Arquivos brasileiros de cardiologia最新文献

Background: Brazil is a country with different biomes and social disparities. There are limited data available on regional differences and prognosis of heart failure (HF) in the country.

Objective: The Rosa dos Ventos study aims to investigate regional differences and the current prognosis of HF outpatients with reduced or mildly reduced ejection fraction in Brazil.

Methods: This is a prospective, multicenter, observational cohort study that will include outpatients older than 18 years with HF and an ejection fraction < 50% in 30 public and private centers distributed in all Brazilian regions. A total of 2,500 patients will be enrolled from June 2021 and October 2023, with a 12-month follow-up period. We will collect data on socioeconomic and clinical status, medical prescription and results of cardiology tests. Follow-up phone calls will be made at 6 and 12 months after inclusion to collect information regarding emergency room visits, hospitalization and mortality.

Conclusion: The Rosa dos Ventos study will allow a more accurate characterization of chronic HF in Brazil. This initiative will provide relevant information for the development of effective management strategies to mitigate the impact of this condition on patients and the healthcare system.

Background: Glycogen synthase kinase 3β (GSK3β) is an enzyme that has roles in the pathogenesis of heart failure (HF). We try to reveal serum GSK3β levels in types of HF.

Objectives: In this study, we evaluated serum GSK3β levels in HF patients. Also, we tried to elucidate any possible relationship between serum GSK3β levels and disease severity among three different types of HF patients.

Methods: We performed a prospective study and enrolled 112 patients: 50 patients in heart failure with preserved ejection fraction (HFpEF) group, 30 patients in heart failure with mildly reduced ejection fraction (HFmrEF) group, and 32 patients in heart failure with reduced ejection fraction group (HFrEF). We also evaluated 50 healthy controls. Echocardiographic examinations were performed. We measured serum GSK-3β and N-terminal pro-B-type natriuretic peptide (NT-proBNP). We measured highly sensitive C-reactive protein (hs-CRP) levels and calculated neutrophil-lymphocyte ratio (NLR) platelets-to-lymphocyte ratio (PLR) from the hemogram count. Statistical significance was accepted p < 0.05.

Results: Serum GSK3β levels were significantly higher among patients with HF compared to healthy controls (median GSK3β levels; 117.26 (45.39 -223.85) vs 13.91 (5.6 -23.3) ng/mL, p<0.001). Also, GSK3β levels were highest among patients with HFpEF and lowest among patients with HFrEF; 236.44 (132.89 -432) vs. 38.72 (23.15-67.31) ng/mL respectively (p<0.001). Median NT-proBNP levels, as expected, were significantly higher among patients with HF compared to healthy controls (660 (291 -1000) vs. 92 (78 -102) pg/mL, p<0.001). As a marker of systemic inflammation, hsCRP values, NLR, and PLR did not differ significantly among HF patients and controls.

Conclusion: GSK3β levels were significantly higher among patients with HF. Also, as the ejection fraction declines, GSK3β levels also reduce, probably as a protective mechanism to prevent further apoptosis and myocyte death.

Background: Individuals with severe hypercholesterolemia (SH) are considered at high atherosclerosis risk and should be intensively treated with lipid-lowering drugs aiming for an LDL-C reduction of≥50% and a goal of <70 mg/dL.

Objectives: This study aimed to evaluate cholesterol control in individuals with SH (LDL-C ≥ 190 mg/dL or 160-189 mg/dL using lipid-lowering drugs) followed in a health evaluation program.

Methods: 55,000 individuals were evaluated, of which 2,214 (4%) had SH, and 1,016 (45.8%) had repeated assessments. Achievement of recommended LDL-C goals was the primary study endpoint. A p-value < 0.05 was considered significant.

Results: Mean age (± SD) was 44.9±8.8 years, 84.2% were men, and 0.5% reported previous myocardial infarction. Mean LDL-C was 203.0±22.0 mg/dL, and although 62.5% referred dyslipidemia, only 19% were using lipid-lowering drugs (5.9% in cases with LDL-C ≥ 190 mg/dL). During a 4.1±2.8-year follow-up, use of lipid-lowering drugs increased from 18.1% to 48.4% (p<0.00001), 5.9% to 45.4% in those with LDL-C ≥ 190 mg/dL (p< 0.00001) though 31% of cases with LDL-C 160-189 mg/dL stopped taking medications. Overall, there was a mean 26.7% reduction in LDL-C (p<0.0001), and LDL-C reductions ≥50% were attained in 19.2%, 19.1%, and 19.7 % of all individuals, and in those with LDL-C > 190 mg/dL and 160-189 mg/dL respectively. Only 3.1% reached LDL-C < 70 mg/dL (2.7% in those with LDL-C ≥ 190 and 5.3% in those with 160-189 mg/dL).

Conclusions: A serious gap was found between treatment recommendations and reality in individuals at high atherosclerosis risk due to SH.

Background: The impact of performing a primary percutaneous coronary intervention (pPCI) off-hours on clinical outcomes is not well established.

Objective: Compare characteristics and major adverse cardiovascular events (MACE) of pPCI off-hours versus on-hours in a high-volume cardiology center.

Methods: Prospective cohort of patients who underwent pPCI for ST elevation myocardial infarction (STEMI) from 2009 to 2019. We defined off-hours pPCI as workdays from 8pm to 7:59 am as well as weekends and holidays. We compared patients treated on- and off-hours as to baseline characteristics and 1-year events.

Results: A total of 2,560 patients were treated off-hours and 1,876 patients treated on-hours. The groups were similar for most of the baseline characteristics. A higher thrombus burden was seen in patients treated off-hours (50% x 45%; p < 0.01), and in this group the radial access was more frequently used (62% x 58%; p = 0.01). Procedural success was not statistically different between the groups (95.7% x 96.4%; p = 0.21). MACE rates were higher in patients treated off-hours at 30 days (10.2% x 8.5%; p = 0.04) and at one year of follow-up (15.4% x 13.1%; p = 0.03), driven by higher death rates at 30 days (7.8% x 6.1%; p = 0.03) and at 1 year follow-up (11.1% x 9.0%; p = 0.02).

Conclusion: In a high-volume cardiology center, clinical characteristics, door-to-balloon times, procedural pPCI success and complication rates of STEMI patients treated on and off-hours were similar. However, patients treated off-hours presented higher MACE and mortality rates, in spite of similar MI and stroke rates.