Publications by authors named "Dinaldo Cavalcanti de Oliveira"

20 Publications

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Beautiful death: point of view.

Rev Assoc Med Bras (1992) 2021 Apr;67(4):481-484

Univervidade Federal de Pernambuco, Programa de Pós-Graduação em Ciências da Saúde - Recife (PE), Brazil.

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http://dx.doi.org/10.1590/1806-9282.20200999DOI Listing
April 2021

Triggering receptor expressed on myeloid cells-1 as pediatric sepsis biomarker.

Rev Assoc Med Bras (1992) 2021 Mar;67(3):449-453

Universidade Federal de Pernambuco, Postgraduate Program in Therapeutic Innovation - Recife (PE), Brazil.

Objective: Triggering receptor expressed on myeloid cells-1 concentration can be used as a predictive, diagnostic, and prognostic marker in patients with sepsis. The objective of this study was to determine the validity of triggering receptor expressed on myeloid cells-1 levels as a biomarker of sepsis in pediatric patients.

Methods: This was an integrative literature review. PubMed, ScienceDirect, LILACS, MEDLINE, and VHL databases were searched for papers published between 2015 and 2020, using the keywords triggering receptor expressed on myeloid cells-1, sepsis, and child.

Results: The review included ten studies, of which four used triggering receptor expressed on myeloid cells-1 as a predictive biomarker; four, as a diagnostic biomarker; and two, as a prognostic biomarker. A total of 1,409 and 1,628 patients were included in primary and review studies, respectively. There was a predominance of significant results for the validity of triggering receptor expressed on myeloid cells-1 levels in the prediction, diagnosis, and prognosis of sepsis in pediatric patients.

Conclusions: Triggering receptor expressed on myeloid cells-1 is a valid predictive, diagnostic, and prognostic biomarker of sepsis with good sensitivity and specificity in the pediatric population.
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http://dx.doi.org/10.1590/1806-9282.20200765DOI Listing
March 2021

Impact of topical nifedipine on wound healing in animal model (pig).

J Vasc Bras 2020 Jul 6;19:e20190092. Epub 2020 Jul 6.

Faculdade de Medicina Nova Esperança - FAMENE, João Pessoa, PB, Brasil.

Background: The human skin is an extremely sophisticated and evolved organ that covers the whole body. External agents or the patient's own diseases can cause skin injuries that can challenge healthcare professionals and impose high social, economic and emotional costs.

Objectives: To evaluate the impact of topical nifedipine on skin wound healing, specifically on polymorphonuclear cells, vascular proliferation, and collagen.

Methods: We used three pigs, and created eight injuries in the dorsal region of each animal. We applied 1%, 10%, and 20% concentration nifedipine creams to four of the wounds in animals 1, 2, and 3 respectively and treated the other twelve wounds with saline solution 0.9% only. We analyzed the presence of polymorphonuclear cells, vascular proliferation, and collagen at six different times (days 1, 3, 7, 14, 21, and 28).

Results: The evaluation of polymorphonuclear levels showed mild cell activity at all times in the control group, while in the nifedipine groups, marked levels were more frequent at all times during the experiment. There was a 4.84-fold increase in the chance of marked vascular proliferation (p = 0.019) and, at the same time, a decrease in collagen formation (OR 0.02 / p = 0.005) in animal 3.

Conclusions: Topical NFD may have an impact on skin wound healing mechanisms. Our study showed that polymorphonuclear cells and vascular proliferation increased. We also demonstrated that collagen formation decreased. Therefore, topical NFD may have a positive impact on skin wound healing. Additional studies are needed to confirm our results.
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http://dx.doi.org/10.1590/1677-5449.190092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202160PMC
July 2020

Caveolin-1 (CAV-1) up regulation in metabolic syndrome: all roads leading to the same end.

Mol Biol Rep 2020 Nov 29;47(11):9245-9250. Epub 2020 Oct 29.

Laboratório de Genética e Biologia Molecular Humana, Departamento de Genética, Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235, Recife, Pernambuco, CEP 50760-901, Brazil.

Metabolic syndrome (MS) is a set of clinical conditions such as insulin resistance, hyperglycemia, systemic arterial hypertension (SAH), dyslipidemia, obesity and high abdominal circumference. Some of these clinical characteristics have been associated with caveolin-1, a caveolae structural protein, responsible for insulin activation, storage and degradation of cholesterol, and so on. Herein we assessed CAV-1 mRNA levels in MS patients comparing to healthy controls (HC) and according patients' clinical features. We included 87 patients in the study, 25 patients with MS, 30 patients with at least one clinical condition (diabetes, SAH, dyslipidemia, obesity and high abdominal circumference), 13 with two clinical conditions and 19 HC. CAV-1 mRNA levels from peripheral blood samples were assessed by Real Time qPCR using specific Taqman probe. The analysis was performed using ∆Cq method and the statistical tests Shapiro-Wilk, One-Way ANOVA and Mann-Whitney. We found CAV-1 increased mRNA levels in patients with MS (1.645 FC, p = 9.794 × 10) and even higher in patients with only one or two clinical conditions (2.215 FC, p = 1.215 × 10 and 1.716 FC, p = 4.197 × 10, respectively). When individual clinical conditions were observed, individuals with high abdominal circumference and obesity present a significantly up regulation when compared to HC (2.956 FC, p = 0.0004 and 3.643 FC, p = 0.002, respectively). This work indicates that CAV-1 gene expression from whole blood samples is associated to MS clinical conditions and may become a potential target for MS treatment and prevention.
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http://dx.doi.org/10.1007/s11033-020-05945-yDOI Listing
November 2020

How Can Galectin-3 as a Biomarker of Fibrosis Improve Atrial Fibrillation Diagnosis and Prognosis?

J Clin Med Res 2020 Oct 21;12(10):647-654. Epub 2020 Sep 21.

Postgraduate Program in Therapeutic Innovation, Federal University of Pernambuco (PPGIT/UFPE), Recife, PE, Brazil.

Galectin-3 (Gal-3) is a biomarker of fibrosis that has been associated with atrial remodeling. Acknowledging the presence of a biomarker in patients with atrial fibrillation (AF) can allow for a better clinical treatment. The aim of this study was to assess the association of Gal-3 with atrial fibrosis in patients with AF. This is a systematic review study. From the total number of studies analyzed, 12 demonstrated a relation between atrial fibrosis and Gal-3 in patients with AF and presented statistically significant association values. We conclude that Gal-3 is associated with atrial fibrosis in patients with AF in all types, as well as after the arrhythmia treatment by ablation.
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http://dx.doi.org/10.14740/jocmr4313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524564PMC
October 2020

GLA Gene Mutation in Hypertrophic Cardiomyopathy with a New Variant Description: Is it Fabry's Disease?

Arq Bras Cardiol 2019 07 10;113(1):77-84. Epub 2019 Jul 10.

Universidade Federal de Pernambuco - Hospital das Clínicas - Área Acadêmica de Medicina Clínica - Centro de Medicina Clínica - CCM, Recife, PE - Brazil.

Background: Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the alpha galactosidase A gene (GLA) that lead to the enzymatic deficiency of alpha galactosidase (α-Gal A), resulting in the accumulation of globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3), causing multiple organ dysfunctions.

Objective: To perform GLA gene screening in a group of patients with echocardiographic diagnosis of hypertrophic cardiomyopathy (HCM).

Methods: a cross-sectional study was conducted with HCM patients from a university hospital. Patients with coronary artery disease and valvulopathies were excluded. Mutation analysis of the GLA gene was performed. In male subjects, the analysis was performed after evidence of low α-Gal A activity.

Results: 60 patients with echocardiographic diagnosis of HCM were included. Age ranged from 12 to 85 years and 60% were women. Mean myocardial fibrosis percentage on MRI was 10.7 ± 13.1% and mean ventricular thickness was18.7 ± 6.7 mm. Four patients had the following GLA gene mutations: c.967C>A (p.Pro323Thr), not yet described in the literature; c.937G>T (p.Asp313Tyr); and c.352C>T (p.Arg118Cys). All patients had normal levels of lyso-Gb3 and non-ischemic myocardial fibrosis on magnetic resonance imaging; one patient had proteinuria and one patient had ventricular tachycardia.

Conclusion: in this study, the frequency of mutation in the GLA gene in patients with HCM was 6.7%. A novel mutation in exon 6 of the GLA gene, c.967C>A (p.Pro323Thr), was identified. Patients with HCM may have GLA mutations and FD should be ruled out. Plasma (lyso-Gb3) levels do not seem to be sufficient to attain a diagnosis and organ biopsy should be considered.
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http://dx.doi.org/10.5935/abc.20190112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6684188PMC
July 2019

Intima-Media Thickness in the Carotid and Femoral Arteries for Detection of Arteriosclerosis in Human Immunodeficiency Virus-Positive Individuals.

Arq Bras Cardiol 2017 Jan;108(1):3-11

Universidade Federal de Pernambuco, Recife, PE, Brazil.

Background: The prevalence of atherosclerosis is higher in HIV-positive people, who also experience it earlier than the general population.

Objectives: To assess and compare the prevalence of atherosclerosis evaluated by the intima-media thickness of carotid and femoral arteries, and by the ankle-brachial pressure index (ABPI) in HIV patients treated or not treated with protease inhibitors (PIs) and controls.

Methods: Eighty HIV+ subjects (40 using PIs and 40 not using PIs) and 65 controls were included in the study. Atherosclerosis was diagnosed by (carotid and femoral) ITM measurement and ABPI. Classical risk factors for atherosclerosis and HIV were compared between the groups by statistical tests. A p ≤ 0.05 was considered significant.

Results: An IMT > P75 or the presence of plaque was higher in the HIV+ than in the control group (37.5% vs 19%, p = 0.04). Comparative analysis showed a significant difference (p=0.014) in carotid IMT between HIV+ with PIs (0.71 ± 0.28 mm), without PIs 0.63 ± 0.11 mm and, and controls (0.59 ± 0.11 mm). There was no significant difference in femoral IMT between the groups or in ABPI between HIV+ subjects and controls. However, a significant difference (p=0.015) was found between HIV+ patients not treated with PIs (1.17 [1.08 - 1.23]), and controls 1.08 [1.07 - 1.17]).

Conclusion: In HIV patients, atherosclerosis is more prevalent and seems to occur earlier with particular characteristics compared with HIV-negative subjects.
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http://dx.doi.org/10.5935/abc.20160197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5245842PMC
January 2017

Use of honey associated with Ananas comosus (Bromelin) in the treatment of acute irritative cough.

Rev Paul Pediatr 2016 Dec 16;34(4):412-417. Epub 2016 Apr 16.

Universidade Federal de Pernambuco (UFPE), Recife, PE, Brasil. Electronic address:

Objective: To evaluate the immediate improvement rate of irritative cough in patients treated with the combination of Ananas comosus extract and honey (Bromelin) compared with the use of honey alone (placebo group).

Methods: Pragmatic, double-blind, randomized, parallel-group study with children aged between 2 and 15 years, with irritative cough for at least 24hours. The double-blind assessment of cough was through the number of observed coughing episodes and intensity score for a period of 10minutes of observation. The decrease of one point in the mean total score was considered as a therapeutic effect.

Results: There was a reduction in coughing episodes in both groups, as well as in the cough score after 30minutes of drug or honey administration. The change in clinical score above two points, which could indicate marked improvement, occurred in five patients in the bromelin group and only in one in the placebo group, but without significant difference. There were no adverse events.

Conclusions: The immediate improvement rate of irritative cough was similar in patients treated with combination of Ananas comosus extract and honey (Bromelin) compared with the use of honey alone (placebo group). It is possible that honey has a therapeutic effect on mucus and cough characteristics (Clinical Trials: NCT01356693).
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http://dx.doi.org/10.1016/j.rpped.2016.03.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5176060PMC
December 2016

Association Between Ankle-Brachial Index and Coronary Lesions Assessed by Coronary Angiography.

Cardiol Res 2015 Feb 9;6(1):216-220. Epub 2015 Feb 9.

Hospital of Clinics, Federal University of Pernambuco, Recife, PE, Brazil.

Background: The ankle-brachial index (ABI) is a simple, non-invasive, and inexpensive method used in the diagnosis of peripheral arterial disease (PAD) and can identify individuals at risk for cardiovascular disease in other arteries of the body, especially the coronary and carotid arteries. The primary objective of this study was to assess whether patients with an ABI < 0.9 have more severe coronary artery disease detected on coronary angiography compared to patients with a normal ABI.

Methods: This is a prospective, analytical, cross-sectional study that was performed from July 1, 2013 to June 31, 2014 that recruited 163 patients (101 men (62%) and 62 women (38%)) according to the inclusion and exclusion criteria. All patients underwent coronary angiography, and then ABI measurements were performed. Pearson's Chi-square and Student's -tests were used to compare variables between groups. The Poisson regression model was used to evaluate whether ABI was an independent predictor of stenoses > 50%.

Results: The prevalence of ABI < 0.9 was 9.8%. Patients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the left anterior descendant (LAD) (68.7% vs. 36%, P = 0.02) and left main (8.7% vs. 0.6%, P < 0.001) than those with a normal ABI. On multivariate Poisson regression, an ABI < 0.9 was an independent predictor of stenosis ≥ 50% in the LAD (odds ratio (OR): 2.05 (1.39 - 3.04), P < 0.001).

Conclusions: Patients with an ABI < 0.9 had a higher prevalence of stenoses ≥ 50% in the LAD and left main than those with a normal ABI. An abnormal ABI was an independent predictor of lesions ≥ 50% in LAD.
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http://dx.doi.org/10.14740/cr376wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295556PMC
February 2015

Association between ankle-brachial index and carotid atherosclerotic disease.

Arq Bras Cardiol 2013 May 9;100(5):422-8. Epub 2013 Apr 9.

Hospital das Clínicas da UFPE, Recife, PE - Brazil.

Background: The association between the ankle brachial index (ABI) and the measurement of intimal medial thickness (IMT) has not been fully studied.

Objective: We aimed to evaluate whether the prevalence of carotid atherosclerosis was higher in patients with ABI < 0.9 than in those with ABI > 0.9.

Methods: From January 2011 to December 2011, 118 patients (48 men and 70 women) were enrolled. ABI and IMT Measurements were performed in all patients. Patients were divided in Group 1 (ABI < 0.9) and Group 2 (ABI > 0.9) according to ABI values. Mann-Whitney, Chi-square and Fischer tests were used for comparison among the groups. Pearson's correlation was used to assess correlation between ABI and IMT.

Results: The prevalence of ABI < 0.9 was 29.7%, whereas carotid atherosclerosis > 1.5 mm was 34.7 %. Clinical characteristics were similar between groups 1 and 2: mean age (64 ± 9 vs. 62 ± 7.2 years, p = 0.1), male gender (40% vs. 41%, p = 0.9), hypertension (74% vs. 59%, p = 0.1), diabetes mellitus (54% vs. 35%, p = 0.051), dyslipidemia (26% vs. 24%, p = 0.8), smoking (57% vs. 65%, p = 0.4). The prevalence of carotid atherosclerosis was higher in group 1 (48.6% vs. 28.9%, p = 0.04). Pearson's correlation between ABI and IMT was -0.235, with a p value = 0.01.

Conclusion: Patients with ABI < 0.9 showed a higher prevalence of carotid atherosclerosis. There was a negative correlation between ABI and IMT.
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http://dx.doi.org/10.5935/abc.20130057DOI Listing
May 2013

A telehealth strategy for increasing adherence in the treatment of hypertension in primary care.

Telemed J E Health 2013 Apr 19;19(4):241-7. Epub 2013 Mar 19.

Nephrology Division, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil.

Objective: This study describes and analyzes a telehealth strategy for Family Health Teams (FHTs) providing primary care services. This strategy aimed to increase the adherence to the treatment of hypertension.

Subjects And Methods: We conducted a before-after study that enrolled 21 professionals and 502 hypertensive patients in two of the Family Health Units connected to our Telehealth Center Network. Seminars addressing the treatment adherence of hypertension were offered by Web conferences, for a period of 6 months, to the FHTs. The adherence to antihypertensive drugs, low salt diet, and physical activity was measured by specific questionnaires. The rates of adherence were assessed before and after a continuing education program (CEP). After the telehealth intervention, 17 professionals and 465 patients were re-evaluated.

Results: The participation in the question and answer session, after the seminar, was significant. The qualitative evaluation of the sessions by FHTs showed 87.5% of great/good. There was a trend toward a greater critical understanding of the results and targets set for the team, although at insignificant levels. The rates of adherence to antihypertensive medication, physical activity, and sodium control, before and after the CEP, were 37.8% versus 46.7% (p<0.004), 90.3% versus 89.9% (p=0.90), and 92.2% versus 96.3% (p<0.001), respectively.

Conclusions: The adherence to antihypertensive drugs and low salt diet improved after the CEP. Preliminarily, this telehealth strategy suggests a positive impact on hypertensive patients.
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http://dx.doi.org/10.1089/tmj.2012.0036DOI Listing
April 2013

Aspirin resistance: fact or fiction?

Arq Bras Cardiol 2010 Sep;95(3):e91-4

Hospital do Coração, Brazil.

A meta-analysis of clinical studies of patients with cardiovascular disease demonstrated that the use of aspirin was associated with a 22% decrease in death rates and relevant ischemic vascular events. However, clinical studies demonstrated that patients that regularly took aspirin presented recurrence of cardiovascular events. Such observation led to the question whether, in some patients, the aspirin was not effective in blocking platelet aggregation and these patients were called unresponsive to aspirin or aspirin-resistant. The clinical aspirin resistance is characterized as the occurrence of cardiovascular events in patients during treatment with aspirin, whereas the laboratory resistance is defined as the persistence of platelet aggregation, documented by laboratory test, in patients regularly taking aspirin. Patients that are aspirin-resistant presented, according to laboratory tests, on average 3.8 times more cardiovascular events when compared to non-resistant ones.
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http://dx.doi.org/10.1590/s0066-782x2010001300024DOI Listing
September 2010

Sepsis in the postoperative period of cardiac surgery: problem description.

Arq Bras Cardiol 2010 Mar;94(3):332-6, 352-6

Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, PE, Brazil.

Background: In spite of the advances in sepsis diagnosis and treatment in the last years, the morbidity and mortality are still high.

Objective: To assess the prevalence, in-hospital evolution and prognosis of patients that presented sepsis in the postoperative period of cardiac surgery.

Methods: This is a prospective study that included patients (n = 7,332) submitted to cardiac surgery (valvular or coronary) between January 1995 and December 2007. The classic criteria of sepsis diagnosis were used to identify the patients that developed such condition and the preoperative comorbidities, in-hospital evolution and prognosis were evaluated.

Results: Sepsis occurred in 29 patients (prevalence = 0.39%). There was a predominance of the male when compared to the female sex (79% vs. 21%). Mean age was 69 +/- 6.5 years. The main preoperative comorbidities were: systemic arterial hypertension (79%), dyslipidemia (48%) and family history of coronary artery disease (38%). The mean Apache score was 18 +/- 7, whereas the Sofa score was 14.2 +/- 3.8. The primary infectious focus was pulmonary in 19 patients (55%). There were 19 positive cultures and the mean IV hydration during the first 24 hours was 1,016 +/- 803 ml. The main complications were acute renal failure (65%), low cardiac output syndrome (55%) and malignant ventricular arrhythmia (55%). Mortality was 79% (23 patients).

Conclusion: The occurrence of sepsis after cardiac surgery was a rare event; however, its occurrence showed catastrophic clinical outcomes. The high morbidity and mortality showed the need to improve treatment, aiming at patients' better clinical evolution.
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http://dx.doi.org/10.1590/s0066-782x2010000300012DOI Listing
March 2010

Postoperative atrial fibrillation after cardiac surgery.

Arq Bras Cardiol 2009 Jul;93(1):59-63

Hospital do Coração, Associação do Sanatório Sírio, Rua Abílio Soares, 625/64 A, São Paulo, SP, Brazil.

Atrial fibrillation (AF) is an arrhythmia frequently seen in the postoperative period of cardiac surgery. In this context, it is associated with the presence of comorbidities, longer length of hospital stay, and higher costs related to surgery. The mechanisms involved in the genesis of AF in the postoperative period of cardiac surgery (AFPO) are different from those causing paroxysmal AF. Knowledge of these mechanisms permits the use of efficient measures to reduce the incidence of this arrhythmia. According to recommendations of the literature, treatment is efficient and safe, because the rates of reversion to sinus rhythm are high and complications are reduced, and it is not associated with a high frequency of side effects.
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http://dx.doi.org/10.1590/s0066-782x2009000700011DOI Listing
July 2009

Subclinical coronary artery disease in patients with type 1 Diabetes Mellitus undergoing hemodialysis.

Arq Bras Cardiol 2009 Jul;93(1):15-21

Hospital do Rim e Hipertensão, Fundação Oswaldo Ramos, Universidade Federal de São Paulo, São Paulo, SP, Brazil.

Background: In patients with type 1 diabetes mellitus, atherosclerosis occurs earlier in life and coronary artery disease (CAD) constitutes the major cause of death.

Objective: Evaluate the prevalence and anatomic characteristics of coronary artery disease (CAD) in type 1 diabetic patients with chronic renal failure undergoing hemodialysis.

Methods: This is a descriptive study of 20 patients with type 1 diabetes mellitus undergoing hemodialysis without known CAD. CAD was assessed by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). QCA was performed in all lesions >30%, visually. All proximal 18-mm segments of the coronary arteries were analyzed by IVUS. All other coronary segments with stenosis >30% were also analyzed.

Results: Angiography detected 29 lesions >30% in 15 patients (75%). Eleven (55%) of the lesions were >50% and 10 (50%) >70%. Thirteen patients had all 3 major arteries interrogated by IVUS. Atherosclerosis was present in all patients and in all 51 proximal 18-mm segments analyzed. The mean vessel diameter of these segments was significantly larger at the IVUS than at the QCA, for all vessels. IVUS images of 25 (86.2%) of the 29 lesions >30% were obtained. Fibrotic plaques were common (48%) and 60% had intermediate vessel remodeling.

Conclusion: CAD was present in all vessels of all type 1 diabetic patients undergoing hemodialysis. These findings are in agreement with other autopsy, angiography and IVUS studies. Additionally, they indicate the need for additional epidemiological and imaging studies to better understand and treat such a complex and serious clinical condition affecting young people.
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http://dx.doi.org/10.1590/s0066-782x2009000700004DOI Listing
July 2009

Risk factors for stroke after coronary artery bypass grafting.

Arq Bras Cardiol 2008 Oct;91(4):213-6, 234-7

Hospital do Coração, Associação do Sanatório Sírio, São Paulo, SP, Brasil.

Background: Stroke is a feared complication after coronary artery bypass grafting surgery (CABG), with an incidence between 1.3 and 4.3%.

Objective: To identify predictive factors for stroke after CABG in the modern era of cardiac surgery.

Methods: This is a case-control study of 65 pairs of patients, paired by sex, age (+ 3 years) and date of CABG (+ 3 months). The cases were patients submitted to elective CABG with extracorporeal circulation (ECC) that presented stroke (defined as clinical neurological deficit up to 24 hours post-operatively and confirmed by imaging assessment) and the controls were those individuals submitted to elective CABG with ECC, but without stroke.

Results: The univariate analysis demonstrated that the number of revascularized vessels was associated with the occurrence of stroke after the CABG (3 +/- 0.8 vs. 2.76 +/- 0.8, p = 0.01). The multivariate analysis by conditional logistic regression showed that systemic arterial hypertension (SAH) [OR: 6.1 (1.5 - 24), p = 0.009] and diabetes mellitus (DM) [OR: 3.1 (1.09 - 11), p= 0.03] were the determinants of the highest chance of stroke after CABG, whereas acute myocardial infarction (AMI) > 1 month, was the determinant of the lowest chance of stroke [OR: 0.1 (0.03 - 0.36), p = 0.003].

Conclusion: Hypertension and diabetes mellitus were identified as independent predictors of stroke within the first 24 postoperative hours after CABG. In patients with such risk factors, it is possible that the knowledge of the causal mechanisms of brain injury represents a strategy capable of decreasing the incidence of stroke after CABG.
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October 2008

Very late clinical progression of patients with acute myocardial infarction submitted to primary angioplasty.

Arq Bras Cardiol 2008 Apr;90(4):221-6

Associação do Sanatório Sírio - Hospital do Coração, São Paulo, SP - Brasil.

Background: Information on the clinical progression, in the long term, of patients submitted to mechanical reperfusion is scarce.

Objective: The objective of this study is to describe the long-term clinical progression of patients submitted to primary stenting.

Methods: Between January 1998 and December 2003 we studied a non-concurring cohort with a fixed population of 202 patients (mean age = 61.2 +/- 7.7 years; 74.7% males and 25.3% females) submitted to primary stenting. All the patients were followed up clinically and we assessed the occurrence of deaths, acute myocardial infarction (AMI), cerebral vascular accident (CVA) and surgical or percutaneous myocardial revascularization (MR). Kaplan-Meier survival curves were built for the following events: death, deaths/AMI, deaths/AMI/CVA and major cardiovascular events (MCE).

Results: In 91.5% of the patients the procedure was successful. During hospital stay, mortality was 3.4%; reinfarction was 0.9%; CVA was 1.8%; and urgent MR was 1.4%. Clinical follow-up varied from 29 to 100 months (mean = 58.7 +/- 19.7 months). Death-free survival was estimated at 93.6%; death/AMI-free survival at 89.6%; death-AMI/CVA-free survival at 87.1%; and MCE-free survival at 71.3%

Conclusion: Primary stenting presented excellent results during hospital stay. Very late clinical follow-up demonstrated that these good initial results have held up.
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April 2008

Postoperative atrial fibrillation following coronary artery bypass graft: clinical factors associated with in-hospital death.

Arq Bras Cardiol 2007 Jul;89(1):16-21

Hospital do Coração, Associação do Sanatório Sírio, São Paulo, SP, Brasil.

Objective: To identify factors associated with a higher likelihood of in-hospital death in patients submitted to coronary artery bypass graft surgery (CABG) who developed atrial fibrillation (AF) postoperatively.

Methods: The authors analyzed data from 397 consecutive patients submitted to CABG that developed AF postoperatively between 2000 and 2003. The patients were divided into 2 groups: group 1 (G1) comprised patients who survived (n=369); and group 2 (G2) comprised patients who died during hospital stay (n=28). Statistical analysis was performed using Student's t test and chi-square test, and p values < 0.05 were considered significant.

Results: A comparative analysis between G1 and G2 showed that there was no difference between the groups as regards age (67.3 +/- 8.4 versus 69.3 +/- 9.6; p = 0.4), male gender (75.9% versus 64.3%; p = 0.1), systemic arterial hypertension (75.3% versus 85.7%; p = 0.2) and congestive heart failure (17% versus 17%; p = 1). Group 2 presented higher rates for previous acute myocardial infarction (14.6% versus 28.6%; p = 0.05), left ventricular ejection fraction < 40% (12.2% versus 32.1%; p = 0.003), previous cerebrovascular accident (0.8% versus 17.9%; p = 0.03), previous percutaneous coronary intervention (19.5% versus 39.3%; p = 0.01) and previous CABG (19.3% versus 35.7%; p = 0.03).

Conclusion: Clinical history of acute myocardial infarction, CABG, percutaneous coronary intervention, cerebrovascular accident and severe ventricular dysfunction were significantly more frequent in the group that died during hospital stay, which suggests a possible association of these factors with a higher likelihood of death following CABG.
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http://dx.doi.org/10.1590/s0066-782x2007001300004DOI Listing
July 2007

Isolated noncompaction of the myocardium.

Arq Bras Cardiol 2007 Feb;88(2):e36-9

Hospital do Coração, São Paulo, SP, Brazil.

Noncompaction of the myocardium (NCM) is a rare congenital heart defect. It was first described 15 years ago, and few cases are published. The purpose of this study is to describe a NCM case. Clinical findings and imaging test results of a 37-year-old female patient with isolated NCM are presented. The patient complained of palpitations; her physical examination revealed extrasystoles, and her 12-lead electrocardiogram showed ventricular bigeminy. Three-dimensional Doppler echocardiography revealed numerous prominent trabeculations with deep intertrabecular recesses with blood flow which communicated with the ventricular cavity, which were more intense in the septal apical region. Cardiac magnetic resonance imaging corroborated the echocardiographic findings. The clinical presentation and the patients laboratory test results confirmed the diagnosis of isolated NCM. The knowledge of the echocardiographic findings of this disease enables an early diagnosis and a more adequate treatment.
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http://dx.doi.org/10.1590/s0066-782x2007000200021DOI Listing
February 2007

Prevalence and risk factors for combined coronary artery disease and aortic aneurysm.

Arq Bras Cardiol 2007 Jan;88(1):40-4

Hospital do Coração, Associação do Sanatório Sírio, São Paulo, SP, Brazil.

Objective: To evaluate CAD prevalence in patients with aortic aneurysm, as well as differences related to aneurysm topographies. To describe the primary risk factors for CAD related to this association and their occasional differences according to AA topographies.

Methods: This was an open, prospective, nonrandomized study that evaluated 95 patients (66 men and 33 women, mean age 63 +/- 11.8). All patients, asymptomatic for CAD, had undergone aortic CT and coronary angiography. According to the AA topography, they were classified into three groups: 1) patients with thoracic aortic aneurysm (TAA); 2) thoracoabdominal aortic aneurysm (TAAA); and 3) abdominal aortic aneurysm (AAA). A database was created to store information from clinical data and complementary examinations. Statistical analysis was performed using the Students t test or analysis of variance (ANOVA) for continuous variables and chi-square test for categorical variables. P values < 0.05 were considered statistically significant.

Results: CAD prevalence was 63.1%, and AAA was more prevalent than TAA and TAAA (76% vs. 70% vs. 30%, p = 0.001). The comparative analysis of CAD risk factors based on the aortic aneurysm topography revealed that smoking and dyslipidemia were more prevalent among AAA patients (74.5% vs. 42.3% vs. 60%, p = 0.01 and (54.2% vs. 19.9% vs. 60%, p = 0.007, respectively). As for coronary lesion severity in the population of AA patients, 12 (20%) had at least one lesion > or = 70% and 19 (31.6%), > or = 50%. Fifteen patients (25%) had single-vessel disease, 11 (18%) had two-vessel disease, and 34 (57%) had three-vessel disease.

Conclusion: Asymptomatic CAD is highly prevalent in AA patients, particularly among those with AAA. Study results suggest the need for diagnostic stratification for CAD in patients with AA, especially those with AAA.
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http://dx.doi.org/10.1590/s0066-782x2007000100007DOI Listing
January 2007
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