Arquivos brasileiros de cardiologia最新文献

With the increasing prevalence of chronic coronary syndromes, many patients with extensive atherosclerosis experience uncontrolled angina, even while receiving optimal medical therapy. This is especially true for patients who are not suitable candidates for surgical or percutaneous revascularization. Numerous treatments have been investigated for managing angina pectoris, and in this context, the coronary sinus reducer has emerged as a promising therapeutic option. Since the 1950s, beginning with Beck's surgery, the coronary venous sinus has been a focal point of research in anti-ischemic therapies. Significant scientific advances have been made in narrowing the venous sinus in the past two decades. Thanks to technological improvements in minimally invasive procedures and better methods for assessing myocardial blood flow, a new therapeutic option has become available for patients suffering from refractory angina and, possibly, for microvascular dysfunction. In this review, we aim to examine key concepts related to angina pectoris and myocardial ischemia, highlighting the historical background, pathophysiological rationale, and technical aspects of coronary sinus reduction as a therapy for refractory angina. Additionally, we will explore the scientific evidence from recent decades, as well as identify existing gaps and outline future research directions concerning this emerging treatment.

Background: Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG) is widely used in cancer care, but its role in assessing cardiotoxicity remains uncertain. Understanding how cardiovascular risk factors influence myocardial glucose uptake may improve its application in this setting.

Objective: To investigate associations between cardiac metabolic patterns on oncologic PET/CT and cardiovascular risk factors.

Methods: We conducted a retrospective, cross-sectional study classifying oncologic PET/CT scans by absence (G1) or presence (G2) of myocardial FDG uptake, visually defined as greater than the aortic blood pool. Clinical data and cardiovascular risk factors were analyzed, and logistic regression identified predictors of presence or absence of uptake, adjusting for potential confounders. Statistical significance was set at p < 0.05.

Results: We included 983 scans (64% women; mean age 56 ± 15.8 years; 39.9% with hypertension; 19.7% with diabetes), of which 559 (56.8%) were G1 and 424 (43.2%) were G2. The most prevalent cancers were lymphoma (28.9%) and breast (17.6%). Male sex (p = 0.0008) and higher weight (p = 0.0001) were independent predictors of myocardial FDG uptake, whereas diabetes (p = 0.01) and coronary artery disease (p = 0.007) predicted absence of uptake.

Conclusions: Despite limitations, this study identified distinct patterns of myocardial FDG uptake on oncologic PET/CT independently associated with cardiovascular risk factors. These findings support the potential of FDG PET/CT for evaluating cardiotoxicity after cancer treatment.

Background: Chronic kidney disease (CKD) is an established risk factor for coronary artery disease (CAD), displaying a linear relationship with glomerular filtration rate (GFR). The prognostic role of the different formulas for the estimation of GFR is still debated.

Objective: To evaluate the impact of GFR calculation in the prediction of angiographically assessed CAD.

Methods: In consecutive patients undergoing coronary angiography, GFR was assessed at admission with the formulas Cockroft-Gault, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), and Modification of Diet in Renal Disease Study (MDRD). A 2-sided p-value < 0.05 was considered statistically significant.

Results: Among 1742 patients, 79.8% displayed CAD. No difference in the mean values of GFR was observed in patients with and without CAD with the three different GFR formulas. We observed a significant association between severe CAD and GFR, by Cockcroft Gault (26.6% vs 35% vs 36.9%, p<0.001), MDRD (27.1% vs 36.9% vs 39%, p<0.001), and CKD-EPI (28.9% vs 39.2% vs 22.2%, p=0.03). In multivariate analysis, only MDRD remained statistically significant (adjusted OR[95%CI]= 1.27[1.01-1.59], p=0.04). In ROC curve analysis, we identified the value of 12.4 ml/min/1.73m^2 as the best predicting value for severe CAD with the MDRD formula. Higher rates of calcifications, restenosis, and chronic occlusion were observed for the Cockroft-Gault and MDRD formulas.

Conclusion: The present study showed a significant association between the extent of angiographically-defined CAD and GFR, estimated by the MDRD, but not for the Cockroft-Gault and CKD-EPI formulas. MDRD values below 12.4 ml/min/1.73m^2 best predicted more severe CAD.

Background: Congenital heart diseases (CHD) require an in-depth anatomopathological understanding. 3D printing is a promising educational tool for creating physical prototypes from imaging data, but costs are a major issue.

Objective: This study aimed to describe a feasible low-cost workflow for the development of 3D-printed (3DP) CHD models and create a shareable educational set.

Methods: Data from cardiac tomography images were used, following the steps of image acquisition, segmentation, digital design, slicing, 3D printing, and post-printing. Valvar structures were created from echocardiographic data using the cartographic heightmap technique and inserted into prototypes. 3DP models were evaluated by an expert team, enhanced, and applied to medical residents during an educational session. Free software, a desktop 3D printer, and low-cost materials were used.

Results: Twelve 3DP models were developed, including ventricular septal defect with patent ductus arteriosus, atrial septal defect, Tetralogy of Fallot, transposition of the great arteries, atrioventricular septal defect, coarctation of the Aorta, hypoplastic left heart syndrome, tricuspid atresia, pulmonary atresia, total anomalous pulmonary venous connection, Truncus arteriosus, and interrupted aortic arch. All residents (100%) agreed that prototypes were "faithful to the anatomy", "visually appealing", "motivated the study", and "allowed better spatial conceptualization". They related 3DP CHD models "are an important pedagogical resource" and can potentially benefit the education of "undergraduate students" (100%), "interdisciplinary team" (100%), "cardiologists, surgeons and residents" (100%), and "families" (93%).

Conclusion: Development of 3DP CHD models using a low-cost workflow is feasible. Models developed are freely available for download and printing, intending to promote education to all interested in CHD.