ABSTRACT Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects. physiology tissues 52yearold yearold 52 year old metallic resection period evaluation defects 5

Resumo Fundamento: Gama-câmaras com detectores de telureto-cádmio-zinco (CZT) permitiram a quantificação da reserva de fluxo miocárdico (RFM), podendo aumentar a acurácia da cintilografia miocárdica de perfusão (CMP) para detectar a causa do desconforto torácico. Objetivo: Avaliar o impacto clínico da RFM para detectar a causa do desconforto torácico. Métodos: 171 pacientes com desconforto torácico que foram submetidos a coronariografia ou angiotomografia de coronárias também realizaram CMP e RFM num intervalo de tempo <30 dias. As aquisições das imagens dinâmicas de repouso e estresse foram iniciadas simultaneamente à injeção de 99mTc sestamibi (10 e 30mCi, respectivamente), ambas com duração de onze minutos, seguidas imediatamente pela aquisição das imagens de perfusão durante 5 minutos. O estresse foi realizado com dipiridamol. Uma RFM global ou por território coronariano <2,0 foi classificada como anormal. Resultados: A idade média foi de 65,9±10 anos (60% do sexo feminino). A avaliação anatômica mostrou que 115 (67,3%) pacientes apresentavam obstrução coronariana significativa, sendo que, 69 apresentavam CMP anormal e 91 apresentavam RFM anormal (60,0% vs. 79,1%, p<0,01). Dentre os pacientes sem obstrução (56 – 32,7%), 7 tinham CMP anormais e 23 tinham RFM global reduzida. A realização da RFM identificou a etiologia do desconforto torácico em 114 pacientes enquanto a CMP identificou em 76 (66,7% vs. 44,4%, p<0,001). Conclusão: A RFM é uma medida fisiológica quantificável que aumenta o impacto clínico da CMP na detecção da causa do desconforto torácico através de uma maior acurácia para detecção de DAC obstrutiva e ainda possibilita identificar a presença de doença microvascular. Fundamento Gamacâmaras Gama câmaras teluretocádmiozinco telureto cádmio zinco CZT (CZT RFM, , (RFM) (CMP Objetivo Métodos 17 30 <3 dias mTc 10 (1 30mCi mCi respectivamente, respectivamente respectivamente) minutos dipiridamol 20 2 0 <2, Resultados 65910 65 9 65,9±1 60% 60 (60 feminino. feminino . feminino) 11 67,3% 673 67 3 (67,3% significativa 6 60,0% 600 (60,0 vs 791 79 1 79,1% p<0,01. p001 p p<0,01 01 p<0,01) 56 (5 32,7%, 327 32,7% 32 32,7%) reduzida 66,7% 667 66 (66,7 444 44 4 44,4% p<0,001. p0001 p<0,001 001 p<0,001) Conclusão microvascular (RFM < ( <2 6591 65,9± (6 67,3 (67,3 60,0 (60, 79,1 p00 p<0,0 32,7 66,7 (66, 44,4 p000 p<0,00 00 659 65,9 67, (67, 60, 79, p0 p<0, 32, 66, (66 44, 65, (67 p<0 p<

Abstract Background: Gamma cameras with cadmium-zinc telluride (CZT) detectors allowed the quantification of myocardial flow reserve (MBF), which can increase the accuracy of myocardial perfusion scintigraphy (MPS) to detect the cause of chest discomfort. Objective: To assess the clinical impact of MBF to detect the cause of chest discomfort. Methods: 171 patients with chest discomfort who underwent coronary angiography or coronary CT angiography also underwent MPS and MBF in a time interval of <30 days. The acquisitions of dynamic imaging of rest and stress were initiated simultaneously with the 99mTc injection sestamibi (10 and 30mCi, respectively), both lasting eleven minutes, followed by immediately acquiring perfusion images for 5 minutes. The stress was performed with dipyridamole. A global or per coronary territory MBF <2.0 was classified as abnormal. Results: The average age was 65.9±10 years (60% female). The anatomical evaluation showed that 115 (67.3%) patients had coronary obstruction significant, with 69 having abnormal MPs and 91 having abnormal MBF (60.0% vs 79.1%, p<0.01). Among patients without obstruction (56 – 32.7%), 7 had abnormal MPS, and 23 had reduced global MBF. Performing MBF identified the etiology of the chest discomfort in 114 patients while MPS identified it in 76 (66.7% vs 44.4%, p<0.001). Conclusion: MBF is a quantifiable physiological measure that increases the clinical impact of MPS in detecting the cause of chest discomfort through greater accuracy for detecting obstructive CAD, and it also makes it possible to identify the presence of the microvascular disease. Background cadmiumzinc cadmium zinc CZT (CZT MBF, , (MBF) (MPS Objective Methods 17 30 <3 days mTc 10 (1 30mCi mCi respectively, respectively respectively) minutes dipyridamole 20 2 0 <2. Results 65910 65 9 65.9±1 60% 60 (60 female. female . female) 11 67.3% 673 67 3 (67.3% significant 6 60.0% 600 (60.0 791 79 1 79.1% p<0.01. p001 p p<0.01 01 p<0.01) 56 (5 32.7%, 327 32.7% 32 32.7%) 66.7% 667 66 (66.7 444 44 4 44.4% p<0.001. p0001 p<0.001 001 p<0.001) Conclusion CAD disease (MBF < ( <2 6591 65.9± (6 67.3 (67.3 60.0 (60. 79.1 p00 p<0.0 32.7 66.7 (66. 44.4 p000 p<0.00 00 659 65.9 67. (67. 60. 79. p0 p<0. 32. 66. (66 44. 65. (67 p<0 p<

Abstract Systemic microvascular dysfunction has been shown to be present in COVID-19, and serum cytokines are known to be involved in the regulation of vascular function. We sought to evaluate systemic microvascular endothelial function, with laser doppler perfusion monitoring (LDPM), and plasma levels of cytokines after acute COVID-19. Individuals admitted to a Cardiology hospital with acute COVID-19 and followed for 12-15 months after recovery underwent noninvasive evaluation of systemic endothelium-dependent microvascular reactivity by cutaneous LDPM with local thermal hyperemia (LTH). A multiplex biometric immunoassay panel was used to assess 48 serum cytokines and chemokines. Twenty patients and 14 control volunteers were enrolled. The areas under the curves of vasodilation induced by LTH were significantly increased after recovery (P=0.009) and were not different from values obtained in healthy volunteers (P= 0.85). The peak microvascular flow during LTH did also significantly increase (P= 0.02), and was not different form values obtained in healthy volunteers (P= 0.55). Several cytokines displayed significantly reduced serum concentrations after recovery from COVID-19. In conclusion, endothelium-dependent systemic microvascular reactivity improved after recovery from COVID-19 in patients with cardiovascular diseases, in parallel with a reduction in the levels of several serum cytokines and chemokines involved in the regulation of vascular function and inflammation. COVID19, COVID19 COVID 19, 19 LDPM, , (LDPM) COVID19. 19. COVID-1 1215 12 15 12-1 endotheliumdependent endothelium dependent LTH. . (LTH) 4 1 enrolled P=0.009 P0009 P 0 009 (P=0.009 P= (P 0.85. 085 0.85 85 0.85) 0.02, 002 0.02 02 0.02) 0.55. 055 0.55 55 0.55) conclusion diseases inflammation COVID1 (LDPM COVID- 121 12- (LTH P=0.00 P000 00 (P=0.00 08 0.8 8 0.0 05 0.5 5 P=0.0 P00 (P=0.0 0. P=0. P0 (P=0. P=0 (P=0

RESUMO A prevenção de eventos cardiovasculares é um dos principais objetivos de um questionário de triagem para a prática de exercícios. O objetivo do estudo foi verificar a validade diagnóstica do questionário do ACSM/AHA (AAPQ), através da sensibilidade (SE) e especificidade (ES), e AUC (área sob a curva). Participaram do estudo 69 indivíduos (40 a 81 anos). Comparações entre sexo e categorias de idade foram realizadas. Não foi verificada diferença significativa. Contudo, a variação nas respostas positivas pareceu aumentar percentualmente, principalmente a partir dos 60 anos (de 78,6% a 100%). Os valores de SE do AAPQ foram altos (88,2%), sugerindo que grande parte dos indivíduos em que o resultado do instrumento foi positivo apresentava alguma contraindicação. Contudo, o valor da ES foi de apenas 13,5%, indicando que o questionário não foi capaz de identificar aqueles indivíduos sem contraindicação ao início de um programa de exercícios. Com isso, o instrumento teria uma baixa capacidade diagnóstica (AUC=0,51). Os resultados sugerem que o questionário apresenta baixa capacidade em identificar indivíduos aptos a iniciar um programa de exercícios.

ABSTRACT The prevention of cardiovascular events is one of the main objectives of a preexercise screening questionnaire. The aim of this study was to evaluate the diagnostic validity of ACSM/AHA questionnaire (AAPQ), through the Sensitivity (Se), Specificity (Sp) and AUC (area under the curve). The study included 69 subjects (40-81 years). Comparisons between sex and age categories were performed. There was no significant difference. However, the variation in positive responses seemed to increase in percentage terms, especially after 60 years (from 78.6% to 100%). The AAPQ Se values were high (88.2%) suggesting that the majority of individuals in whom the instrument was positive showed some contraindication. However, the Sp value was only 13.5%, indicating that the questionnaire was not able to identify those with no contra indication to start an exercise program. Thus, the instrument would have a low diagnostic capacity (AUC = 0.51). The results suggest that the questionnaire presents a low capacity to identify individuals suitable for inclusion in an exercise program.

Resumo Fundamentos: A hipercolesterolemia familiar (HF) é uma doença autossômica dominante, caracterizada por altos níveis plasmáticos do colesterol da lipoproteína de baixa densidade (LDL-C) e pelo alto risco de desenvolvimento prematuro de doenças cardiovasculares. Objetivo: Avaliar características clínicas e antropométricas de pacientes com fenótipo para hipercolesterolemia familiar (HF), com ou sem diagnóstico genético de HF. Métodos: Quarenta e cinco pacientes com LDL-C > 190 mg/dL foram genotipados para seis genes relacionados com a HF: LDLR, APOB, PCSK9, LDLRAP1, LIPA e APOE. Pacientes que apresentaram resultado positivo para qualquer uma das mutações foram diagnosticados com HF por confirmação genética. O fenótipo para HF foi classificado pelo critério da Dutch Lipid Clinic Network. Resultados: Comparando os pacientes com a HF geneticamente confirmada com aqueles sem a confirmação, os primeiros apresentaram maior pontuação do escore para HF, uma maior frequência de xantelasma e maiores níveis de LDL-C e apo B. Houve correlações significativas entre o LDL-C e a pontuação do escore para HF (R = 0,382, p = 0,037) e entre LDL-C e gordura corporal (R = 0,461, p = 0,01). Os pacientes com mutações, no entanto, não apresentaram qualquer correlação entre o LDL-C e outras variáveis, enquanto aqueles sem mutação apresentaram correlação entre o LDL-C e a pontuação do escore. Conclusão: O LDL-C correlacionou-se com a pontuação do escore e com a gordura corporal, tanto na população total de pacientes quanto nos pacientes sem a confirmação genética de HF. Naqueles com HF geneticamente confirmada, não houve correlação entre o LDL-C e outras variáveis clínicas ou bioquímicas dos pacientes.

Abstract Background: Familial hypercholesterolemia (FH) is a common autosomal dominant disorder, characterized by a high level of low-density lipoprotein cholesterol (LDL-C) and a high risk of premature cardiovascular disease. Objective: To evaluate clinical and anthropometric characteristics of patients with the familiar hypercholesterolemia (FH) phenotype, with or without genetic confirmation of FH. Methods: Forty-five patients with LDL-C > 190 mg/dl were genotyped for six FH-related genes: LDLR, APOB, PCSK9, LDLRAP1, LIPA and APOE. Patients who tested positive for any of these mutations were considered to have genetically confirmed FH. The FH phenotype was classified according to the Dutch Lipid Clinic Network criteria. Results: Comparing patients with genetically confirmed FH to those without it, the former had a higher clinical score for FH, more often had xanthelasma and had higher LDL-C and apo B levels. There were significant correlations between LDL-C and the clinical point score for FH (R = 0.382, p = 0.037) and between LDL-C and body fat (R = 0.461, p = 0.01). However, patients with mutations did not have any correlation between LDL-C and other variables, while for those without a mutation, there was a correlation between LDL-C and the clinical point score. Conclusions: LDL-C correlated with the clinical point score and with body fat, both in the overall patient population and in patients without the genetic confirmation of FH. In those with genetically confirmed FH, there were no correlations between LDL-C and other clinical or biochemical variables in patients.

Oral care is frequently suboptimal in children from developing countries, especially those suffering from severe systemic diseases. The aim of the present study was to analyze the oral epidemiological profile of 3-to-5-year-old children with congenital heart disease. Dental and medical records of children evaluated at the Dental Service of the National Institute of Cardiology, Rio de Janeiro, Brazil, were reviewed. Caries experience was reported using the dmft index. Negative behavior towards dental management was recorded. The sample consisted of 144 children aged 4.41 ± 0.95 years. The mean dmft value was 5.4 ± 4.9, and 80.5% had at least one caries lesion. Dmft index was greater in the presence of cyanotic cardiac disease and in children with negative behavior. An increase in the “missing” component of the dmft index was also found in children using medicine on a daily basis. A higher caries experience was associated with children whose fathers had only an elementary education. In conclusion, children with congenital heart disease had high levels of caries experience at a young age. Cyanosis, negative behavior, daily use of medicine, one-parent family and the educational level of fathers seem to influence caries experience in children with congenital cardiac disease.