Navegando por Palavras-chave "Coronary artery disease"

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    Adesão ao tratamento farmacológico de pacientes com doença arterial coronariana
    (Universidade Federal de São Paulo (UNIFESP), 2018-11-28) Padilha, Jaqueline Correia [UNIFESP]; Lopes, Juliana de Lima [UNIFESP]; Lopes, Camila Takáo [UNIFESP]; http://lattes.cnpq.br/4904538541897667; http://lattes.cnpq.br/1478157388713375; http://lattes.cnpq.br/7382025576973343; http://lattes.cnpq.br/7382025576973343; Universidade Federal de São Paulo (UNIFESP)
    Objective: To evaluate the pharmacological adherence of patients with coronary artery disease (CAD). Method: An correlational cross-sectional and correlational study performed in a Cardiology hospital of São Paulo from September to October 2016. The sample consisted on 198 patients. The dependent variable, pharmacological adherence, was evaluated by the Morisky Green test, which categorizes patients in adherent or non-adherent. The independent variables investigated were those proposed by the World Health Organization that are related to the patient, to socioeconomic factors, to the disease, to the treatment and to the health care system, as well as others identified in the literature. The relationship between the independent variables and adherence was investigated by Fisher's exact test, Student’s T test or Mann-Whitney test. The association between the independent variables and adherence was investigated by the Cox model. Prevalence ratios (PR) with 95% confidence intervals (CI) were used as association measures, considering p <0.05. The project was approved by the Research Ethics Committees of the Federal University of São Paulo and the Hospital Real and Benemérita Beneficência Portuguesa of São Paulo. Results: 64.6% of the participants were men, with a mean age of 65.7+11.4 years and mean education of 7.3+5.41 years. Eighty-five participants (43.0%) adhered to pharmacological treatment. In the univariate analysis, the factors associated with adherence were fatigue (p=0.01), other symptoms, such as palpitation (p = 0.04) and being attended through medical insurance (p=0.035) and no adherence: complex treatment (p=0.042), alcohol consumption (p=0.042) and being attended Public Health System (p=0.048). In the multiple analysis, the factors that remained significantly associated with adherence were fatigue (PR=3.308, 95% CI 1.83-5.99, p=0.001), other symptoms (RP=3.29, 95% CI=2.18-4.98, p=0.001) and alcohol consumption (PR=0.347, 95% CI 0.13-0.91, p=0.031). Conclusion: The presence of fatigue or other CAD symptoms is associated with a three-fold increase in the chance of adherence to pharmacological treatment, whereas the prevalence of non-adherence among alcohol users is 2.88 times greater than that of patients who do not drink. Nurses should focus on counseling hospitalized patients with CAD so they do not stop taking medications when they are asymptomatic and stop smoking.
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    Allelic variations of the vitamin D receptor (VDR) gene are associated with increased risk of coronary artery disease in type 2 diabetics: the DIABHYCAR prospective study
    (Masson Editeur, 2013-05-01) Ferrarezi, D. A. F.; Bellili-Munoz, N.; Dubois-Laforgue, D.; Cheurfa, N.; Lanui, A.; Reis, A. F. [UNIFESP]; Le Feuvre, C.; Roussel, R.; Fumeron, F.; Timsit, J.; Marre, M.; Velho, G.; INSERM; Universidade de São Paulo (USP); Cochin Hosp; Univ Paris 05; Univ Paris Diderot; Universidade Federal de São Paulo (UNIFESP); Hop La Pitie Salpetriere; Hop Xavier Bichat
    Aim. - Vitamin D deficiency is associated with coronary artery disease (CAD), and the actions of vitamin D are mediated by binding to a specific nuclear vitamin D receptor (VDR). This study investigated the associations of VDR gene variants with CAD in two cohorts of type 2 diabetes patients.Methods. - A cohort of 3137 subjects from the prospective DIABHYCAR study (CAD incidence: 14.8%; follow-up: 4.4 +/- 1.3 years) and an independent, hospital-based population of 713 subjects, 32.3% of whom had CAD, were assessed. Three SNPs in the VDR gene were genotyped: rs1544410 (BsmI); rs7975232 (ApaI); and rs731236 (TaqI).Results. - in the DIABHYCAR cohort, an association was observed between the A allele of BsmI and incident cases of CAD (HR: 1.16, 95% CI: 1.05-1.29; P=0.002). Associations were also observed between BsmI (P = 0.01) and TaqI (P=0.04) alleles and baseline cases of CAD. the AAC haplotype (BsmI/ApaI/TaqI) was significantly associated with an increased CAD prevalence at the end of the study compared with the GCT haplotype (OR: 1.12, 95% CI: 1.02-1.28; P = 0.04). in a cross-sectional study of the independent hospital-based cohort, associations of ApaI (P=0.009) and TaqI (P=0.03) alleles with CAD were observed, with similar haplotype results (OR: 1.33, 95% CI: 1.03-1.73; P=0.03).Conclusion. - the haplotype comprising the minor allele of BsmI, major allele of ApaI and minor allele of TaqI of VDR (AAC) was associated with an increased risk of CAD in type 2 diabetes patients. This effect was independent of the effects of other known cardiovascular risk factors. (C) 2013 Published by Elsevier Masson SAS.
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    Anger control and cardiovascular outcomes
    (Elsevier B.V., 2013-10-09) Schmidt, Marcia M.; Lopes, Renato D. [UNIFESP]; Newby, L. Kristin; Moura, Mauro R.; Stochero, Luciele; Gottschall, Carlos M.; Quadros, Alexandre S.; Fundacao Univ Cardiol IC FUC; Duke Univ; Universidade Federal de São Paulo (UNIFESP); Brazilian Clin Res Inst
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    Association between sex hormone-binding globulin (SHBG) and metabolic syndrome among men
    (Associação Paulista de Medicina - APM, 2014-01-01) Callou, Emmanuela Quental [UNIFESP]; Sá, Francisco Carleial Feijó de; Oliveira, Kelly Cristina de [UNIFESP]; Feres, Fausto; Verreschi, Ieda Therezinha do Nascimento [UNIFESP]; Universidade Federal do Ceará; Universidade Federal de São Paulo (UNIFESP); Instituto Dante Pazzanese de Cardiologia
    CONTEXT AND OBJECTIVE:Metabolic syndrome consists of a set of factors that imply increased risk of cardiovascular diseases. The objective here was to evaluate the association between sex hormone-binding globulin (SHBG), sex hormones and metabolic syndrome among men.DESIGN AND SETTING:Retrospective analysis on data from the study Endogenous oestradiol but not testosterone is related to coronary artery disease in men, conducted in a hospital in São Paulo.METHODS:Men (aged 40-70) who underwent coronary angiography were selected. The age, weight, height, waist circumference, body mass index and prevalence of dyslipidemia, hypertension and diabetes of each patient were registered. Metabolic syndrome was defined in accordance with the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (NCEP-ATPIII). Serum samples were collected to assess the levels of glucose, total cholesterol, HDL-cholesterol (high density lipoprotein), triglycerides, albumin, SHBG, estradiol and total testosterone (TT). The levels of LDL-cholesterol (low density lipoprotein) were calculated using Friedewald's formula and free testosterone (FT) and bioavailable testosterone (BT) using Vermeulen's formula.RESULTS:141 patients were enrolled in the study. The prevalence of metabolic syndrome was significantly higher in the first SHBG tercile than in the second and third terciles. A statistically significant positive association between the SHBG and TT values was observed, but no such association was seen between SHBG, BT and FT.CONCLUSION:Low serum levels of SHBG are associated with higher prevalence of metabolic syndrome among male patients, but further studies are required to confirm this association.
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    Association of ADIPOQ variants, total and high molecular weight adiponectin levels with coronary artery disease in diabetic and non-diabetic Brazilian subjects
    (Elsevier B.V., 2012-03-01) Oliveira, Carolina S. V. [UNIFESP]; Saddi-Rosa, Pedro [UNIFESP]; Crispim, Felipe [UNIFESP]; Canani, Luis H.; Gerchman, Fernando; Giuffrida, Fernando M. A. [UNIFESP]; Vieira, Jose G. H. [UNIFESP]; Velho, Gilberto; Reis, Andre F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Rio Grande do Sul; INSERM
    Objective: To investigate the association of ADIPOQ variants, total and high molecular weight adiponectin (HMW) adiponectin levels with the prevalence of diabetes mellitus and coronary artery disease (CAD) diagnosed by coronary angiography in Brazilian subjects with high cardiovascular risk.Methods: 603 subjects undergoing coronary angiography were studied in regard to their glycemic status and presence of CAD (lesions >0%). We evaluated baseline concentrations of total and HMW adiponectin and three ADIPOQ variants: - 11391G>A (rs17300539), + 45T>G (rs2241766) and + 276G >T (rs1501299).Results: the G-allele of rs2241766 was associated with higher levels of total and HMW adiponectin, and the A-allele of rs17300539 was associated with higher levels of HMW adiponectin. Lower levels of total and HMW adiponectin were independently associated with CAD. the G-allele of rs2241766 (OR 2.45,95% C.I. 1.05-6.04, p = 0.04) and the G-allele of rs1501299 (OR 1.89,95% C.I. 1.04-3.45, p = 0.03) were associated with CAD, and these associations were independent of circulating levels of adiponectin.Conclusions: in Brazilian subjects with high cardiovascular risk, CAD was associated with lower total and HMW adiponectin levels. the rs2241766 and rs1501299 polymorphisms were associated with CAD. the rs2241766 variant was associated with total and HMW adiponectin levels, while rs17300539 was associated with HMW adiponectin levels. (C) 2012 Elsevier Inc. All rights reserved.
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    Association of circulating levels of nicotinamide phosphoribosyltransferase (NAMPT/Visfatin) and of a frequent polymorphism in the promoter of the NAMPT gene with coronary artery disease in diabetic and non-diabetic subjects
    (Biomed Central Ltd, 2013-08-22) Saddi-Rosa, Pedro [UNIFESP]; Oliveira, Carolina Soares [UNIFESP]; Crispim, Felipe [UNIFESP]; Giuffrida, Fernando de Mello Almada [UNIFESP]; Lima, Valter Correia de [UNIFESP]; Vieira, Jose Gilberto [UNIFESP]; Doria, Alessandro; Velho, Gilberto; Reis, Andre Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEDEBA; Joslin Diabet Ctr; Univ Paris 07
    Background: Nicotinamide phosphoribosyltransferase (NAMPT) is the limiting enzyme in one of pathways of synthesis of Nicotinamide Adenine Dinucleotide, a redox coenzyme. NAMPT is considered as an insulin-mimetic factor and a potential regulatory factor in inflammatory and immune processes. Associations of circulating NAMPT levels with cardiovascular disease (CVD) and insulin resistance have been reported. We investigated association of circulating NAMPT levels and the rs9770242 NAMPT gene polymorphism with coronary artery disease (CAD).Methods: We studied 594 Brazilian subjects undergoing a coronary angiography (49% of whom had type 2 diabetes). CAD, defined as stenosis greater than 50% in one major coronary vessel or branch, was observed in 68% of subjects. Genetic studies were also performed in 858 North-American Non-Hispanic White subjects with type 2 diabetes (49% with CAD).Results: We observed an interaction between glycemic and CAD status on the comparison of NAMPT levels by CAD status. NAMPT levels were higher in type 2 diabetic patients with CAD as compared to those without CAD: 5.27 +/- 2.93 ng/ml vs. 4.43 +/- 2.94 ng/ml, p = 0.006 (mean +/- SD). NAMPT levels were not significantly different in non-diabetic subjects with or without CAD. the T-allele of rs9770242 was associated with CAD in the Brazilian cohort (OR 1.46, 95% CI 1.06 - 2.01, p = 0.02) while no association was observed in the North-American cohort.Conclusions: Our data suggest that circulating NAMPT levels are associated with CAD in type 2 diabetic patients. NAMPT rs9770242 polymorphism may be associated with CAD in some populations.
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    Association of classical risk factors and coronary artery disease in type 2 diabetic patients submitted to coronary angiography
    (Biomed Central Ltd, 2014-03-29) Bittencourt, Celia [UNIFESP]; Piveta, Valdecira M. [UNIFESP]; Oliveira, Carolina S. V. [UNIFESP]; Crispim, Felipe [UNIFESP]; Meira, Deyse [UNIFESP]; Saddi-Rosa, Pedro [UNIFESP]; Giuffrida, Fernando M. A.; Reis, Andre F. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEDEBA
    Background: Coronary artery disease (CAD) is the leading cause of death among individuals with type 2 diabetes (T2DM). T2DM accelerates atherosclerosis alongside classical risk factors such as dyslipidemia and hypertension. This study aims to investigate the association of hyperglycemia and associated risk factors with CAD in outpatients with T2DM undergoing coronary angiography.Methods: 818 individuals referred to coronary angiography were evaluated for glucose disturbances. After exclusion of those with prediabetes, 347 individuals with T2DM and 94 normoglycemic controls were studied for BMI, blood pressure, fasting plasma glucose, HbA1c, lipids, HOMA, adiponectin, Framingham risk score, number of clinically significant coronary lesions (stenosis > 50%).Results: Among T2DM subjects, those with CAD (n = 237) had worse glycemic control (fasting glucose 162.3 + 69.8 vs. 143.4 + 48.9 mg/dL, p = 0.004; HbA1c 8.03 + 1.91 vs. 7.59 + 1.55%, p = 0.03), lower HDL (39.2 + 13.2 vs. 44.4 + 15.9 mg/dL, p = 0.003), and higher triglycerides (140 [106-204] vs. 121 [78.5-184.25] mg/dL, p = 0.002), reached more often therapeutic goals for LDL (63.4% vs. 51.4%, p = 0.037) and less often goals for HDL (26.6% vs. 37.3%, p = 0.04), when compared to CAD-free individuals (n = 110). the same differences were not seen in normoglycemic controls. in T2DM subjects HbA1c tertiles were associated with progressively higher number of significant coronary lesions (median number of lesions 2 [A1c < 6.8%]; 2.5 [A1c 6.8-8.2%]; 4 [A1c > 8.2%]; p = 0.01 for trend).Conclusions: Classic risk factors such as glycemic control and lipid profile were associated with presence of CAD in T2DM subjects undergoing coronary angiography. Glycemic control is progressively associated with number and extent of coronary lesions in patients with T2DM.
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    Brazilian guidelines on prevention of cardiovascular disease in patients with diabetes: a position statement from the Brazilian Diabetes Society (SBD), the Brazilian Cardiology Society (SBC) and the Brazilian Endocrinology and Metabolism Society (SBEM)
    (Biomed Central Ltd, 2017) Bertoluci, Marcello Casaccia; Moreira, Rodrigo Oliveira; Faludi, Andre; Izar, Maria Cristina [UNIFESP]; Schaan, Beatriz D.; Valerio, Cynthia Melissa; Bertolami, Marcelo Chiara; Chacra, Ana Paula; Bolivar Malachias, Marcus Vinicius; Vencio, Sergio; Kerr Saraiva, Jose Francisco; Betti, Roberto; Turatti, Luiz; Helfenstein Fonseca, Francisco Antonio [UNIFESP]; Bianco, Henrique Tria [UNIFESP]; Sulzbach, Marta; Bertolami, Adriana; Nunes Salles, Joao Eduardo; Hohl, Alexandre; Trujilho, Fabio; Lima, Eduardo Gomes; Miname, Marcio Hiroshi; Zanella, Maria Teresa [UNIFESP]; Lamounier, Rodrigo; Sa, Joao Roberto [UNIFESP]; Amodeo, Celso; Pires, Antonio Carlos; Santos, Raul D.
    Background: Since the first position statement on diabetes and cardiovascular prevention published in 2014 by the Brazilian Diabetes Society, the current view on primary and secondary prevention in diabetes has evolved as a result of new approaches on cardiovascular risk stratification, new cholesterol lowering drugs, and new anti-hyperglycemic drugs. Importantly, a pattern of risk heterogeneity has emerged, showing that not all diabetic patients are at high or very high risk. In fact, most younger patients who have no overt cardiovascular risk factors may be more adequately classified as being at intermediate or even low cardiovascular risk. Thus, there is a need for cardiovascular risk stratification in patients with diabetes. The present panel reviews the best current evidence and proposes a practical risk-based approach on treatment for patients with diabetes. Main body: The Brazilian Diabetes Society, the Brazilian Society of Cardiology, and the Brazilian Endocrinology and Metabolism Society gathered to form an expert panel including 28 cardiologists and endocrinologists to review the best available evidence and to draft up-to-date an evidence-based guideline with practical recommendations for risk stratification and prevention of cardiovascular disease in diabetes. The guideline includes 59 recommendations covering: (1) the impact of new anti-hyperglycemic drugs and new lipid lowering drugs on cardiovascular risk
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    Cateterismo cardíaco, diagnóstico (angiografia) e terapêutico (angioplastia) na doença arterial coronária dos pacientes diabéticos
    (Sociedade Brasileira de Endocrinologia e Metabologia, 2007-03-01) Lima, Valter C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); FOR Hospital do Rim e Hipertensão
    Screening, diagnosis and revascularization of coronary artery disease (CAD) in type 2 diabetes mellitus are major challenges for current clinical practice. Diagnostic (angiography) and therapeutic (angioplasty) cardiac catheterization are important resources for the clinical assessment and management of coronary atherosclerosis. Anatomic peculiarities of CAD in diabetics can be well characterized by angiography, associated or not by intravascular ultrasound. The worse outcome following coronary revascularization procedures, either angioplasty or surgery, in diabetic is one of the main fields of clinical research. In spite of controversies, about one quarter of angioplasty and one third of surgical revascularization procedures are performed in diabetics. Two ongoing, large, randomized, multicentric trials are investigating the best management of CAD in diabetics. The BARI 2D trial is randomizing asymptomatic or mildly symptomatic patients with CAD for either medical therapy or revascularization (angioplasty or surgery, according to the best clinical judgment). The FREEDOM trial is randomizing stable patients with multivessel CAD for either angioplasty with drug eluting stents or surgery, with or without extracorporeal circulation. While the evidences are not available, in order to decide on the best revascularization procedure for individual patients, medical practice has been balanced according to a number of variables. Conditions that favor angioplasty: short lesions, lesions in large vessels, absence of left anterior descending artery disease, previous coronary bypass surgery and high surgical risk due to co-morbidities. Conditions that favor surgery: long lesions, lesions in small vessels, presence of left anterior descending artery disease and need for associated valve surgery.
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    Confiabilidade e validade da versão curta da escala de depressão geriátrica (EDG-15) em população clínica com doença arterial coronária
    (Universidade Federal de São Paulo (UNIFESP), 2009-04-29) Pinho, Miriam Ximenes [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background. Depression is highly prevalent among patients with Coronary Artery Disease (CAD). The Geriatric Depression Scale (GDS) is a screening instrument widely used to detect depression in the elderly. In Brazil, the psychometric properties of the short version of the scale are not yet fully exploited. Objectives. To examine the psychometric properties of the short version of the GDS among elderly outpatients with CAD. Methods. A cross-sectional study examined 209 elderly outpatients (≥ 65 years) with CAD using the GDS-15, CIRS, BOMFAQ and CAMDEX. Reliability of the GDS-15 was calculated using KR20 coefficient. A factor analysis of this scale was conducted. The GDS-15 score was compared with the diagnosis of depression (DSM-IV) to test its criterion validity. To assess the concurrent validity, GDS-15 score was correlated with the score of CAMDEX Depression Scale, MMSE, CAMCOG and BOMFAQ. Results. Clinical depression was diagnosed in 35.71% of the sample evaluated according to the DSM-IV. The cutoff point 5/6 produced a moderate accuracy (AUROC=0.84), a sensitivity of 79.92% and a specificity of 78.29% for the diagnosis of major depression or dysthymia. Internal consistency was 0.80. In factor analysis, a three-factor solution explained 52.72% of the total variance. GDS-15 scores correlated with CAMDEX Depression Scale scores. Conclusions. In general, GDS-15 produced good reliability and validity (concurrent and criterion-related) criteria. In cardiologic settings its use may be helpful in screening for depression in a simple and quick way.
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    Estado nutricional e fatores de risco cardiovascular em crianças e adolescentes filhos ou netos de coronariopatas jovens
    (Universidade Federal de São Paulo (UNIFESP), 2011-05-25) Kovacs, Cristiane [UNIFESP]; Schimith Escrivão, Maria Arlete Meil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Family history of early cardiovascular disease is a major cardiovascular risk factor in childhood and adolescence. Children and adolescents with positive family history that also often have other cardiovascular risk factors. Objective: To evaluate the nutritional status and its relationship with cardiovascular risk factors in children or young grandchildren of coronary artery disease. Methods: A cross-sectional study with 100 children and adolescents 5-17 years, children or grandchildren of young coronary patients. The variables studied were gender, age, weight, height, body mass index (BMI), waist circumference, nutritional status, blood pressure, metabolic syndrome, dietary habits, physical activity, results of laboratory tests (glucose, total cholesterol and fractions, triglycerides). To examine the associations between the variables we used the Fisher exact test, with significance level of 5%. Results: The nutritional status, it was observed that 60% were normal and 40% were overweight. In the evaluation of laboratory tests, 29% had total cholesterol, LDL increased 8%, 45% low HDL and triglycerides increased 13%. In the group with overweight, the percentages were higher triglyceride levels (p = 0.005) and increased waist circumference (p <0.001), 22.5% had abnormal blood pressure and altered glucose 5%. Physical inactivity was present in 40% and 87% of them had excessive intake of atherogenic fat. Besides a family history of coronary disease, 30% of the population had more than two cardiovascular risk factors and 41% more than three. Conclusion: The association of cardiovascular risk factors among children and adolescents, children or grandchildren of young coronary patients, this study confirms the influence of family history and his contribution to the risk of developing cardiovascular disease.
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    Estudo iWONDER (Imaging WhOle vessel coroNary tree with intravascular ultrasounD and iMap® in patiEnts with acute myocaRdial infarction): racional e desenho do estudo
    (Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista - SBHCI, 2012-06-01) Souza, Cristiano Freitas de [UNIFESP]; Alves, Claudia Maria Rodrigues [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Bonfim, Alexandre Vidal [UNIFESP]; Silva, Erlon Oliveira de Abreu [UNIFESP]; Pereira Júnior, Edilberto Castilho [UNIFESP]; Falcão, Felipe José de Andrade [UNIFESP]; Lanaro, Eduardo [UNIFESP]; Barbosa, Adriano Henrique Pereira [UNIFESP]; Souza, José Augusto Marcondes de [UNIFESP]; Sousa, José Marconi A. [UNIFESP]; Souza, Rodrigo Almeida [UNIFESP]; Rigla, Juan; Caixeta, Adriano [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Boston Scientific Setor de Imagem em Cardiologia Intervencionista; Hospital Israelita Albert Einstein
    BACKGROUND: Intravascular ultrasound (IVUS) provides a sensitive and reproducible measurement of coronary artery dimensions, atherosclerotic plaque, and arterial lumen. Advances in IVUS technology now allow the characterization of the composition and morphology of atherosclerotic plaques. Although previous studies have reported data using IVUS radiofrequency analysis, the use of a new modality (iMap®, Boston Scientific, Santa Clara, USA) of atherosclerotic plaque characterization is very little known. Our objective is to analyze the morphological, phenotypic and tissue characteristics of culprit and non-culprit atherosclerotic plaques determined by angiography in patients undergoing coronary angiography due to acute myocardial infarction (AMI). METHODS: Prospective, cross-sectional, single center study (Hospital São Paulo - Escola Paulista de Medicina - Universidade Federal de São Paulo (UNIFESP)/UNIFESP, São Paulo, SP, Brazil). Fifty patients will be selected for ultrasound analysis according to the following inclusion criteria: age < 75 years, non-ST-segment elevation AMI or recent ST-segment elevation AMI, with or without previous fribrinolytic agents. CONCLUSIONS: The present study is aimed at obtaining morphological, phenotypic and tissue characteristics of the atherosclerotic plate using an imaging modality not extensively evaluated in patients with AMI.
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    Estudo randomizado comparando coronariografia rotacional de duplo eixo e coronariografia convencional em uma população com alta prevalência de doença arterial coronariana
    (Universidade Federal de São Paulo (UNIFESP), 2017-12-21) Giuberti, Rafael Souto De Oliveira [UNIFESP]; Caixeta, Adriano Mendes [UNIFESP]; Fernandes, Rósley Weber Alvarenga [UNIFESP]; http://lattes.cnpq.br/3171865886478958; http://lattes.cnpq.br/5721132146877848; http://lattes.cnpq.br/5582274449140779; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Comparar a segurança, a dose de radiação, o volume de contraste e precisão diagnóstica entre a coronariografia rotacional de duplo eixo (CRDE) e a coronariografia convencional. Introdução: A coronariografia convencional é o método padrão ouro no diagnóstico da doença arterial coronariana e baseia-se na análise de projeções fixas ortogonais bidimensionais, que podem não ser ideais para avaliar determinados segmentos coronarianos. CRDE é uma técnica alternativa que permite a visualização dinâmica das artérias coronárias, em múltiplos ângulos, com uma única injeção de contraste para cada coronária. Métodos: Duzentos e um pacientes foram aleatoriamente designados para coronariografia convencional (n = 100) ou CRDE (n = 101) e comparadas segurança, a exposição do paciente à radiação e o consumo de meio de contraste. Posteriormente, foram selecionadas consecutivamente as primeiras setenta e sete (77) lesões coronarianas em ambos os grupos, avaliadas por dois observadores independentes e classificadas entre lesões leves (30% a 49%), moderadas (50% a 69%), e graves (>70%). A correlação inter-observador foi estimada pelo índice Kappa. Resultados: Os dados demográficos iniciais e características clínicas foram semelhantes em ambos os grupos. A prevalência geral de doença arterial coronariana foi de 77,6%. O grupo rotacional obteve redução significativa na quantidade de contraste, 60 ml (IQR: 52,5- 71,5 ml) contra 76 ml (IQR: 68-87 ml), P <0,0001; e dose de radiação pela Air Kerma, 269,5 mGy (IQR: 176-450,5) versus 542,1 mGy (IQR: 370,7-720,8), P <0,0001. Houve menos pacientes que necessitaram de projeções adicionais no grupo rotacional: 54,0% versus 75,0%; P=0,002. O índice de correlação interobservador no grupo rotacional foi de 0,71, considerado bom, já no grupo convencional a correlação foi regular, 0,53. Conclusão: Em uma população com alta prevalência de doença arterial coronariana, CRDE foi segura e resultou em diminuição significativa no volume de contraste e na dose de radiação. A reprodutibilidade superior para CRDE comparada à coronariografia convencional pode ser justificada pela possibilidade de se quantificar uma mesma lesão em diversas angulações.
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    Exercise may cause myocardial ischemia at the anaerobic threshold in cardiac rehabilitation programs
    (Associação Brasileira de Divulgação Científica, 2009-03-01) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Meneghelo, Romeu Sergio; Stefanini, Edson [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Smanio, Paola Emanuela Poggio; Mastrocolla, Luiz Eduardo; Ferraz, Almir Sergio; Buglia, Susimeire; Piegas, Leopoldo Soares; Carvalho, Antonio Carlos [UNIFESP]; Instituto Dante Pazzanese de Cardiologia Serviço de Reabilitação Cardiovascular; Instituto Dante Pazzanese de Cardiologia Seção Médica de Medicina Nuclear; Instituto Dante Pazzanese de Cardiologia Departamento de Saúde; Universidade Federal de São Paulo (UNIFESP)
    Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Our objective was to determine the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99m-sestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise test determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise test at the prescribed workload and heart rate. Myocardial perfusion images were analyzed using a score system of 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (P < 0.05). The presence of myocardial ischemia during exercise was defined as a difference ≥2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. MIBI-SPECT showed myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise programs. Changes in patient care and exercise programs were implemented as a result of our finding of ischemia during the prescribed exercise.
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    Ischemia/reperfusion is an independent trigger for increasing myocardial content of mRNA B-type natriuretic peptide
    (Springer, 2009-11-01) Ramos, Lafayete William F. [UNIFESP]; Murad, Neif [UNIFESP]; Goto, Eduardo [UNIFESP]; Antonio, Edinei L. [UNIFESP]; Silva, Jose A.; Tucci, Paulo F. [UNIFESP]; Carvalho, Antonio C. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Ctr Nove Julho
    This study aims to determine whether a relation exists between ischemia/reperfusion and myocardial B-type natriuretic peptide (BNP) mRNA expression independent of variations in intracavitary diastolic volume and consequently, of cardiomyocyte stretching. Twenty-three rats were subjected to the following conditions: control (C), 15 min of ischemia (I15), or ischemia plus 15 (R15), 30 (R30), or 45 (R45) min of reperfusion in the in situ hearts. Isolated hearts of sixteen additional rats (sham, n = 8; occlusion, n = 8) were perfused for studies in the absence of ventricular distension. All hearts were divided in two segments (ischemic and nonischemic). Ventricular distension was avoided by excluding the atria and mitral valves. in both experiments, BNP mRNA was quantified by real-time polymerase chain reaction in both nonischemic and ischemic regions. in the in situ hearts, myocardial BNP mRNA values at R15 (4.24 +/- 0.75) in the ischemic region were higher than in other groups (C: 1.43 +/- 0.81, P = 0.044; I15: 3.05 +/- 0.62, P = 0.048; R30: 0.76 +/- 0.84, P = 0.001; R45: 1.47 +/- 0.60, P = 0.046, [analysis of variance]). in isolated hearts without ventricular distension, myocardial BNP mRNA (arbitrary units) content at R15 in ischemic regions (4.54 +/- 0.26) was greater than in nonischemic regions in both occlusion (3.51 +/- 0.20, P < 0.001) and sham (3.38 +/- 0.25, P = 0.0001 and 3.47 +/- 0.19, P = 0.0001) groups. the present data show that ischemia/reperfusion is responsible for increased BNP mRNA myocardial content independent of changes of ventricular cavity diastolic volume.
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    No limiar anaeróbico ventilatório exercício pode causar isquemia miocárdica em programa de reabilitação cardiovascular
    (Universidade Federal de São Paulo (UNIFESP), 2009-01-28) Fuchs, Angela Rúbia Cavalcanti Neves [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Myocardial ischemia may occur during an exercise session in cardiac rehabilitation programs. However, it has not been established whether it is elicited when exercise prescription is based on heart rate corresponding to the anaerobic threshold as measured by cardiopulmonary exercise testing. Objectives: To assess the incidence of myocardial ischemia in cardiac rehabilitation programs according to myocardial perfusion SPECT in exercise programs based on the anaerobic threshold. Methods: Thirty-nine patients (35 men and 4 women) diagnosed with coronary artery disease by coronary angiography and stress technetium-99msestamibi gated SPECT associated with a baseline cardiopulmonary exercise test were assessed. Ages ranged from 45 to 75 years. A second cardiopulmonary exercise testing determined training intensity at the anaerobic threshold. Repeat gated-SPECT was obtained after a third cardiopulmonary exercise testing at the prescribed workload and heart rate. Results: Myocardial perfusion images, analyzed using a score system: 6.4 at rest, 13.9 at peak stress, and 10.7 during the prescribed exercise (p<0.05). The presence of myocardial ischemia during exercise was defined as a difference ³ 2 between the summed stress score and summed rest score. Accordingly, 25 (64%) patients were classified as ischemic and 14 (36%) as nonischemic. Conclusion: MIBI-SPECT has shown myocardial ischemia during exercise within the anaerobic threshold. The 64% prevalence of ischemia observed in the study should not be looked on as representative of the whole population of patients undergoing exercise program. The changes in patient care and exercise program were implemented as a result of our findings (ischemia during the prescribed exercise).
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    Quantificação do mRNA BNP Miocárdico em Ratas Submetidas à Isquemia/Reperfusão na Ausência de Distensão Ventricular
    (Universidade Federal de São Paulo (UNIFESP), 2009-06-24) Ramos, Lafayete William Ferreira [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Aims. To determine whether a relation exists between ischemia/reperfusion and myocardial BNP mRNA expression independent of variations in intracavitary diastolic volume and consequently, of cardiomyocyte stretching. Methods. Twenty-three rats were subjected to the following conditions: control (C), 15 minutes of ischemia (I15), or ischemia plus 15 (R15), 30 (R30) or 45 (R45) min of reperfusion in the in situ hearts. Isolated hearts of sixteen additional rats (sham, n=8; occlusion, n=8) were perfused for studies in the absence of ventricular distension. All hearts were divided in two segments (ischemic and non-ischemic). Ventricular distension was avoided by excluding the atria and mitral valves. In both experiments, BNP mRNA was quantified by real-time PCR in both non-ischemic and ischemic regions. Results. In the in situ hearts, myocardial BNP mRNA values at R15 (4.24±0.75) in the ischemic region were higher than in other groups (C: 1.43±0.81, p=0.044; I15: 3.05±0.62, p=0.048; R30: 0.76±0.84, p=0.001; R45: 1.47±0.60, p=0.046, [ANOVA]). In isolated hearts without ventricular distension, myocardial BNP mRNA (arbitrary units) content at R15 in ischemic regions (4.54±0.26) was greater than in nonischemic regions in both occlusion (3.51±0.20, p<0.001) and sham (3.38±0.25, p=0.0001 and 3.47±0.19, p=0.0001) groups. Conclusion. The present data show that ischemia/reperfusion is responsible for increased BNP mRNA myocardial content independent of changes of ventricular cavity diastolic volume.
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    Relação entre os títulos de anticorpos anti LDLox e marcadores do risco cardiovascular
    (Universidade Federal de São Paulo (UNIFESP), 2008-11-26) Santos, Andreza Oliveira dos [UNIFESP]; Izar, Maria Cristina de Oliveira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objectives: Oxidized lipoproteins and antibodies anti-oxidized LDL (anti-oxLDL) have been detected in human plasma and in atherosclerotic lesions. However, the role of these autoantibodies in the maintenance of health or in the pathogenesis of acute coronary syndromes (ACS) remains unclear. We examined the relationship of human IgG antibodies anti- ox LDL with cardiovascular disease risk markers. Methods: Titers of human anti-oxLDL were measured in hypertensive subjects in stage 1 (n=94) without other risk factors, and in individuals with metabolic syndrome after recent acute coronary syndrome (n=116). Autoantibodies against copper ion oxidized LDL were measured by ELISA. Results: Hipertensive patients presented lower BMI, waist circunference, higher blood pressure levels than those with ACS (p<0.001). HDL-C and Apo A1 were higher, whereas triglycerides and Apo B were lower in those with hypertension stage 1 (p<0.0001). Anti-oxLDL titers were higher in hypertensive patients compared to those with acute coronary syndromes, and hypertensive patients presented lower hs-CRP than those with ACS (p<0.0001). Taken into account both populations, univariate analysis showed small, but significant inverse correlations between the hs-CRP (r=-0.284), BMI (r=-0.256), waist circunference (r=-0.368), apo B (r= -0.191), and blood glucose (r= - 0.303) and positive correlations between systolic and diastolic blood pressure (r=0.319 and r=0.167, respectively), HDL-C and Apo A1 (r=0.224 and r=0.257, respectively), with anti-ox LDL titers (p<0.02). After multiple linear regression, hs-CRP, fasting glycemia and waist circunference remained independently associated with anti-oxLDL. Conclusions: Our results suggest that low titers of circulating anti-oxLDL antibodies may be associated with increased cardiovascular risk.
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    Risk factors, biochemical markers, and genetic polymorphisms in early coronary artery disease
    (Sociedade Brasileira de Cardiologia - SBC, 2003-04-01) Izar, Maria Cristina de Oliveira [UNIFESP]; Fonseca, Francisco Antonio Helfenstein [UNIFESP]; Ihara, Silvia Saiuli Miki [UNIFESP]; Kasinski, Nelson [UNIFESP]; Sang, Won Han [UNIFESP]; Lopes, Ieda Edite Lanzarini [UNIFESP]; Pinto, Leonor do Espírito Santo de Almeida [UNIFESP]; Relvas, Waldir Gabriel Miranda [UNIFESP]; Lourenco, Dayse Maria [UNIFESP]; Tufik, Sergio [UNIFESP]; De Paola, Angelo Amato Vincenzo [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To assess the risk factors, lipid and apolipoprotein profile, hemostasis variables, and polymorphisms of the apolipoprotein AI-CIII gene in early coronary artery disease (CAD). METHODS: Case-control study with 112 patients in each group controlled by sex and age. After clinical evaluation and nutritional instruction, blood samples were collected for biochemical assays and genetic study. RESULTS: Familial history of early CAD (64 vs 39%), arterial hypertension (69 vs 36%), diabetes mellitus (25 vs 3%), and previous smoking (71 vs 46%) were more prevalent in the case group (p<0.001). Hypertension and diabetes were independent risk factors. Early CAD was characterized by higher serum levels of total cholesterol (235 ± 6 vs 209 ± 4 mg/dL), of LDL-c (154 ± 5 vs 135 ± 4 mg/dL), triglycerides (205 ± 12 vs 143 ± 9 mg/dL), and apolipoprotein B (129 ± 3 vs 105 ± 3 mg/dL), and lower serum levels of HDL-c (40 ± 1 vs 46 ± 1 mg/dL) and apolipoprotein AI (134 ± 2 vs 146 ± 2mg/dL) [p<0.01], in addition to an elevation in fibrinogen and D-dimer (p<0.02). The simultaneous presence of the rare alleles of the APO AI-CIII genes in early CAD are associated with hypertriglyceridemia (p=0.03). CONCLUSION: Of the classical risk factors, hypertension and diabetes mellitus were independently associated with early CAD. In addition to an unfavorable lipid profile, an increase in the thrombotic risk was identified in this population. An additive effect of the APO AI-CIII genes was observed in triglyceride levels.
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    Síntese de recomendações de diretrizes clínicas de alta qualidade para diagnóstico e tratamento de doença arterial coronariana, angina e dor no peito
    (Universidade Federal de São Paulo, 2022-02-11) Silva, Gabriela Maria da [UNIFESP]; Melo, Daniela Oliveira de [UNIFESP]; Coletto, Yara Cardoso; http://lattes.cnpq.br/7510120278081806; http://lattes.cnpq.br/5052823551616937; http://lattes.cnpq.br/0084522228491337
    As doenças cardiovasculares (DCV) são a principal causa de morte no Brasil e no mundo. Atingem mais de 30% da população e impactam diretamente no sistema público de saúde e na qualidade de vida dos indivíduos. No Sistema Único de Saúde (SUS), as DCV são responsáveis pelos maiores custos com hospitalização. Dentre as DCV, a Doença Arterial Coronariana (DAC) se destaca por ser a principal causa de morte no Brasil na última década. As diretrizes clínicas (DC) buscam nortear os cuidados de pacientes com DAC, auxiliam na tomada de decisão e reduzem os gastos com saúde. A alta qualidade metodológica desses documentos é essencial para fornecer recomendações adequadas, delineando práticas clínicas baseadas em evidências. Diante disso, DC de alta qualidade são fundamentais para atualização dos profissionais de saúde quanto a avaliação de risco, diagnóstico, tratamento e conscientização dos pacientes com DAC, Síndrome Coronariana Crônica (SCC), angina e dor no peito. Sendo assim, o objetivo desse trabalho foi sintetizar recomendações de diretrizes de alta qualidade sobre DAC, SCC, angina e dor no peito e propor recomendações consolidadas e traduzidas para assegurar o acesso e a aplicabilidade na atenção primária de saúde (APS). Foi realizada uma revisão sistemática para identificar DC para o cuidado de DAC. As DC foram avaliadas com a segunda versão do instrumento validado Appraisal of Guidelines for Research and Evaluation (AGREE-II). Na qual, foram identificadas e avaliadas DC, sendo sete selecionadas para comparação. As recomendações foram extraídas para uma planilha no Microsoft Excel® e classificadas em sete tópicos: avaliação de risco, diagnóstico, terapia farmacológica e não farmacológica, prevenção de eventos, estilo de vida e conscientização do paciente. Após a extração, as recomendações foram analisadas de acordo com a convergência e a divergência das informações fornecidas nas diferentes DC. Na qual, a maioria das recomendações se mostraram convergentes e complementares, apesar da diferença de escopo entre as DC. O que contribuiu para a obtenção de um compilado no idioma português com 324 recomendações. Portanto, a comparação de recomendações de DC de alta qualidade sobre DAC, SCC, angina e dor no peito permitiu a produção de um material com alto potencial de aplicação na APS e de fácil acesso para auxiliar na tomada de decisão e na prática clínica diária dos profissionais de saúde. Além de possibilitar a adaptação das recomendações para o contexto local.