Antecedentes. Factores psicosociales han demostrado asociación independiente con la enfermedad arterial coronaria (EAC); sin embargo, la variable estrés sigue siendo sub detallada y hay pocos estudios que utilizaron la angiografía coronaria (CA) para evaluar EAC. Objetivos. Comparar los niveles de depresión, el estrés y los acontecimientos vitales estresantes en tres grupos de personas: en pacientes post-IM (infarto de miocardio), en pacientes que presentan síntomas cardiacos y cateterismo cardíaco normal y en individuos sin síntomas de enfermedades cardíacas. Métodos. Se realizó un estudio de casos y controles -dos grupos de casos y un grupo control-. El estudio incluyó a 105 pacientes con infarto de miocardio reciente (grupo MI), 101 pacientes con síntomas cardíacos y CA normal (grupo CS), y 100 pacientes sin síntomas de la enfermedad (grupo NS). Se utilizó multivariante de regresión logística para evaluar el estrés y los acontecimientos vitales con una odds ratio de intervalo de confianza del 95% (IC), controlando por edad, sexo, nivel educativo, ingresos, grupo de apoyo social, el indice de masa corporal (IMC), el sedentarismo y los antecedentes familiares de infarto de miocardio o muerte súbita. Resultados. Los pacientes del grupo MI mostraron depresión con una OR=4.47 (IC del 95%, 02:36-08:46, p<0.001), y el estrés OR=5.37 (IC 95%, 2.94-9.78; p<0,001) mientras que el grupo CS mostró depresión OR=6.95 (95% CI, 3.64 a 13.28, p<0.001) y el estrés OR=9.18 (95% CI, 4.73 a 17.82, p<0.001) en comparación con los pacientes sin síntomas. Después de ajustar por factores de riesgo: edad, sexo, educación, ingresos, apoyo social, obesidad, sedentarismo, antecedentes familiares de infarto de miocardio o muerte súbita, el OR mostró la siguiente variación: en el grupo de MI, depresión OR=2.51 (IC del 95%, 1:05 a 5:98, p=0.038), el estrés, OR=8.76 (IC del 95%, 3:48-22:01, p<0.001), y CS grupo, depresión OR=3.25 (95% CI, 1.40 a 7.55, p<01) y el estrés OR=12.24 (95%, IC, 4.81 a 31.14, p<0.001). El efecto de elevación de la variable estrés después del ajuste fue promovida por las variables de edad, sexo e inactividad física, y no afectó el nivel de significación (p<0.001). Conclusiones. Este estudio ha demostrado que los sujetos con síntomas cardíacos sin EAC presentan similares niveles de depresión y / o estrés a los de los pacientes post-IM. También se demostró que los pacientes post-IM y los pacientes CS tienen más estrés y depresión que los controles, incluso cuando se ajustan por edad, sexo, nivel de educación, ingreso familiar, apoyo social, obesidad, sedentarismo y antecedentes familiares de infarto de miocardio y / o muerte súbita.

Background. Psychosocial factors have been reported to be independently associated with coronary artery disease (CAD). However the stress variable is still sub detailed and there are few studies that used coronary angiography (CA) to assess CAD. Objectives. To compare levels of depression, stress and stressful life events in three groups of individuals: post-MI (Myocardial Infarction) patients; patients presenting symptoms and no previous MI who underwent cardiac catheterization and had non-significant obstructive CAD and individuals with no symptoms of cardiac disease or others diseases. Methods. We conducted a case-control study, with two cases groups and one control group. The study included 105 patients with recent Myocardial Infarction (MI group), 101 patients with cardiac symptoms and normal CA (CS group), and 100 patients without symptoms of disease (NS group). Multivariate logistic regression was used to assess stress and vital events with an Odds Ratio of 95% confidence interval (CI), controlling for age, sex, education level, income, social support group, Body Mass Index (BMI), sedentary lifestyle and family history of MI or sudden death. Results. MI patients group showed depression with an OR= 4.47(95% CI, 2:36 to 8:46, p<.001), and stress OR= 5.37(95%CI, 2.94-9.78, p<.001) whereas CS group showed depression: OR= 6.95(95%CI, 3.64-13.28, p<.001) and stress: OR=9.18 (95%CI, 4.73-17.82, p<.001) compared to patients without symptoms. After adjusting the groups for the following risk factors: age, sex, education, income, social support, obesity, sedentary lifestyle, family history of MI or sudden death, the OR showed the following variation: in the MI group, depression OR=2.51 (95%CI, 1:05 to 5:98, p=.038), stress, OR=8.76(95%CI, 3:48 to 22:01, p<.001), while the CS group showed: depression OR=3.25(95%CI, 1.40-7.55,p<01) and stress OR=12.24 (95%, CI, 4.81-31.14, p<.001). The raised effect of variable stress after adjustment was promoted by age, sex and physical inactivity variables, and did not affect the significance level (p<.001). Conclusions. This study has demonstrated that subjects with cardiac symptoms without overt CAD show similar depression and/or stress levels than post-MI patients, and that post-MI patients and CS patients experience more stress and depression than control patients, even when they adjusted in terms of age, sex, education level, family income, social support, obesity, sedentary lifestyle and family history of MI and / or sudden death.

Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall, foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos: o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA) = 2,8; o GE = FE < 40% ficou com 60 pacientes com médias de idade 48 ± 17 anos, FE = 27 ± 13% e (NYHA) = 3,6. Nas cirurgias, foram utilizados hipotermia e hemodiluição moderadas, oxigenador de bolhas, infusão cardioplégica St. Thomas. As médias dos tempos de circulação extracorpórea e parada cardíaca foram: no G1 =8 2 ± 18 e 49 ±7 minutos, e 96 ± 11 e 55 ± 6 minutos, no Grupo 2; o tamanho das próteses foi 25,2 ± 1,8 milímetros. No Grupo 1, a mortalidade imediata foi 3,8% no G1 e 5,8 no G2, e a tardia 4% no G1, e no G2 foi 8,7%. No G1 houve significante associação entre a mortalidade e a função ventricular sistólica. Clínicamente, no G1, 65% dos pacientes estão na (NYHA) I, 28% na II, 5% na III e 2% na IV. No G2, 46% estão na (NYHA) I, 25% na II, 13% na III, e 16% na IV. A sobrevida atuarial em sete anos foi 88 ± 2% no G1 e 76 ± 4% no G2. Portanto, os pacientes com FE < 40% apresentaram mortalidade mais elevada, menor sobrevida a curto e longo prazo e resultados clínicos menos satisfatórios. Para obtermos melhores resultados, devemos operar antes que a FE em repouso e exercício se torne deprimida, ou que apareça intolerância ao exercício moderado.

To evaluate the prognostic value of resting left ventricular ejection fraction (LVEF) a series of 210 consecutive patients with aortic valve disease operated upon between May 1981 and October 1988 was studied retrospectively. All patients had their aortic valve replaced by Omniscience or Meditronic prosthesis; 112 formed the study group because they have complete follow up and cineangiocardiographic data. Based on pre-operatory left ventricular ejection fraction the patients were divided in two groups: Group 1 = 52 patients with LVEF > 40%, 39 ± 12 years, NYHA functional class 2.8, and EF 58 ± 10%. Group 2 = 60 patients with LVEF < 40, 48 ± 17 years, NYHA functional class 3.6, and LVEF of 27 ± 12%. During surgery moderate hypothermia and hemodilution were utilized, with dubble oxygenator and cardioplegia With St. Thomas cardioplegic solution. Mean extracorporeal circulation and cardiac arrest time were respectively 82 ± 18 and 49 ± 7 minutes in Group 1 and 96 ± 11 and 55 ± 6 minutes in Group 2. The size of the prosthesis were 25.2 ± 1.8 mm in Group 1. The short term mortality was 3.8% in Group 1 and 5.8 in Group 2. The long-term mortality was 4.0% in Group 1 and 8.7% in Group 2. In Group 1 there was a significant association between mortality and left ventricular systolic function. In the follow-up evaluation, among patients in Group 1, 65% were in class I, 28% were in functional class II, 5% in class III, and 2% in class IV. Among patients in group II 46% were in class I, 25% in class II, 13% in class III, and 16% in class IV. The 7 year survival rate was 88 ± 2% in Group 1 and 76 ± 4% in Group 2. Thus, patients with LVEF less than 40% had higher short and longterm mortality and worse clinical course. For better surgical results patients with aortic valve disease should be operated upon before the reduction of left ventricular systolic function.