic biomarkers in patients with coronary artery disease.2-6 This issue of the International Journal of Cardiovascular...

Reblampa Rev Bras Latinoam Marcapasso Arritmia, Jun 1, 2000

The Signal-Averaged Electrocardiogram (SAECG) is a register obtained through amplifying technique... more The Signal-Averaged Electrocardiogram (SAECG) is a register obtained through amplifying techniques of high frequency and low amplitude electric signals which allow the detection of low voltage electric potentials that may occur in the terminal portion of the QRS and represent areas of slow and fractionate electric conduction. The presence of these potentials has been regarded as a foretelling factor in fatal arrhythmic events, being therefore useful in sudden death prevention, especially in ischemic heart disease where its diagnostic value is already well established. Although still under investigation, its use has been extended to heart diseases of other aetiologies and other situations such as in the pre-operative period of heart surgery, after thrombolytic therapy and in syncope investigation. This revision aims to an updated approach of the method, its clinical use and limitations. DESCRIPTORS: signal-averaged electrocardiography, late potentials, ventricular tachycardia, sudden death, syncope. Reblampa 78024-266

Journal of the American College of Cardiology, 2014

Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) ... more Background: The survival of schistosomiasis-associated pulmonary arterial hypertension (Sch-PAH) patients in endemic areas is unknown, but can be estimated using predictive equations. Methods: We retrospectively analyzed all consecutive patients diagnosed with Sch-PAH referred to the Pronto SocorroCardiologico de Pernambuco between 2004 and 2010 using specific therapy and measured laboratory, diagnostic imaging, and baseline hemodynamic parameters. Observed and predicted survivals according to the National Institutes of Health (NIH) and Pulmonary Hypertension Connection (PHC) registry equations were compared by the Kaplan-Meier method, log-rank test and Cox proportional hazards model. Results: Sixty-eight patients (47 [69.1%] women) observed for a mean of 3.1 years (range, 7-72 months), median survival was 74 months, and 42 (61.7%) survived. The sex and age distributions were similar for functional class I/II and III/IV patients. Hemodynamic abnormalities were severe: mean right atrial pressure, 12.6 ± 6.2 mmHg; mean pulmonary artery pressure, 60.3 ± 13.69 mmHg; pulmonary vascular resistance, 14.62 ± 7.04 Wood units; and cardiac index, 2.3 ± 0.8 L/min/m 2. The usual idiopathic PAH predictors were not prognostic in Sch-PAH patients. The 1-, 3-and 5-year survival rates were 92.1%, 75.2%, and 50.8%, respectively, and those estimatedby the NIH and PHC registry equations were 68%, 45% and 32% (p = 0.001), and 93%, 79% and 68% (p = 0.340), respectively. Conclusions: Sch-PAH patients in endemic areas have severe hemodynamic profiles and reduced long-term survivaldespite treatment. The PHC registry equation may be a useful tool to estimate survival in Sch-PAH.

Sao Paulo Medical Journal

INTRODUCTION Coronary artery disease is a condition characterized by increased atherosclerotic pl... more INTRODUCTION Coronary artery disease is a condition characterized by increased atherosclerotic plaque in the epicardial arteries and is associated with high morbidity and mortality. Coronary artery disease accounts for nearly 360,000 events per year 1 in the United States, among which most occur in the hospital setting, and many events evolve to death before the patients are transported to the emergency room. 1 In the first six months of 2019, 137,713 hospitalizations due to coronary artery disease were recorded in Brazil, and 5.8% culminated in inhospital death. 2 Some clinical factors and complementary test markers help in the prognostic evaluation of coronary artery disease. Among these, the following can be highlighted: advanced age, male gender, systemic arterial hypertension, diabetes mellitus, dyslipidemia, smoking and myocardial dysfunction. 3,4 However, the impairment of cardiac vagal activity over the first year after a diagnosis of myocardial infarction has been made is also a good indicator for identifying the development of heart disease and sudden death over the short and medium term. 5-7 Analysis on the behavior of heart rate turbulence (HRT), obtained through 24-hour Holter monitoring, is one of the easiest and most efficient means for assessing cardiac autonomic dysfunction. 8 Sade et al. 8 found that HRT was similar to the ejection fraction in an assessment of the prognosis of 128 individuals post-infarction. On the other hand, the Innovative Stratification of Arrythmic Risk-Heart Rate Turbulence (ISAR-HRT) 9 study showed that altered HRT parameters increased the risk of death almost sixfold, in a prospective analysis on 1,500 survivors of myocardial infarction analyzed over a 22-month period. This risk exceeded the risks attributed to severe ventricular dysfunction, diabetes mellitus and age over 65 years.

Current Cardiology Reviews

Obesity, a chronic disease established as a global epidemic by the World Health Organization, is ... more Obesity, a chronic disease established as a global epidemic by the World Health Organization, is considered a risk factor for atrial fibrillation (AF), the most common sustained cardiac arrhythmia, which has high morbidity and mortality. Although both obesity and AF are diseases associated with negative outcomes, studies have shown the presence of an obesity paradox, in which patients with a high body mass index (BMI) and AF have a better prognosis than patients with a normal BMI. Despite the fact that the mechanisms that lead to this paradox are still uncertain, adequate anticoagulation in obese patients seems to play an important role in reducing adverse events in this group. In this perspective article, the authors discuss the relationship between new oral anticoagulants (NOACs), namely, apixaban, edoxaban and rivaroxaban (factor Xa inhibitors) and dabigatran (direct inhibitor of thrombin), and the obesity paradox, seeking to deepen the understanding of the mechanism that leads to this paradox.

European Heart Journal - Case Reports, 2021

Arquivos Brasileiros de Cardiologia, 2019

Cardiovascular diseases (CVD) are the leading cause of death in the world, with coronary heart di... more Cardiovascular diseases (CVD) are the leading cause of death in the world, with coronary heart disease being the main etiology, accounting in 2016 for 31% of global deaths. 1 Myocardial infarction (MI) is usually due to changes in the arterial wall or thrombotic occlusion of a coronary vessel caused by the rupture of a vulnerable plaque. 1,2 Instability in the atherosclerotic plaque is the result of local and systemic oxidative stress, thus leading to platelet activation and formation of aggregates in the circulation. 3 The major function of platelets is as part of the homeostatic mechanism, halting blood loss after tissue trauma, but in oxidative conditions, they are associated with various CVD such as hypertension, heart failure, stroke, diabetes and atherosclerosis. 3

Journal of Substance Use, 2019

Objective: The aims of the present research were to determine the prevalence of the use of dietar... more Objective: The aims of the present research were to determine the prevalence of the use of dietary supplements and anabolic-androgenic steroids (AAS) without professional guidance in the countryside of Northeastern Brazil, and to compare blood pressure (BP) between nonusers of dietary supplements, thermogenic supplement users and AAS users. Methods: The sample consisted of 346 resistance training (RT) practitioners and bodybuilders. The participants answered a questionnaire on the use of dietary supplements and/or AAS. In addition, the participants underwent BP assessment. Results: 76.9% of the sample consumed dietary supplements and AAS at some point in their lives. 66.8% (95% CI: 61.5-71.7) of our sample used only food supplements without any guidance from a qualified professional. AAS and cosmetic doping was reported by 8.1% (95%CI: 5.6-11.2%) and 2.0% (95%CI: 1.0-4.2%) of the sample, respectively. Regarding BP, a significant difference was observed for systolic BP when nonusers of dietary supplements were compared to users of thermogenic supplements (126.5 ± 15.1 mmHg s. 134.7 ± 14.5 mmHg; p= .034) and when compared to AAS users (126.5 ± 15.1 mmHg vs. 136.6 ± 12.2 mmHg; p= .010). Conclusions: Our findings point to excessive consumption of dietary supplements and AAS (without professional guidance) by RT practitioners and bodybuilders. In addition, we observed high systolic blood pressure in users of thermogenic supplements and AAS users.

(SP), Goiânia (GO), Recife (PE), Brasília (DF)Belo Horizonte (MG) Objetivo-Avaliar através de ens... more (SP), Goiânia (GO), Recife (PE), Brasília (DF)Belo Horizonte (MG) Objetivo-Avaliar através de ensaio clínico prospectivo, randomizado, duplo-cego cruzado contra placebo, a eficácia do sotalol na dose oral de 320mg diários em reduzir taquiarritmias ventriculares não sustentadas (TVNS). Métodos-Foram avaliados em condições de controle (Ct), placebo (Pb) e droga (Dg), 90 portadores de um número médio 2³50 extra-sístoles horárias (EV), com ou sem respostas pareadas (RP) e TVNS, registradas no Holter. Considerou-se a droga como efetiva, frente a uma redução ³75% das EV e ³90% das RP e TVNS. Avaliaram-se os resultados globais e os observados em doenças específicas, incluindo a cardiopatia chagásica crônica, arritmias ventriculares idiopáticas e doença coronariana e hipertensiva sistêmica. Resultados-Não ocorreram diferenças significativas entre Ct e Pb. Globalmente, a droga reduziu as EV em 42% (38/90 pacientes), as RP em 48% (32/67 e as TVNS em 53% (19/36), com médias respectivas entre Pb e Dg de 11.770±13.818 para 1.043±1.554 nas EV (p<0,001); de 439±586 para 27±52 nas RP (p<0,001) e de 445±1.147 para 2,5±5,8 nas TVNS (p<0,102). Nos chagásicos, redução das EV de 33% (13/39 pacientes), das RP em 42% (14/ 34) e das TVNS em 64% (12/22). Nos idiopáticos, a redução das EV foi de 53% (17/32 pacientes), das RP de 50% (10/20) e das TVNS de 36% (4/11). Nos isquêmicos e/ou hipertensos, a redução das EV foi de 47% (7/15 pacientes) e de 73% nas RP (8/11). Conclusão-Na população estudada e na dose indicada, o sotalol mostrou ser um fármaco efetivo para controle de TVNS, apresentando mínimos efeitos colaterais.

Journal of Bodywork and Movement Therapies, 2019

BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in he... more BACKGROUND Whole-body vibration (WBV) is an exercise modality that can promote improvements in heart rate variability (HRV) with lower patient overload, and consequently reduce cardiovascular risk in renal transplant patients. The aim of this study was to evaluate the effects of a 12-week WBV training program of two weekly sessions on HRV. METHODS A double-blind, randomized controlled clinical trial with 12 kidney transplant recipients of both genders who underwent WBV training (35 Hz) twice a week for 12 weeks on alternate days (WBV Group) and training with sub-therapeutic WBV (8 Hz) (Sham Group). Variables were evaluated in time and frequency domains of HRV through the 24-h Holter monitor, heart rate (HR), blood pressure (BP) and maximum oxygen consumption (VO2max) through an exercise stress test. RESULTS The delta between Sham and WBV groups showed an increase in the low frequency (Δ = 959.05 Hz; p = 0.01) and in the high frequency (Δ = 204.42 Hz; p = 0.04) of the HRV compared to Sham group. No changes in the ergometric variables were observed for any of the groups. CONCLUSION The present study evidenced an increase in the low and high frequency of HRV in individuals who participated in the Sham WBV group. There was no improvement in the autonomic balance in the groups, in the other HRV parameters, or the exercise test after the WBV training period.

International Journal of Therapy and Rehabilitation, 2019

Background/Aims Whole body vibration is an exercise alternative that can be used in the rehabilit... more Background/Aims Whole body vibration is an exercise alternative that can be used in the rehabilitation of renal transplant recipients with the aim of reducing cardiovascular risk. The aim of this study was to evaluate the effects of whole body vibration training on heart rate variability, cardiorespiratory parameters and functional capacity on five renal transplant recipients. Methods Renal transplant recipients underwent whole body vibration exercise twice a week for a total of 12 weeks. All participants were monitored using the 24-hour Holter to evaluate the heart rate variability domains. An exercise test to evaluate maximal oxygen consumption and the distance walked in the Six-Minute Walk Test to evaluate functional capacity were also recorded. Results Overall, two of the five transplant recipients improved sympathovagal balance at the end of the study. Maximal oxygen consumption improved in three transplanted patients, and the distance walked improved for two patients. The resu...

Arquivos Brasileiros de Cardiologia, 2019

Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment ... more Note: The purpose of these Guidelines is to inform. They do not substitute the clinical judgment of doctors who, in final analysis, must determine which treatments are appropriate for their patients.

International journal of innovative research in medical science, Jul 24, 2019

Marfan syndrome (MS) is an autosomal dominant inherited connective tissue disease. The systemic c... more Marfan syndrome (MS) is an autosomal dominant inherited connective tissue disease. The systemic complications of this disorder occur due to osteo-articular, cardiovascular, and ophthalmologic alterations. The cardiovascular involvement of MS is characterized mainly by aortic root and arch changes, resulting in increased susceptibility for the development of aneurysms. In the present study, we describe a case of type B abdominal aortic dissection in a patient with MS followed by spinal cord ischemia that rapidly evolved to paraplegia. Although rare, medullary ischemia is associated with a poor prognosis, as noted in the present case, wherein the patient died.

ABC Imagem Cardiovascular, 2018

International journal of innovative research in medical science, Oct 21, 2019

Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardia... more Objective: Ventricular septal rupture (VSR) is a rare but serious complication of acute myocardial infarction, which occurs in about 0.2 to 0.3% of patients with myocardial ischemia. If early therapy is not initiated, 90% of patients with VSR will die within the first month. This study aimed to evaluate the epidemiological and clinical characteristics of patients with VSR as a mechanical complication of acute myocardial infarction. Methods: A prospective study was conducted among nine patients who presented to the Cardiovascular Emergency Room of Pernambuco with acute coronary syndrome with ST segment elevation and VSR complications. Results: There were five women and 4 men, and the mean age of the patients was 72.5 years. The median time from the onset of the symptoms of acute coronary syndrome with ST segment elevation to the diagnosis of VSR was 3.5 days. Among the nine patients included in the study, three were treated surgically. Of all the patients, including those who underwent corrective surgery, eight patients died, 44.4% (N = 4), in the first four days after AMI. Conclusion: VSR occurs more frequently among elderly patients with multi-arterial involvement, lower wall infarction, and involvement of the right coronary artery. The prognosis is extremely limited, especially in patients who are already admitted to the cardiac emergency room with Killip IV, with > 24 hours of clinical evolution, and do not require surgical correction.