Arquivos brasileiros de cardiologia最新文献

Background: Initial clinical and imaging associations in Takayasu's arteritis (TAK) are poorly defined.

Objectives: To characterize initial manifestations, their associations, and long-term outcomes in a TAK cohort.

Methods: A single-center retrospective cohort study (2000 to 2024) included patients diagnosed with TAK. The significance level was set at p<0.05.

Results: Among 203 patients identified, 54 were excluded due to incomplete data. The final cohort comprised 149 patients (89.9% female), with a median age at diagnosis of 31 years. At diagnosis, 92.6% were symptomatic. Claudication of upper (36.2%) and lower (30.9%) limbs was frequent, alongside advanced vascular damage like stenosis (85.9%) and occlusions (52.3%). Upper limb claudication was independently predicted by reduced upper limb pulses (OR=4.83; 95%CI=2.08-11.24; p=0.001) and right subclavian artery occlusion (OR=8.06; 95%CI=1.94-33.44; p=0.004). Lower limb claudication was predicted by right subclavian artery occlusion (OR=6.65; 95%CI=2.05-21.61; p=0.002), right subclavian artery thickening (OR=5.12; 95%CI=1.18-22.71; p=0.029), and left subclavian artery stenosis (OR=2.71; 95%CI=1.21-60.56; p=0.016). Over a median 10-year follow-up, despite 91.3% remission, cardiovascular comorbidities increased, and 26.8% required surgery.

Conclusions: Limb claudication is a key prognostic indicator of advanced radiological damage and diagnostic delay. This is reinforced by a long-term dissociation between high clinical remission and progressive vascular disease, demanding vigilant monitoring.

Background: Comprehensive physiological characterization of coronary endotypes remains limited, especially in epicardial dysfunction.

Objectives: To describe hemodynamic profiles across the full spectrum of coronary endotypes and explore potential links with ischemia.

Methods: Patients with suspected chronic coronary syndromes who underwent invasive physiological assessment in the ANFIBIO Project (NCT05374694) were classified according to fractional flow reserve [(FFR)≤0.80] and index of microcirculatory resistance [(IMR)≥25] in the left anterior descending artery into four groups: normal indices, isolated epicardial, isolated microvascular, and combined dysfunction. Coronary pressure, flow, and resistance indices were compared between groups.

Results: A total of 130 patients were finally included. A gradual decrease in hyperemic coronary flow [(Qcor) in mL/min; normal indices: 387±192, isolated epicardial: 278±153, isolated microvascular: 130±41, combined: 96±33; p<0.001] and a progressive increase in total coronary resistance [(RTotal) in Wood units (WU); normal indices: 238±139, isolated epicardial: 373±167, isolated microvascular: 694±210, combined: 999±342; p<0.001] were observed as more compartments were involved. Also, epicardial dysfunction was primarily associated with reduced distal coronary pressure (Pd) and elevated epicardial resistance [(REpi) in WU; normal indices: 25±18, isolated epicardial: 145±113, isolated microvascular: 66±34, combined: 389±282; p<0.001], whereas microvascular dysfunction was characterized by preserved Pd but markedly decreased Qcor and increased microvascular resistance [(RMicro) in WU; normal indices: 213±124, isolated epicardial: 228±73, isolated microvascular: 628±195, combined: 610±137; p<0.001]. Combined dysfunction shares mechanisms of both epicardial and microvascular dysfunction.

Conclusions: Coronary endotypes exhibit distinct hemodynamic patterns with specific pressure- and flow-related ischemic mechanisms. Integrated physiological assessment is essential for accurate endotype characterization and personalized therapeutic strategies.

Background: In recent years, the impact of diet and lifestyle on coronary heart disease (CHD) has garnered significant attention. Caffeine, a common dietary component, and its metabolites may influence cardiovascular health.

Objective: This study aimed to investigate the association between urinary levels of caffeine and its metabolites and the incidence of CHD as well as to assess how these associations vary across different population groups.

Methods: Data from the NHANES database (2009-2014) were analyzed using multivariable logistic regression models and smooth curve fitting techniques. Participants were categorized into a control group (n = 5,005) and a CHD group (n = 222) based on CHD status. Urinary levels of caffeine and its metabolites were measured and recorded. Multivariable logistic regression was used to evaluate the association between urinary caffeine/metabolite levels and CHD incidence, while smooth curve fitting was employed to explore potential nonlinear relationships. A significance level of 5% was used to determine statistical significance.

Results: Higher urinary paraxanthine levels were associated with a lower risk of CHD. In contrast, elevated urinary caffeine levels were positively associated with CHD incidence among Mexican Americans, an association not observed in other racial/ethnic groups.

Conclusion: Lower urinary paraxanthine levels may reflect a reduced risk of CHD, while higher urinary caffeine levels could indicate an increased CHD risk in specific populations.

Background: Contrast-induced nephropathy (CIN) is a common complication following angiographic procedures, potentially related to the volume of contrast agent administered. However, it is unclear whether the type of contrast also influences its occurrence.

Objective: To evaluate the interaction between contrast volume and contrast type (iso-osmolar vs low-osmolar) in the development of CIN.

Methods: A post hoc subanalysis was performed on patients undergoing diagnostic or therapeutic coronary procedures who were randomized 1:1 to receive low-osmolar or iso-osmolar contrast media. The overall sample (n = 2,268) was stratified by contrast volume: Group I (< 150 mL; n = 1,985) and Group II (≥ 150 mL; n = 283), and groups were compared by contrast type. The primary endpoint was CIN at 48- and 96-hours post-procedure. CIN was defined as a ≥ 25% or ≥ 0.5 mg/dL increase in serum creatinine from baseline at 48 hours. The effects of contrast type and volume were tested with logistic regression including an interaction term, adjusted for acute coronary syndrome, ventricular dysfunction, baseline creatinine, sex, and age (p < 0.05).

Results: We included 2,268 consecutive patients; two-thirds were male; hypertension was present in 85%, diabetes in 52%, and chronic kidney disease in 31%. Mean contrast volume was 75.3 ± 28.0 mL in Group I and 188.6 ± 46.9 mL in Group II. The incidence of CIN was higher with greater volume (14.8% vs 17.7%) but not statistically significant (adjusted odds ratio = 1.25; 95% CI = 0.89-1.73; p = 0.191). The model with the interaction term showed no evidence of an interaction between the type of contrast and volume (p > 0.999).

Conclusion: The type of contrast was not associated with CIN, even among patients exposed to higher contrast volumes.