Cardiology Research and Reviews

  • EXTERNAL DEFIBRILLATION/ CARDIOVERSION PROTOCOL IN PATIENTS WITH AN IMPLANTED CARDIOVERTER DEFIBRILLATOR OR PACEMAKER: SYSTEMATIC REVIEW AND META-ANALYSIS

    Introduction: The use of cardiac implantable electronic devices (CIED) is increasing, and implanted patients require more often interventional procedures such as external defibrillation (ED) and electrical cardioversion (ECV). The creation of periprocedural care algorithms for patients with CIED is complex: the different programming capabilities of currently manufactured devices, confusion regarding the differences between pacemakers (PM) and implanted cardiac defibrillator (ICD), the use of old devices in some patients and lastly the continuous evolution in CIED technology with the introduction of leadless PM and subcutaneous implanted cardioverter defibrillators (S-ICD). Procedural advisories have been developed by professional societies, but the recommendations of these societies differ regarding to ED and ECV use. Methods: We performed a systematic database search of studies published between January 2000 and October 2021 assessing ED and ECV by the selection process (PRISMA) and identified 5 prospective eligible articles. Two meta-analyses assessed the proportion of patients with complications and the proportion of patients with no clinicallly relevant parameter modifications, respectively. Results: The final population for the meta-analysis included 2077 patients. The meta-analysis showed a weighted random pooled effect size of 0.55% (95% CI = 0.04% − 1.06 %) for complications, and of 22.4% (95% CI = 2.03% – 42.7%) for no clinically relevant modification parameters. Conclusions: Our review indicates that few dysfunctions are detectable in patients with chest implanted CIED treated with ECV or ED. When an impanted patient undergoes ECV or ED procedures, caution is needed including CIED interrogation before and after the procedure.

  • ABSENCE OF OXIDATIVE STRESS AND SIRTUINS RECRUITMENT ON CARDIAC TISSUE POST STRESS

    Stress has emerged as a factor associated with cardiovascular disease. Catecholamines released during the stress reaction by the sympathetic nerves and the adrenal medulla couple to β1-and β2-adrenoceptors in the cardiomyocytes membrane enhancing heart function in order to attend the organism demand. This might produce excessive reactive oxygen species what may culminate with oxidative stress and progression of several cardiac diseases. Sirtuins have been described as cardioprotective factors and important regulators of the cellular stress response in the heart. The aim of this work is to investigate the putative participation of oxidative stress and sirtuins in the heart of rats submitted to foot shock stress, an experimental model where there is up regulation of β2-adrenoceptors and downregulation of β1-adrenoceptors. The data have shown that in the myocardium of rats submitted to foot shock stress the H2O2 concentration, catalase and superoxide dismutase activity, NAD+/NADH ratio, as well as the protein expression of sirtuins 1 and 3 were not altered. Pharmacological blockade of the β2-adrenoceptors by ICI118,551, did not modify this scenario. It is concluded that foot shock stress does not cause disruptions in oxidative stress or redox state processes in the myocardium, and consequently, sirtuins are not recruited to stress response.

  • AN EASY AFFORDABLE STATISTICAL AND ECONOMIC (EASE) APPROACH TO AVOID UNNECESSARY AND EXPENSIVE EXAMS TO MONITOR PATIENTS WITH SMALL AAA

    Abdominal Aortic Aneurysm (AAA) is a localized enlargement of the abdominal aorta, such that the diameter exceeds 30 mm. AAA is a progressive growth leading to rupture, with high risk of mortality, therefore elective surgical repair is indicated when AAA diamenter is >55 mm. Screening programs, that use morphological imaging, have been developed internationally with the aim of detecting AAA before rupture with important limitations in term of cost and benefit for patients. Furthermore, different biochemical markers have been proposed to monitor AAA progression to overcome the above-mentioned limitations but none of them is used in the clinical practice. In fact, most of the biomarkers proposed are expensive and not feasible in the majority of laboratories. Combining different methodologies coming from Statistics and Operational Research fields, we developed an algorithm able to assess the importance of common biomarkers, requested in the clinical practice to evaluate the health of patient, and therefore no exams are required. Furthermore, we develop an Easy, Affordable Statistics and Economic (EASE) model able to identify if the AAA remain below the cut off for surgical repair. This prediction can provide guidance to how closely the patient’s abdominal aorta should be monitored avoiding additional and expensive exams.

  • LEFT VENTRICULAR LEAD IMPLANTATION FOR DETECTION OF VENTRICULAR ARRHYTHMIAS IN PATIENT WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR AND LOW R WAVE IN RIGHT VENTRICLE

    Dilated cardiomyopathy (DCM) is a disease characterised as left ventricular (LV) or biventricular dilatation with impaired systolic function. Regardless of underlying cause patients with DCM have a propensity to ventricular arrhythmias and sudden cardiac death. Implantable Cardioverter Defibrillator (ICD) implantation for these patients results in significant reduction of sudden cardiac death [1-3]. ICD devices may be limited by right ventricle (RV) sensing dysfunction with low RV sensing amplitude. We present a clinical case of patient with DCM, implanted ICD and low R wave sensing on RV lead.

  • ARSENIC SPECIES BINDING PROTEINS IN CARDIOVASCULAR TISSUES FROM CARDIAC PATIENTS OF CHILE

    The intracellular As-protein binding in cytosol and methanol–water extract of the auricle and saphene tissues of As impacted people was evaluated by bidimensional size exclusion FPLC-UV-ICP-MS. The fractionation of cytosol using Superdex, Phenomenex and MonoQ HR 5/5 columns, shows that As is distributed in a wide range of contiguous fractions of each column, being 8, 25, 50 % the percentages of As in the collected fractions, respectively. In the methanol: water extracts a similar study than performed with the cytosol using preparative gel chromatography on Sephadex G-75 and Shephadex G-100 columns and the MonoQ HR 5/5 anion protein exchange was carried out. A very low As (

  • THE RELATIONSHIP BETWEEN ADMINISTRATIVE FACTORS AND EFFECTIVENESS OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION REFERRAL SYSTEM AMONG THAI HOSPITALS

    Background: This descriptive study aimed to study the relationship between administrative factors and the effectiveness of the referral system of patients with acute ischemic heart disease in Thai hospitals. Materials and methods: The target population was 1,180 hospitals that serving heart disease in Thailand. Data were collected by using a questionnaire. A total of 1,022 response data were obtained. Administrative factors were analyzed using descriptive statistics, and the relationship was analyzed using multiple regression analysis (MRA) methods. Results: The study showed that the administrative factors which consisted of personnel, finance, supporting, and management factors had overall average readiness at a high level (x̄ = 3.34, S.D. = 0.27). Except budget sufficiency was at a low level (x̄ = 2.43, S.D. = 0.43). All factors were related to the mortality rate significantly, as follows: management factor (Adjusted R2 = 0.433), personnel factor (Adjusted R2 = 0.231), supporting factor (Adjusted R2 = 0.092) and financial factor (Adjusted R2 = 0.035). All factors were also significantly related to the timely cardiac catheterization rate, as follows: management factor (Adjusted R2 = 0.442), personnel factor (Adjusted R2 = 0.244), supporting factor (Adjusted R2 = 0.212) and financial factor (Adjusted R2 = 0.091). Conclusion: Thai Ministry of Public Health should provide adequate support for administrative factors, especially in terms of management, personnel, supporting factors, and budget sufficiency.

  • ANALYSE THE RISK FACTORS OF CORONARY HEART DISEASE IN YOUNG AND MIDDLE – AGED MALE PATIENTS USING MULTIVARIATE STATISTICAL

    Objective: To study the correlation between various risk factors and coronary CTA calcification score ( CACS ) in young and middle-aged male patients with coronary heart disease by multiple linear regression, and to predict plaque properties by Mahalanobis distance discrimination method. This study provides evidence for early clinical evaluation of the extent of coronary artery calcification and the property of plaque in patients having suffered coronary heart disease. Methods: choose 98 male patients under 55 years old with coronary heart disease randomly and collecte relevant medical history data and test results while in hospital.Utilizing the theory of multiple linear regression and Mahalanobis distance discriminant to analyse these dates. Results: Factors including hypertension classification×years, number of cigarettes smoked(packs / week )×years,and time of diabetes(years) have a positive correlation between CACS respectively. Comparing calcified plaque and vulnerable plaque, mixed plaque and vulnerable plaque,there is a significant differences ( p < 0.01) while hs-CRP and IL-6 are as the indicator. Mahalanobis distance discrimination method has a discrimination accuracy of 91.83 % for the group wrih susceptible factors only. Conclusion: The model of predicting the extent of coronary artery calcification by multiple linear regression has high reliability. Vulnerable plaques can be distinguished from plaques of other properties efficiently using Mahalanobis distance discrimination method.

  • ROLE OF MESENCHYMAL STEM CELLS IN CARDIOVASCULAR DISEASE

    In recent years, globally there is an incredible boost in stem cell research has kindled the expectations of both patients and physicians. Mesenchymal stem cells (MSCs) seem to represent a future powerful tool in regenerative medicine, owing to their availability, ease of manipulation, and therapeutic potential, therefore they are particularly important in medical research. Mesenchymal stem cells (MSCs) are capable self-renewing, multipotent progenitor cells with multilineage potential to differentiate into cell types, such as adipocytes, cardiomyocytes, endothelial cells and vascular smooth muscle cells, although the relative contribution of trilineage differentiation and paracrine effectors on cardiac repair. MSCs shows to have the beneficial effects of MSC-based therapies offers most attractive options to treatment of wide range of diseases from cartilage defects to cardiac disorders. Cardiovascular diseases (CVDs) are an important cause of death and disease worldwide. Because injured cardiac tissue cannot be repaired itself, it is urgent to develop other alternate therapies. Stem cells can be differentiated into cardiomyocytes, endothelial cells, and vascular smooth muscle cells for the treatment of CVDs. In addition to cardiac stem cells, mesenchymal stem cells represent another multipotent cell population in the heart; these cells are located in regions near pericytes and exhibit regenerative, angiogenic, antiapoptotic, and immunosuppressive properties.

  • NURSING INTERVENTIONS TO PATIENTS AFFECTED BY ACUTE MYOCARDIAL INFARCTION

    Objective: To identify and describe in the current literature nursing interventions for patients affected by acute myocardial infarction. Methods: This is an integrative literature review conducted with materials indexed in the Virtual Health Library (VHL), in the databases: BDENF, LILACS and MEDLINE. Using as descriptors: Assistance, Myocardial Infarction and Nursing, mediated by the Boolean operator AND. The inclusion criteria were: full text, available, free of charge, in Portuguese, published in the chronicity of time from 2015 to 2020 and which responds to the research theme. Results: After crossing the descriptors, 1701 publications were identified, of which were included in review 10 that met the established criteria. 04 on the basis of LILACS, 01 on MEDLINE and 05 on BDENF, with the following percentages: 40%, 10%, 50%, respectively. Conclusion: It is necessary to continually update the team’s chest pain protocol and approaches to patients affected with acute myocardial infarction, as they present constant changes. Thus, aiming at improvements in interventions, quality assistance, minimization of adverse events and maximization of patient safety.

  • ASSOCIATION BETWEEN THE NUTRITIONAL STATUS AND RISK OF CARDIOVASCULAR DISEASES IN PATIENTS WITH RHEUMATOID ARTHRITIS ACCOMPANIED IN A REFERENCE CENTER IN A BRAZIL NORTHEAST REFERENCE CENTER

    Introduction: Rheumatoid arthritis is an autoimmune and inflammatory disease, chronic and progressive, highly limiting, which can be aggravated when the nutritional status of this patient has dystrophy, so the body composition can influence the activity of this disease. Objective: To evaluate the association between nutritional status and the risk of cardiovascular disease in patients with rheumatoid arthritis in a reference center in the northeast. Material and Methods: Cross-sectional study carried out in a rheumatology clinic of a reference center in Northeast Brazil (Recife / PE) with patients with rheumatoid arthritis. Anthropometric measurements of weight and height were taken to assess the parameter of Body Mass Index (BMI). Measures of waist circumference (WC) and hip circumference (HC) were also taken to assess the parameters of waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR), in order to investigate cardiovascular risk. The data were treated using the SPSS version 17.0 for Windows and Excel 2010. For the correlation analysis, the Chi-square test was used. The level of significance was set at 5%. The Bioethics Research Committee of the Instituto de Medicina Integral Professor Fernando Figueira (IMIP) approved the present study under nº 19163619.1.0000.5201 the participants signed the Informed Consent Form (ICF). Results: The study included 54 patients aged between 18 and 58 years old and a mean age of 47.26 years +/- 11.72 SD, 96.3% of whom were female. 42.9% of the studied population had obesity according to the Body Mass Index, followed by 35.7% with overweight. According to WC 52.6% had an increased risk for cardiovascular diseases. WHR and WHtR found risk for cardiovascular diseases in 64.9% and 84.5%, respectively. The association between BMI and WC was 0.000 p-value, whereas for BMI and WHR, WHtR was 0.176 p-value and 0.095 p-value respectively. Conclusions: There was a prevalence of obesity and overweight in patients…