Arquivos brasileiros de cardiologia最新文献

Background: The COVID-19 pandemic has affected millions globally, with persistent impacts extending beyond the acute phase. One such effect is post-COVID (long COVID), characterized by symptoms such as fatigue and exercise intolerance lasting more than 60 days. Although regular exercise is associated with reduced risk of severe outcomes, reports of decreased athletic performance after COVID-19 - even among highly active individuals (HAIs) - have raised concerns regarding the long-term effects on physical health. Cardiopulmonary exercise testing (CPET) is a valuable tool to assess exercise intolerance and to investigate the metabolic and ventilatory consequences of COVID-19.

Objectives: To evaluate the impact of COVID-19 on cardiopulmonary function in HAIs by analyzing metabolic and ventilatory responses using CPET before and after infection.

Methods: CPET data were retrospectively analyzed from HAIs of both sexes. Primary outcomes included changes in peak oxygen uptake ( V ⋅ O2peak) and ventilatory efficiency ( V ⋅ E/ V ⋅ CO2 slope). Statistical significance was set at 5% (p < 0.05).

Results: A total of 43 HAIs (72.1% male; 44 ± 10 years) were included. The median interval between CPETs was 479 days, with testing performed a mean of 44 ± 27 days after COVID-19. V ⋅ O2peak decreased by a mean of 1.5 mL/kg/min (p = 0.017), representing a 3.84% reduction in predicted V ⋅ O2peak values (p = 0.045). V ⋅ E/ V ⋅ CO2 slope increased by 1.2 (p = 0.017).

Conclusion: Although HAIs are not immune to the effects of COVID-19, their high baseline physical activity levels appear to confer substantial cardiopulmonary resilience. Only minimal post-infection alterations were observed, which suggests that maintaining fitness may provide protective benefits against long-term sequelae of COVID-19.

Background: Atrial cardiomyopathy encompasses various atrial abnormalities, including left atrial enlargement (LAE), which is associated with adverse cardiovascular and neurocognitive outcomes. P-wave duration ≥120 ms on 12-lead electrocardiogram (ECG) is a widely available, cost-effective tool and one of the main diagnostic criteria adopted. However, its diagnostic performance in large-scale studies remains underexplored.

Objectives: To evaluate the correlation between P-wave duration and left atrial volume (LAV) measured by transthoracic echocardiogram (TTE) and determine the diagnostic accuracy of P-wave duration ≥120 ms for identifying LAE.

Methods: We conducted a cross-sectional analysis of baseline data from the ELSA-Brasil cohort participants in sinus rhythm. P-wave duration was automatically measured via standard 12-lead ECG, with ≥120 ms indicating enlargement. LAE was defined as LAV>34 mL/m2 by TTE. Spearman's rank test assessed correlation. Diagnostic performance metrics - sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV), positive and negative likelihood ratio (LR+ and LR-) - were calculated. Also, a Receiver Operating Characteristic (ROC) was constructed. Statistical significance was set at p-value<0.05 with 95% confidence interval.

Results: The study included 2589 participants, 419 (16,1%) with LAV index>34 mL/m2. P-wave duration correlated weakly with LAV (Spearman's ρ = 0.120, p < 0.001). Diagnostic accuracy measurements were AUC = 0.557 ± 0.032; Sn = 0.296; Sp = 0.811; PPV = 0.232; NPV = 0.856; LR+ 1.566; LR- 0.868.

Conclusion: P-wave duration demonstrates limited diagnostic value for identifying LAE, suggesting against its recommendation as a standalone diagnostic criterion for this condition.

Background: Drug-eluting stents (DES) remain the standard of care for percutaneous coronary intervention in small vessel coronary artery disease (SVD). Paclitaxel-coated balloons (PCB) have emerged as an alternative, with recent trials suggesting favorable short- and mid-term outcomes, although most were limited by small sample sizes.

Objectives: To compare angiographic and clinical outcomes between DES and PCB in patients with SVD.

Methods: Searches were conducted in PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov for studies comparing PCB and DES in SVD, defined as a reference vessel diameter < 3.0 mm. A random-effects meta-analysis was performed, and results were reported as mean differences (MD) or risk ratios (RR). Statistical significance was set at p < 0.05. Heterogeneity was assessed using the chi-square, Tau, and Tau2 tests. The review protocol was registered in PROSPERO (CRD42024506502).

Results: A total of 12 studies comprising 17,441 patients (mean age of 58-73 years) were included, with clinical follow-up of 8 to 36 months. All studies evaluated PCB. No significant differences were found between PCB and DES in target lesion revascularization (RR, 1.24; 95% CI, 0.82-1.85; p = 0.30), late lumen loss (MD, -0.09 mm; 95% CI, -0.41 to 0.23; p = 0.57), major adverse cardiovascular events (RR, 1.01; 95% CI, 0.76-1.33; p = 0.95), all-cause mortality (RR, 0.81; 95% CI, 0.50-1.31; p = 0.39), cardiovascular mortality (RR, 1.74; 95% CI, 0.78-3.89; p = 0.17), and myocardial infarction (RR, 0.76; 95% CI, 0.46-1.27; p = 0.30).

Conclusions: PCB angioplasty demonstrated clinical and angiographic outcomes comparable to DES in SVD, supporting its role as a safe, effective alternative in selected patients.