Arquivos brasileiros de cardiologia最新文献

Background: The optimal transfusion strategy in acute myocardial infarction (AMI)-associated anemia remains uncertain.

Objectives: To compare all-cause mortality between liberal versus restrictive transfusion strategies in patients with AMI-associated anemia, using a meta-analytic approach.

Methods: Pubmed, Embase, and ClinicalTrials.gov were systematically searched for randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in AMI-associated anemia. Random-effects meta-analysis and trial sequential analysis (TSA) were conducted to compare blood use, efficacy, and safety endpoints. The p-values were 2-sided with an α of 0.05.

Results: In a pooled analysis involving 4,217 participants from three RCTs followed-up for 30 days, no statistically significant differences emerged between restrictive and liberal strategies in all-cause mortality (RR 1.03; 95% CI 0.67-1.57; p=0.90) and other efficacy endpoints (recurrent AMI, unscheduled revascularization, acute heart failure, stroke, and acute kidney injury), as well as in safety endpoints including allergic reactions, infection, and acute lung injury. TSA did not reach futility boundaries. In patients assigned to restrictive strategy, substantial differences in transfusion use were observed across RCTs, correlating with mortality rates, and likely accounting for between-study heterogeneity in treatment effects.

Conclusions: In patients with AMI-associated anemia, there is no clear superiority between liberal and restrictive transfusion strategies in all-cause mortality or other major outcomes in 30 days. However, the heterogeneity observed in blood use between the restrictive groups likely explains variable findings across RCTs.

Background: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality.

Objective: To develop a risk score to predict bleeding in patients after valve surgery.

Methods: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP.

Results: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance.

Conclusion: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

Background: Chagas cardiomyopathy (ChCC) is one of the causes of the implantation of pacemakers (PM) in many patients and has been associated with an adverse prognosis.

Objectives: To compare the prognosis of the chagasic and non-chagasic populations undergoing PM and cardiac resynchronizer implantation.

Methods: Observational, retrospective study, which analyzed a cohort of patients who underwent implantation of these devices, in a tertiary center, from October 2007 to December 2017, comparing the chagasic group with non-chagasic patients. The non-parametric Kaplan-Meier method was used to calculate patient survival. The significance level adopted in the statistical analysis was 5%. The primary outcome was mortality from any cause, while the secondary outcomes were the occurrence of hospitalization and the combination of hospitalization and death.

Results: A total of 911 patients were included, of which 23.4% had ChCC. In a Cox analysis adjusted for sex and age, Chagas disease (ChD) was not associated with an increased risk of death (HR: 1.14, CI:95%, 0.86-1.51, p=0.365), hospitalization (HR: 0.79, CI:95%, 0.61-1.04, p=0.09) or combined outcome of death and hospitalization (HR: 0.90, CI:95%, 0.72-1 .12, p=0.49).

Conclusions: ChD was not associated with an increased risk of death, hospitalization, or combined outcome of death and hospitalization, even after adjustment for sex and age. These results contrast with those of previous studies and suggest changes in the quality of care of patients with cardiomyopathy.

Background: Arterial stiffness is associated with higher burden of atrial arrhythmias and worsening left atrial function (conduit and reservoir), even before dilation of this cavity. PACs: premature atrial contractions; cfPWV: carotid-femoral pulse wave velocity.

Background: Increased arterial stiffness is currently an independent risk factor for atrial fibrillation, but the pathophysiological mechanisms of this arrhythmia remain an area of knowledge gap to be explored.

Objectives: To investigate the existence of an association between arterial stiffness and the density of premature atrial contractions (PACs) in hypertensive individuals without atrial fibrillation.

Methods: Cross-sectional study with hypertensive patients without diagnosed atrial fibrillation, who were studied with speckle-tracking echocardiography to assess left atrial (LA) strain and carotid-femoral pulse wave velocity (cfPWV) to assess arterial stiffness. All patients underwent 24h-ECG Holter and laboratory tests. Significance level was set at p<0.05.

Results: Seventy participants from a single centre without overt cardiovascular disease were included. The cfPWV was correlated with higher density of PACs in 24h-Holter monitoring, independently of LV mass index (1.48 [1.08-2.03], p-value 0.005). Increased cfPWV was correlated with decreased LA strain values, with Spearman correlation coefficients of -0.27 (p-value 0.027) and -0.29 (p-value 0.018) for reservoir and conduit 2D Strain, respectively.

Conclusions: In this study with hypertensive patients, it was possible to demonstrate an association between arterial stiffness and higher density of atrial arrhythmias. Furthermore, arterial stiffness was associated with lower left atrial strain values for reservoir and conduit functions.

Background: Individual and Joint Association between Cardiovascular Disease Risk Factors and Inadequate Lifestyle Behaviors in a Sample from Brazil. CVD: cardiovascular diseases.

Background: Cardiovascular diseases (CVD) are often influenced by modifiable factors, notably individuals' lifestyle choices, which play a crucial role in modulating cardiovascular risk.

Objective: To investigate the individual and simultaneous association between inadequate lifestyle behaviors and risk factors for CVD in adults and older adults.

Method: A cross-sectional study with 1079 users of the Health Academy Program in Brazil. Information related to inadequate diet, excessive alcohol consumption, smoking, and physical inactivity were individually and collectively investigated (0, 1, or ≥ 2 factors) in association with CVD risk factors (hypertension, hypercholesterolemia, diabetes mellitus, and obesity), considering the following two outcomes: presence of CVD risk factors and number of CVD risk factors present in the same individual (0, 1, 2, or ≥ 3 risk factors). Logistic and multinomial logistic regression analyses were used. The statistical significance adopted was 5%.

Results: A higher number of inadequate lifestyle behavior was associated with greater odds of simultaneous presence of 1, 2, or ≥ 3 CVD risk factors. The simultaneous adoption of 1 and ≥ 2 inadequate lifestyle behaviors was associated with greater odds of hypercholesterolemia. Simultaneous adherence to ≥ 2 inadequate lifestyle behaviors was associated with lower odds of hypertension.

Conclusion: A greater number of inadequate lifestyle behaviors was associated with higher odds of simultaneous presence of multiple CVD risk factors.