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[SciELO Preprints] - Risk of Adverse Health Outcomes in Patients with Poor Adherence to Cardiovascular Medication Treatment: a Systematic Review
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Malachias, Marcus Vinícius Bolívar Kaiser, Sergio Emanuel Albuquerque, Denilson Campos de Brandão, Andréa Araujo Sposito, Andrei C. Moura, Lidia Zytynski Magalhães, Lucélia Batista Neves Cunha Mota-Gomes, Marco Antonio Clausell, Nadine Jardim, Paulo César Veiga Nadruz, Wilson Barros, Bruno Monteiro Luna , Leonardo Castro Barroso, Weimar Kunz Sebba

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Publication date: 2024-09-16

Abstract: Pt En

Introdução: As doenças cardiovasculares (DCV) continuam a ser a principal causa de mortalidade em todo o mundo. A adesão ao tratamento medicamentoso é uma questão importante no manejo das DCV crônicas, influenciando diretamente os resultados e os custos com saúde. Objetivos: Esta revisão sistemática, apoiada pela Sociedade Brasileira de Cardiologia, avalia o impacto da baixa adesão aos medicamentos cardiovasculares em desfechos clínicos críticos, como morte e eventos cardiovasculares. Métodos: Foi realizada uma busca abrangente em quatro bases de dados, incluindo Medline, Embase, Lilacs e Cochrane Library. A revisão incluiu revisões sistemáticas com meta-análises que relataram estimativas de risco para a adesão aos medicamentos cardiovasculares. Foram selecionadas quatro revisões sistemáticas, cada uma incorporando estudos observacionais. Resultados: Os principais achados indicam que um aumento na adesão aos medicamentos reduz significativamente o risco de eventos cardiovasculares, acidente vascular cerebral (AVC) e morte por todas as causas. Especificamente, uma melhoria de 20% na adesão a medicamentos antihipertensivos, hipolipemiantes e outros medicamentos cardiovasculares correlacionou-se com reduções nos eventos cardiovasculares de 7%, 10% e 9%, respectivamente; AVC de 17%, 13% e 18%; e morte de 12%, 9% e 10%. A certeza das evidências foi moderada, sugerindo que esses efeitos provavelmente estão presentes. Esses achados enfatizam a importância de melhorar a adesão ao tratamento medicamentoso para aprimorar os resultados clínicos no manejo das DCV. Conclusões: As evidências demonstraram reduções em desfechos duros tanto na prevenção primária quanto secundária através do controle de condições como hipertensão e concentrações elevadas de colesterol LDL, bem como os benefícios da terapia antiplaquetária em doenças ateroscleróticas. No entanto, são necessários estudos adicionais para elucidar melhor a relação entre a adesão aos medicamentos cardiovasculares e a melhoria dos desfechos clínicos críticos.

Background: Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Medication adherence is an important issue in managing chronic CVD, directly influencing outcomes and healthcare costs. Objectives: This systematic review, supported by the Brazilian Society of Cardiology, evaluates the impact of poor adherence to cardiovascular medications on critical clinical outcomes such as death and cardiovascular events. Methods: A comprehensive search was conducted across four databases, including Medline, Embase, Lilacs, and the Cochrane Library. The review included systematic reviews with meta-analyses that reported risk estimates for adherence to cardiovascular medications. Four systematic reviews, each incorporating observational studies, were selected. Results: The principal findings indicate that an increase in adherence to medications significantly reduces the risk of cardiovascular events, stroke, and all-cause death. Specifically, a 20% improvement in adherence to antihypertensive, lipid-lowering, and other cardiovascular medications correlated with reductions in cardiovascular events by 7%, 10%, and 9%, respectively; stroke by 17%, 13%, and 18%; and death by 12%, 9%, and 10%. The certainty of the evidence was moderate, suggesting that these effects are likely present. These findings emphasize the importance of enhancing medication adherence to improve clinical outcomes in CVD management. Conclusions: Evidence has demonstrated reductions in hard endpoints in both primary and secondary prevention through the control of conditions such as hypertension and elevated LDL cholesterol concentrations, as well as the benefits of antiplatelet therapy in atherosclerotic disease. However, additional studies are needed to better elucidate the relationship between adherence to cardiovascular medications and the improvement of critical clinical outcomes.

https://doi.org/10.1590/SciELOPreprints.9997

Transplante Combinado de Coração e Rim Realizado em Etapas com Máquina de Perfusão Pulsátil: Uma Estratégia Viável para o Transplante Combinado Pulsátil
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Manfro, Arthur Gus

; Franco, Rodrigo Fontanive

; Manfro, Roberto Ceratti

; Clausell, Nadine

; Goldraich, Livia Adams

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 7 elocation e20240007

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20240007

Risco de Desfechos Adversos à Saúde em Pacientes com Baixa Adesão ao Tratamento Medicamentoso Cardiovascular: Uma Revisão Sistemática Cardiovascular
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Malachias, Marcus Vinícius Bolívar

; Kaiser, Sergio Emanuel

; Albuquerque, Denilson Campos de

; Brandão, Andrea Araújo

; Sposito, Andrei Carvalho

; Moura, Lidia Zytysnky

; Magalhães, Lucélia Batista Neves Cunha

; Mota-Gomes, Marco Antonio

; Clausell, Nadine

; Jardim, Paulo César Veiga

; Nadruz, Wilson

; Barros, Bruno Monteiro

; Luna, Leonardo Castro

; Barroso, Weimar Kunz Sebba

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 10 elocation e20240469

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

Abstract Background Cardiovascular diseases (CVD) remain the leading cause of mortality worldwide. Medication adherence is an important issue in managing chronic CVD, directly influencing outcomes and healthcare costs. Objectives This systematic review, supported by the Brazilian Society of Cardiology, evaluates the impact of poor adherence to cardiovascular medications on critical clinical outcomes such as death and cardiovascular events. Methods A comprehensive search was conducted across four databases, including Medline, Embase, Lilacs, and the Cochrane Library. The review included systematic reviews with meta-analyses that reported risk estimates for adherence to cardiovascular medications. Four systematic reviews, each incorporating observational studies, were selected. Results An increase in adherence to medications significantly reduces the risk of cardiovascular events, stroke, and all-cause death. Specifically, a 20% improvement in adherence to antihypertensive, lipid-lowering, and other cardiovascular medications correlated with reductions in cardiovascular events by 7%, 10%, and 9%, respectively; stroke by 17%, 13%, and 18%; and death by 12%, 9%, and 10%. The certainty of the evidence was moderate, suggesting that these effects are likely present. These findings emphasize the importance of enhancing medication adherence to improve clinical outcomes in CVD management. Conclusions Evidence has demonstrated reductions in hard endpoints in both primary and secondary prevention through the control of conditions such as hypertension and elevated LDL cholesterol concentrations, as well as the benefits of antiplatelet therapy in atherosclerotic disease. However, additional studies are needed to better elucidate the relationship between adherence to cardiovascular medications and the improvement of critical clinical outcomes. (CVD worldwide costs Cardiology databases Medline Embase Lilacs Library metaanalyses meta analyses selected allcause all Specifically 20 antihypertensive lipidlowering, lipidlowering lipid lowering, lowering lipid-lowering 7 7% 10 10% 9 9% respectively 17 17% 13 13% 18% 18 12 12% moderate present management concentrations disease However 2 1

Resumo Fundamento As doenças cardiovasculares (DCV) são a principal causa de mortes no mundo. A adesão ao tratamento medicamentoso é um fator importante no manejo de DCV crônicas, influenciando diretamente a ocorrência de desfechos e custos da saúde. Objetivos Esta revisão sistemática, apoiada pela Sociedade Brasileira de Cardiologia, tem como objetivo avaliar o impacto da baixa adesão aos medicamentos para DCV sobre desfechos clínicos críticos como morte e eventos cardiovasculares. Métodos Foi realizada uma busca abrangente em quatro bases de dados: Medline, Embase, Lilacs e Cochrane. Foram incluídas revisões sistemáticas e metanálises que avaliaram estimativas de risco para adesão aos medicamentos cardiovasculares. Quatro revisões sistemáticas, cada uma incorporando estudos observacionais, foram selecionadas. Resultados O aumento na adesão aos medicamentos reduz significativamente o risco de eventos cardiovasculares, acidente vascular cerebral (AVC) e morte por todas as causas. Uma melhoria de 20% na adesão a medicamentos anti-hipertensivos, hipolipemiantes e outros medicamentos cardiovasculares foi correlacionada com reduções nos eventos cardiovasculares em 7%, 10% e 9%, respectivamente; AVC em 17%, 13% e 18%; e morte em 12%, 9% e 10%. A certeza das evidências foi moderada, sugerindo que esses efeitos provavelmente estão presentes. Esses achados enfatizam a necessidade de aumentar a adesão aos tratamentos para melhorar os desfechos clínicos no manejo das DCV. Conclusões Evidências demonstraram reduções em morte e desfechos críticos, tanto na prevenção primária quanto na secundária, por meio do controle de condições como hipertensão e colesterol LDL elevado, assim como benefícios da terapia antiplaquetária na doença aterosclerótica. Mais estudos são necessários para melhor elucidar a relação entre a adesão aos medicamentos cardiovasculares e a melhora de desfechos clínicos críticos. (DCV mundo crônicas saúde sistemática Cardiologia dados Medline Embase Cochrane observacionais selecionadas (AVC causas 20 antihipertensivos, antihipertensivos anti hipertensivos, hipertensivos anti-hipertensivos 7 7% 10 9 respectivamente 17 17% 13 18% 18 12 12% moderada presentes secundária elevado aterosclerótica 2 1

https://doi.org/10.36660/abc.20240469

Valor Preditivo dos Biomarcadores Cardíacos na Função Tardia do Enxerto em Pacientes com Transplante Renal
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Amantéa, Rodrigo Pinheiro

; Olsen, Virgílio da Rocha

; Hastenteufel, Laura Caroline Tavares

; Borges, Flávia K.

; Manfro, Roberto Ceratti

; Goldraich, Lívia Adams

; Clausell, Nadine

Arquivos Brasileiros de Cardiologia

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2024, Volume 121 N. 11 elocation e20230858

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20230858

Uso do Modelo de Risco ADHERE como Preditor de Piora Intra-Hospitalar de Insuficiência Cardíaca em uma Coorte IntraHospitalar Intra Hospitalar
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Bernardes, Daniela de Souza

; Santos, Marina Scherer

; Mantovani, Vanessa Monteiro

; Almeida Neto, Omar Pereira de

; Goldraich, Livia Adams

; Clausell, Nadine

; Rabelo-Silva, Eneida Rejane

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 8 elocation e20220584

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Pacientes hospitalizados com insuficiência cardíaca (IC) aguda descompensada estão sujeitos a desenvolver episódios de piora que requerem intervenções mais complexas. O modelo de predição de risco “Acute Decompensated Heart Failure National Registry” (ADHERE) foi desenvolvido nos Estados Unidos para prever o risco de piora intra-hospitalar da IC. Objetivo Utilizar o modelo de predição de risco ADHERE para avaliar o risco de piora intra-hospitalar da IC e determinar a sua sensibilidade e especificidade em pacientes hospitalizados. Métodos O presente estudo de coorte foi realizado em um hospital universitário público brasileiro e os dados de 2013 a 2020 foram coletados retrospectivamente. Foram considerados estatisticamente significativos valores de p < 0,05. Resultados Foram incluídos 890 pacientes com idade média de 74 ± 8 anos. O modelo mostrou que no grupo de 490 pacientes de risco, 254 (51,8%) desenvolveram piora intra-hospitalar da IC. No grupo de 400 pacientes sem risco, apenas 109 (27,2%) apresentaram piora da IC. Os resultados demonstraram uma curva estatisticamente significativa (área sob a curva = 0,665; erro padrão = 0,018; p < 0,01; intervalo de confiança = 0,609 a 0,701), indicando boa precisão. O modelo apresentou sensibilidade de 69,9% e especificidade de 55,2%, com valor preditivo positivo de 52% e valor preditivo negativo de 72,7%. Conclusões Na presente coorte, demonstramos que o modelo de predição de risco ADHERE foi capaz de discriminar pacientes que, de fato, desenvolveram piora da IC durante o período de internação daqueles que não desenvolveram. (IC complexas Acute Registry (ADHERE intrahospitalar intra hospitalar 201 202 retrospectivamente 005 0 05 0,05 89 7 anos 49 25 51,8% 518 51 (51,8% 40 10 27,2% 272 27 2 (27,2% área 0,665 0665 665 0,018 0018 018 0,01 001 01 0609 609 0,60 0,701, 0701 0,701 , 701 0,701) precisão 699 69 9 69,9 552 55 55,2% 52 727 72 72,7% fato 20 00 0,0 4 51,8 5 (51,8 1 27,2 (27,2 0,66 066 66 060 60 0,6 070 0,70 70 6 69, 55,2 72,7 0, 51, (51, 27, (27, 06 07 0,7 55, 72, (51 (27 (5 (2 (

Abstract Background Patients admitted with acute decompensated heart failure (HF) are subject to developing worsening episodes that require more complex interventions. The Acute Decompensated Heart Failure National Registry (ADHERE) risk model was developed in the United States to predict the risk of in-hospital worsening HF. Objective To use the ADHERE risk model in the assessment of risk of in-hospital worsening HF and to determine its sensitivity and specificity in hospitalized patients. Methods This cohort study was conducted at a Brazilian public university hospital, and data from 2013 to 2020 were retrospectively collected. P values < 0.05 were considered statistically significant. Results A total of 890 patients with a mean age of 74 ± 8 years were included. The model showed that, in the group of 490 patients at risk, 254 (51.8%) developed in-hospital worsening HF. In the group of 400 patients not at risk, only 109 (27.2%) experienced worsening HF. The results demonstrated a statistically significant curve (area under the curve = 0.665; standard error = 0.018; P < 0.01; confidence interval = 0.609 to 0.701), indicating good accuracy. The model had a sensitivity of 69.9% and a specificity of 55.2%, with a positive predictive value of 52% and a negative predictive value of 72.7%. Conclusions In this cohort, we showed that the ADHERE risk model was able to discriminate patients who in fact developed worsening HF during the admission period, from those who did not. (HF interventions (ADHERE inhospital hospital 201 202 collected 005 0 05 0.0 89 7 included 49 25 51.8% 518 51 (51.8% 40 10 27.2% 272 27 2 (27.2% area 0.665 0665 665 0.018 0018 018 0.01 001 01 0609 609 0.60 0.701, 0701 0.701 , 701 0.701) accuracy 699 69 9 69.9 552 55 55.2% 52 727 72 72.7% period 20 00 0. 4 51.8 5 (51.8 1 27.2 (27.2 0.66 066 66 060 60 0.6 070 0.70 70 6 69. 55.2 72.7 51. (51. 27. (27. 06 07 0.7 55. 72. (51 (27 (5 (2 (

https://doi.org/10.36660/abc.20220584

Endomiocardiofibrose como Causa Rara de Transplante Cardíaco e Associação com Trombofilia: Relato de Caso
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Hastenteufel, Laura Caroline Tavares

; Clausell, Nadine Oliveira

; Oliveira, Francine Hehn de

; Leitão, Santiago Alonso Tobar

; Goldraich, Lívia Adams

Arquivos Brasileiros de Cardiologia

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jan 2022, Volume 118 N. 1 Pages 103 - 105

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210040

Diretriz de Miocardites da Sociedade Brasileira de Cardiologia – 2022
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Montera, Marcelo Westerlund

; Marcondes-Braga, Fabiana G.

; Simões, Marcus Vinícius

; Moura, Lídia Ana Zytynski

; Fernandes, Fabio

; Mangine, Sandrigo

; Oliveira Júnior, Amarino Carvalho de

; Souza, Aurea Lucia Alves de Azevedo Grippa de

; Ianni, Bárbara Maria

; Rochitte, Carlos Eduardo

; Mesquita, Claudio Tinoco

; de Azevedo Filho, Clerio F.

; Freitas, Dhayn Cassi de Almeida

; Melo, Dirceu Thiago Pessoa de

; Bocchi, Edimar Alcides

; Horowitz, Estela Suzana Kleiman

; Mesquita, Evandro Tinoco

; Oliveira, Guilherme H.

; Villacorta, Humberto

; Rossi Neto, João Manoel

; Barbosa, João Marcos Bemfica

; Figueiredo Neto, José Albuquerque de

; Luiz, Louise Freire

; Hajjar, Ludhmila Abrahão

; Beck-da-Silva, Luis

; Campos, Luiz Antonio de Almeida

; Danzmann, Luiz Cláudio

; Bittencourt, Marcelo Imbroinise

; Garcia, Marcelo Iorio

; Avila, Monica Samuel

; Clausell, Nadine Oliveira

; Oliveira Jr, Nilson Araujo de

; Silvestre, Odilson Marcos

; Souza, Olga Ferreira de

; Mourilhe-Rocha, Ricardo

; Kalil Filho, Roberto

; Al-Kindi, Sadeer G.

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Ferreira, Silvia Moreira Ayub

; Rizk, Stéphanie Itala

; Mattos, Tiago Azevedo Costa

; Barzilai, Vitor

; Martins, Wolney de Andrade

; Schultheiss, Heinz-Peter

Arquivos Brasileiros de Cardiologia

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2022, Volume 119 N. 1 Pages 143 - 211

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20220412

Electromyographical and Physiological Correlation in Patient with Heart Disease
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Bona, Renata Luísa

; Bonezi, Artur

; Biancardi, Carlo M

; Castro, Flavio Antonio de Souza

; Clausell, Nadine

International Journal of Cardiovascular Sciences

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dec 2021, Volume 34 N. 6 Pages 665 - 674

Abstract: En | Text: En | PDF: En

Abstract Background: Walking is an economic activity, the more efficient the mechanical contribution, the less metabolic energy is necessary to keep walking. Patients with chronic heart failure and heart transplant present peripheral musculoskeletal disorders, dyspnea, and fatigue in their activities. Objective: In this scenario, the present study sought to verify the correlations between metabolic and electromyographic variables in chronic heart failure, heart transplant patients, and healthy controls. Methods: Regression and correlation between cost of transport and electromyographic cost, as well as correlation between oxygen consumption and muscle coactivation in patients and controls at five different walking speeds have been performed, with alpha = 0.05. Results: Strong correlation values (r controls: 0.99; chronic heart failure: 0.92; heart transplant: 0.88) indicate a linear relationship between the cost of transport and electromyographic cost. Oxygen consumption was significantly correlated to muscle activation in all groups. Conclusion: These results suggested that dynamic muscle coactivation was an important factor, especially for CHF and HT. These data support the idea that peripheral muscle limitations play an important role in people with CHF and HT. These findings indicate a strong relation between metabolic and electromyographic variables. For chronic heart failure and heart transplant patients, it can help to explain some difficulties in daily activities and aid in physical rehabilitation. Background activity contribution disorders dyspnea Objective scenario Methods performed 005 0 05 0.05 Results r 0.99 099 99 0.92 092 92 0.88 088 88 groups Conclusion factor HT rehabilitation 00 0.0 0.9 09 9 0.8 08 8 0.

https://doi.org/10.36660/ijcs.20200063

Atualização de Tópicos Emergentes da Diretriz Brasileira de Insuficiência Cardíaca – 2021
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Marcondes-Braga, Fabiana G.

; Moura, Lídia Ana Zytynski

; Issa, Victor Sarli

; Vieira, Jefferson Luis

; Rohde, Luis Eduardo

; Simões, Marcus Vinícius

; Fernandes-Silva, Miguel Morita

; Rassi, Salvador

; Alves, Silvia Marinho Martins

; Albuquerque, Denilson Campos de

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Ramires, Felix José Alvarez

; Bacal, Fernando

; Rossi Neto, João Manoel

; Danzmann, Luiz Claudio

; Montera, Marcelo Westerlund

; Oliveira Junior, Mucio Tavares de

; Clausell, Nadine

; Silvestre, Odilson Marcos

; Bestetti, Reinaldo Bulgarelli

; Bernadez-Pereira, Sabrina

; Freitas Jr, Aguinaldo F.

; Biolo, Andréia

; Barretto, Antonio Carlos Pereira

; Jorge, Antônio José Lagoeiro

; Biselli, Bruno

; Montenegro, Carlos Eduardo Lucena

; Santos Júnior, Edval Gomes dos

; Figueiredo, Estêvão Lanna

; Fernandes, Fábio

; Silveira, Fabio Serra

; Atik, Fernando Antibas

; Brito, Flávio de Souza

; Souza, Germano Emílio Conceição

; Ribeiro, Gustavo Calado de Aguiar

; Villacorta, Humberto

; Souza Neto, João David de

; Goldraich, Livia Adams

; Beck-da-Silva, Luís

; Canesin, Manoel Fernandes

; Bittencourt, Marcelo Imbroinise

; Bonatto, Marcely Gimenes

; Moreira, Maria da Consolação Vieira

; Avila, Mônica Samuel

; Coelho Filho, Otavio Rizzi

; Schwartzmann, Pedro Vellosa

; Mourilhe-Rocha, Ricardo

; Mangini, Sandrigo

; Ferreira, Silvia Moreira Ayub

; Figueiredo Neto, José Albuquerque de

; Mesquita, Evandro Tinoco

Arquivos Brasileiros de Cardiologia

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jun 2021, Volume 116 N. 6 Pages 1174 - 1212

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20210367 3168 downloads

10.

Os Desafios da Insuficiência Cardíaca Ontem, Hoje e Amanhã, e os 20 Anos do DEIC
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Mesquita, Evandro Tinoco

; Mendes, Ana Paula

; Moura, Lidia

; Figueiredo Neto, José Albuquerque de

; Marcondes-Braga, Fabiana G.

; Bacal, Fernando

; Moreira, Maria da Consolação Vieira

; Clausell, Nadine Oliveira

Arquivos Brasileiros de Cardiologia

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feb 2021, Volume 116 N. 2 Pages 359 - 362

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20201200 899 downloads

11.

Tópicos Emergentes em Insuficiência Cardíaca: Abordagem Contemporânea da Insuficiência Cardíaca Avançada
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Marcondes-Braga, Fabiana G.

; Vieira, Jefferson L.

; Souza Neto, João David de

; Calado, Gustavo

; Ayub-Ferreira, Silvia Moreira

; Bacal, Fernando

; Clausell, Nadine

Arquivos Brasileiros de Cardiologia

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dec 2020, Volume 115 N. 6 Pages 1193 - 1196

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.36660/abc.20201194 829 downloads

12.

Safety and Results of Bioelectrical Impedance Analysis in Patients with Cardiac Implantable Electronic Devices
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Garlini, Luíza Matos

; Alves, Fernanda Donner

; Kochi, Adriano

; Zuchinali, Priccila

; Zimerman, Leandro

; Pimentel, Mauricio

; Perry, Ingrid Schweigert

; Souza, Gabriela Corrêa

; Clausell, Nadine

Brazilian Journal of Cardiovascular Surgery

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apr 2020, Volume 35 N. 2 Pages 169 - 174

Abstract: En | Text: En | PDF: En

Abstract Objective: To analyze the dual interference between cardiac implantable electronic devices (CIEDs) and bioelectrical impedance analysis (BIA). Methods: Forty-three individuals admitted for CIEDs implantation were submitted to a tetrapolar BIA with an alternating current at 800 microA and 50 kHz frequency before and after the devices’ implantation. During BIA assessment, continuous telemetry was maintained between the device programmer and the CIEDs in order to look for evidence of possible electric interference in the intracavitary signal of the device. Results: BIA in patients with CIEDs was safe and not associated with any device malfunction or electrical interference in the intracardiac electrogram of any electrode. After the implantation of the devices, there were significant reductions in BIA measurements of resistance, reactance, and measurements adjusted for height resistance and reactance, reflecting an increase (+ 1 kg; P<0.05) in results of total body water and extracellular water in liter and, consequently, increases in fat-free mass (FFM) and extracellular mass in kg. Because of changes in the hydration status and FFM values, without changes in weight, fat mass was significantly lower (-1.2 kg; P<0.05). Conclusion: BIA assessment in patients with CIEDs was safe and not associated with any device malfunction. The differences in BIA parameters might have occurred because of modifications on the patients’ body composition, associated to their hydration status, and not to the CIEDs.

https://doi.org/10.21470/1678-9741-2019-0098 759 downloads

13.

Impaired Right Ventricular Function in Heart Transplant Rejection
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Carrion, Luciana J. B. M.

; Sperotto, Alice

; Nazario, Raffaela

; Goldraich, Livia A.

; Clausell, Nadine

; Rohde, Luís Eduardo

; Santos, Angela Barreto Santiago

Arquivos Brasileiros de Cardiologia

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apr 2020, Volume 114 N. 4 Pages 638 - 644

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A prática de triagem para complicações tem proporcionado altas taxas de sobrevida entre pacientes que receberam transplante cardíaco (TC). Objetivos: Visamos avaliar se alterações no strain longitudinal global (SLG) do ventrículo esquerdo (VE) e do ventrículo direito (VD) estão associadas à rejeição celular. Métodos: Pacientes que foram submetidos à TC em um único centro (2015 - 2016; n = 19) foram incluídos nesta análise retrospectiva. Foram avaliados um total de 170 biópsias com ecocardiogramas correspondentes. Foram realizadas comparações entre pares de biópsia/ecocardiograma com nenhuma ou leve (0R/1R) evidência de rejeição celular (n = 130 e n = 25, respectivamente) e aqueles com episódios de rejeição moderada (2R) (n = 15). Foram considerados estatisticamente significativos os valores de p < 0,05. Resultados: A maioria dos pacientes eram mulheres (58%) com idade média de 48 ± 12,4 anos. Em comparação com os ecocardiogramas dos pacientes com rejeição 0R/1R, os pacientes com biópsias 2R apresentaram maior espessura da parede posterior do VE, relação E/e’ e relação E/A, em comparação com o outro grupo. A função sistólica do VE não diferiu entre os grupos. Por outro lado, a função sistólica do VD foi reduzida no grupo 2R em comparação ao outro grupo, quando avaliada por TAPSE, onda S e variação fracional da área do VD. Adicionalmente, SLG VD (−22,97 ± 4,4% no grupo 0R/1R vs. −20,6 ± 4,9% no grupo 2R, p = 0,038) foi reduzido no grupo 2R, em comparação com o grupo 0R/1R. Conclusão: Em pacientes de TC, rejeição celular aguda moderada está associada à disfunção sistólica do VD, avaliado pelo strain do VD, bem como por parâmetros ecocardiográficos convencionais. Vários parâmetros ecocardiográficos podem ser utilizados para realizar triagem para rejeição celular.

Abstract Background: The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. Objectives: Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. Methods: Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e’ ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (−23.0 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. Conclusion: In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.

https://doi.org/10.36660/abc.20190054 846 downloads

14.

Brazilian Society of Cardiology - The Women’s Letter
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Oliveira, Glaucia Maria Moraes de

; Negri, Fátima Elizabeth Fonseca de Oliveira

; Clausell, Nadine Oliveira

; Moreira, Maria da Consolação V.

; Souza, Olga Ferreira de

; Macedo, Ariane Vieira Scarlatelli

; Marino, Barbara Campos Abreu

; Polanczyk, Carisi Anne

; Lantieri, Carla Janice Baister

; Marques-Santos, Celi

; Freire, Cláudia Maria Vilas

; Nercolini, Deborah Christina

; Pedroti, Fatima Cristina Monteiro

; Barbosa, Imara Correia de Queiroz

; Santos, Magaly Arrais dos

; Braile, Maria Christiane Valéria Braga

; Paiva, Maria Sanali Moura de Oliveira

; Dracoulakis, Marianna Deway Andrade

; Holanda, Narriane Chaves

; Rolim, Patricia Toscano Rocha

; Teixeira, Roberta Tavares Barreto

; Mattos, Sandra

; Silva, Sheyla Cristina Tonheiro Ferro da

; Brandão, Simone Cristina Soares

; Lemke, Viviana de Mello Guzzo

; Lopes, Marcelo Antônio Cartaxo Queiroga

Arquivos Brasileiros de Cardiologia

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jun 2019, Volume 112 N. 6 Pages 713 - 714

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20190111 1001 downloads

15.

Continuous Intravenous Inotropes in Ward Units: Expanding Therapy Outside Intensive Care using a Safety-Oriented Protocol
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Hastenteufel, Laura Caroline Tavares

; Clausell, Nadine

; Neyeloff, Jeruza Lavanholi

; Domingues, Fernanda Bandeira

; Caballero, Larissa Gussatschenko

; Silva, Eneida Rejane Rabelo da

; Goldraich, Lívia Adams

Arquivos Brasileiros de Cardiologia

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may 2019, Volume 112 N. 5 Pages 573 - 576

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Pacientes selecionados com insuficiência cardíaca (IC), clinicamente estáveis que necessitam de terapia inotrópica intravenosa prolongada podem se beneficiar de sua continuidade fora da unidade de terapia intensiva (UTI). Nosso objetivo foi relatar a experiência inicial e a segurança de um protocolo estruturado para terapia inotrópica em unidades de terapia não-intensiva em 28 pacientes consecutivos hospitalizados com IC que receberam alta da UTI. A utilização de doses inotrópicas baixas a moderadas, orientadas por um processo de cuidado focado na segurança, pode reconfigurar seu papel como terapia de transição enquanto aguarda terapias avançadas definitivas e permite a alta precoce da UTI.

Abstract Selected clinically stable patients with heart failure (HF) who require prolonged intravenous inotropic therapy may benefit from its continuity out of the intensive care unit (ICU). We aimed to report on the initial experience and safety of a structured protocol for inotropic therapy in non-intensive care units in 28 consecutive patients hospitalized with HF that were discharged from ICU. The utilization of low to moderate inotropic doses oriented by a safety-focused process of care may reconfigure their role as a transition therapy while awaiting definitive advanced therapies and enable early ICU discharge.

https://doi.org/10.5935/abc.20190078 1398 downloads

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