Resumo Fundamento Pacientes com idade superior a 50 anos requerem quatro vezes mais intervenções cirúrgicas que o grupo mais jovem. Muitas diretrizes recomendam a realização do eletrocardiograma pré-operatório nessa faixa etária. Objetivos Determinar a importância do ECG pré-operatório em pacientes com idade superior a 50 anos e com classificação de risco cirúrgico ASA I e II. Métodos Foram recrutados pacientes com idade superior a 50 anos, sem comorbidades, submetidos à intervenção cirúrgica sob anestesia geral. Os pacientes foram randomizados para a realização (grupo A n=214) ou não (grupo B n=213) do ECG pré-operatório. Foram analisadas as variáveis: sexo, idade, resultado do ECG, da radiografia do tórax e dos exames laboratoriais, risco cirúrgico, duração do procedimento, eventos adversos e mortalidade intra-hospitalar. O nível de significância estatística adotado foi de 5%. Resultados Houve ocorrência de desfechos adversos em 23 (5,4%) pacientes, com um número significante de eventos adversos nos pacientes do sexo masculino (OR=7,91, IC95% 3,3-18,90, p<0,001) e naqueles com intervenções de maior porte cirúrgico (OR=30,02, IC95% 4,01-224,92, p<0,001). Não houve diferença entre os grupos que realizaram ou não o ECG (OR=1,59, IC95% 0,67-3,75, p=0,289). As demais variáveis não mostraram diferenças significantes. Na regressão logística multivariada o sexo masculino (OR=6,49; IC95% 2,42-17,42, p<0,001) e o porte cirúrgico (OR=22,62; IC95% 2,95-173,41, p=0,002) foram preditores independentes de desfechos adversos, enquanto realizar ou não ECG (OR=1,09; IC95% 0,41-2,90, p=0,867) permaneceu sem significância estatística. Conclusões Os resultados sugerem que o ECG pré-operatório não foi capaz de predizer aumento do risco de desfechos adversos nos pacientes estudados, durante a fase hospitalar. 5 jovem préoperatório pré operatório etária II comorbidades geral n=214 n214 n 214 n=213 n213 213 préoperatório. operatório. laboratoriais procedimento intrahospitalar. intrahospitalar intra hospitalar intra-hospitalar 5% 2 5,4% 54 4 (5,4% OR=7,91, OR791 OR 7 91 (OR=7,91 IC95 IC 3,318,90, 331890 3,3 18,90, 3 18 90 3,3-18,90 p<0,001 p0001 p 0 001 OR=30,02, OR3002 30 02 (OR=30,02 4,01224,92, 40122492 4,01 224,92, 01 224 92 4,01-224,92 p<0,001. . OR=1,59, OR159 1 59 (OR=1,59 0,673,75, 067375 0,67 3,75, 67 75 0,67-3,75 p=0,289. p0289 p=0,289 289 p=0,289) significantes OR=6,49 OR649 6 49 (OR=6,49 2,4217,42, 2421742 2,42 17,42, 42 17 2,42-17,42 OR=22,62 OR2262 22 62 (OR=22,62 2,95173,41, 29517341 2,95 173,41, 95 173 41 2,95-173,41 p=0,002 p0002 002 OR=1,09 OR109 09 (OR=1,09 0,412,90, 041290 0,41 2,90, 0,41-2,90 p=0,867 p0867 867 estudados n=21 n21 21 5,4 (5,4 OR=7,91 OR79 9 (OR=7,9 IC9 318 3,318,90 33189 33 3, 1890 18,90 3,3-18,9 p<0,00 p000 00 OR=30,02 OR300 (OR=30,0 01224 4,01224,92 4012249 401 4,0 22492 224,92 4,01-224,9 OR=1,59 OR15 (OR=1,5 673 0,673,75 06737 067 0,6 375 3,75 0,67-3,7 p028 p=0,28 28 OR=6,4 OR64 (OR=6,4 4217 2,4217,42 242174 242 2,4 1742 17,42 2,42-17,4 OR=22,6 OR226 (OR=22,6 95173 2,95173,41 2951734 295 2,9 17341 173,41 2,95-173,4 p=0,00 OR=1,0 OR10 (OR=1,0 412 0,412,90 04129 041 0,4 290 2,90 0,41-2,9 p=0,86 p086 86 n=2 n2 5, (5, OR=7,9 OR7 (OR=7, 31 3,318,9 3318 189 18,9 3,3-18, p<0,0 p00 OR=30,0 OR30 (OR=30, 0122 4,01224,9 401224 40 4, 2249 224,9 4,01-224, OR=1,5 OR1 (OR=1, 0,673,7 0673 06 0, 37 3,7 0,67-3, p02 p=0,2 OR=6, OR6 (OR=6, 421 2,4217,4 24217 24 2, 174 17,4 2,42-17, OR=22, OR22 (OR=22, 9517 2,95173,4 295173 29 1734 173,4 2,95-173, p=0,0 OR=1, 0,412,9 0412 04 0,41-2, p=0,8 p08 8 n= (5 OR=7, (OR=7 3,318, 331 18, 3,3-18 p<0, p0 OR=30, OR3 (OR=30 012 4,01224, 40122 224, 4,01-224 (OR=1 0,673, 0,67-3 p=0, OR=6 (OR=6 2,4217, 2421 17, 2,42-17 OR=22 OR2 (OR=22 951 2,95173, 29517 173, 2,95-173 OR=1 0,412, 0,41-2 ( OR=7 (OR= 3,318 3,3-1 p<0 OR=30 (OR=3 4,01224 4012 4,01-22 0,673 0,67- p=0 OR= 2,4217 2,42-1 OR=2 (OR=2 2,95173 2951 2,95-17 0,412 0,41- (OR 3,31 3,3- p< OR=3 4,0122 4,01-2 p= 2,421 2,42- 2,9517 2,95-1 4,012 4,01- 2,951 2,95-

Abstract Background Patients aged over 50 years require four times more surgical interventions than younger groups. Many guidelines recommend the performance of preoperative electrocardiogram (ECG) in this population. Objectives To determine the value of preoperative ECG in patients aged over 50 years and classified as ASA I–II (surgical risk). Methods Patients older than 50 years, without comorbidities, who underwent surgical intervention and general anesthesia were included in the study. Patients were randomized to undergo ECG (group A, n=214) or not (group B, n=213) in the preoperative period. The following variables were analyzed: sex, age, ECG, chest x-ray and laboratory tests results, surgical risk, surgery duration, adverse events and in-hospital mortality. The level of significance was set at 5%. Results Adverse outcomes were reported in 23 (5.4%) patients, with a significant number of adverse events in male patients (OR=7.91 95%CI 3.3-18.90, p<0.001) and in those undergoing major surgeries (OR=30.02 95%CI 4.01-224.92, p<0.001). No differences were observed between patients who underwent ECG and those who did not (OR=1.59, 95%CI, 0.67-3.75, p=0.289). No significant differences were found in the other variables. In multivariate logistic regression, male sex (OR = 6.49; 95%CI 2.42-17.42, p<0.001) and major surgery (OR=22.62; 95%CI 2.95-173.41, p=0.002) were independent predictors of adverse outcomes, whereas undergoing (or not) ECG (OR=1.09; IC95% 0.41-2.90, p=0.867) remained without statistical significance. Conclusion Our findings suggest that preoperative ECG could not predict an increased risk of adverse outcomes in our study population during the hospital phase. 5 groups (ECG III I II risk. . risk) comorbidities group A n=214 n214 n 214 B n=213 n213 213 period analyzed age xray x ray results duration inhospital mortality 5% 2 5.4% 54 4 (5.4% OR=7.91 OR791 OR 7 91 (OR=7.9 95CI CI 95 3.318.90, 331890 3.3 18.90, 3 18 90 3.3-18.90 p<0.001 p0001 p 0 001 OR=30.02 OR3002 30 02 (OR=30.0 4.01224.92, 40122492 4.01 224.92, 01 224 92 4.01-224.92 p<0.001. OR=1.59, OR159 1 59 (OR=1.59 0.673.75, 067375 0.67 3.75, 67 75 0.67-3.75 p=0.289. p0289 p=0.289 289 p=0.289) regression 6.49 649 6 49 2.4217.42, 2421742 2.42 17.42, 42 17 2.42-17.42 OR=22.62 OR2262 22 62 (OR=22.62 2.95173.41, 29517341 2.95 173.41, 173 41 2.95-173.41 p=0.002 p0002 002 OR=1.09 OR109 09 (OR=1.09 IC95 IC 0.412.90, 041290 0.41 2.90, 0.41-2.90 p=0.867 p0867 867 phase n=21 n21 21 5.4 (5.4 OR=7.9 OR79 9 (OR=7. 318 3.318.90 33189 33 3. 1890 18.90 3.3-18.9 p<0.00 p000 00 OR=30.0 OR300 (OR=30. 01224 4.01224.92 4012249 401 4.0 22492 224.92 4.01-224.9 OR=1.59 OR15 (OR=1.5 673 0.673.75 06737 067 0.6 375 3.75 0.67-3.7 p028 p=0.28 28 6.4 64 4217 2.4217.42 242174 242 2.4 1742 17.42 2.42-17.4 OR=22.6 OR226 (OR=22.6 95173 2.95173.41 2951734 295 2.9 17341 173.41 2.95-173.4 p=0.00 OR=1.0 OR10 (OR=1.0 IC9 412 0.412.90 04129 041 0.4 290 2.90 0.41-2.9 p=0.86 p086 86 n=2 n2 5. (5. OR=7. OR7 (OR=7 31 3.318.9 3318 189 18.9 3.3-18. p<0.0 p00 OR=30. OR30 (OR=30 0122 4.01224.9 401224 40 4. 2249 224.9 4.01-224. OR=1.5 OR1 (OR=1. 0.673.7 0673 06 0. 37 3.7 0.67-3. p02 p=0.2 6. 421 2.4217.4 24217 24 2. 174 17.4 2.42-17. OR=22. OR22 (OR=22. 9517 2.95173.4 295173 29 1734 173.4 2.95-173. p=0.0 OR=1. 0.412.9 0412 04 0.41-2. p=0.8 p08 8 n= (5 OR=7 (OR= 3.318. 331 18. 3.3-18 p<0. p0 OR=30 OR3 (OR=3 012 4.01224. 40122 224. 4.01-224 (OR=1 0.673. 0.67-3 p=0. 2.4217. 2421 17. 2.42-17 OR=22 OR2 (OR=22 951 2.95173. 29517 173. 2.95-173 OR=1 0.412. 0.41-2 ( OR= 3.318 3.3-1 p<0 OR=3 4.01224 4012 4.01-22 0.673 0.67- p=0 2.4217 2.42-1 OR=2 (OR=2 2.95173 2951 2.95-17 0.412 0.41- 3.31 3.3- p< 4.0122 4.01-2 p= 2.421 2.42- 2.9517 2.95-1 4.012 4.01- 2.951 2.95-

ABSTRACT Objective: To identify the obesity diagnosis with the highest association with physical frailty associated with sarcopenia EWGSOP II (sarcopenic obesity). Subjects and methods: We performed a cross-sectional analysis of 371 community-dwelling older adults. Appendicular skeletal lean mass and total body fat (TBF) were assessed using dual-energy x-ray absorptiometry, and physical frailty was defined using Fried's criteria. The phenotypes were identified according to the presence of sarcopenia by EWGSOP II and obesity, which was diagnosed using two concepts: BMI obesity (BMI ≥ 30 kg/m2) and TBF obesity (percentage of TBF ≥ 35% for women and ≥ 25% for men). Finally, the association of each group with physical frailty was evaluated. Results: The mean age was 78.15 ± 7.22 years. Sarcopenia EWGSOP II was diagnosed in 19.8% (n = 73), body mass index obesity was identified in 21.8% (n = 81), TBF obesity was identified in 67.7% (n = 251), and physical frailty was identified in 38.5% (n = 142). In a regression analysis for frailty, sarcopenic TBF obesity presented an odds ratio of 6.88 (95% confidence interval 2.60-18.24; p < 0.001). Conclusion: In older Brazilian adults, sarcopenic obesity diagnosed by TBF obesity has a robust association with frailty and is independent of body mass index. Objective obesity. . obesity) methods crosssectional cross sectional 37 communitydwelling community dwelling adults (TBF dualenergy dual energy xray x ray absorptiometry Frieds Fried s criteria concepts 3 kg/m2 kgm2 kgm kg m2 m percentage 35 25 men. men men) Finally evaluated Results 7815 78 15 78.1 722 7 22 7.2 years 198 19 8 19.8 n 73, 73 , 73) 218 21 21.8 81, 81 81) 677 67 67.7 251, 251 251) 385 38 5 38.5 142. 142 142) 688 6 88 6.8 95% 95 (95 2.6018.24 2601824 2.60 18.24 2 60 18 24 2.60-18.24 0.001. 0001 0.001 0 001 0.001) Conclusion kg/m 781 1 78. 72 7. 19. 21. 67. 38. 14 68 6. 9 (9 6018 2.6018.2 260182 260 2.6 1824 18.2 2.60-18.2 000 0.00 00 ( 601 2.6018. 26018 26 2. 182 18. 2.60-18. 0.0 2.6018 2601 2.60-18 0. 2.601 2.60-1 2.60-

Abstract Background: Transplant Renal Artery Stenosis (TRAS) is a recognized vascular complication after kidney transplantation. The overall risk predictors of TRAS are poorly understood. Methods: Retrospective analysis of patients with suspected TRAS (Doppler ultrasound PSV > 200 cm/s) who underwent angiographic study in a single center between 2007 and 2014. All patients with stenosis > 50% were considered with TRAS. Stenosis restricted in the body of the artery was also analyzed in a subgroup. Results: 274 patients were submitted to a renal angiography and 166 confirmed TRAS. TRAS group featured an older population (46.3 ± 11.0 vs. 40.9 ±14.2 years; p = 0.001), more frequent hypertensive nephropathy (30.1% vs. 15.7%; p = 0.01), higher incidence of Delayed Graft Function (DGF) (52.0% vs. 25.6%; p < 0.001) and longer Cold Ischemia Time (CIT) (21.5 ± 10.6 vs. 15.7 ± 12.9h; p < 0.001). In multivariable analyses, DGF (OR = 3.31; 95% CI 1.78-6.30; p < 0.0001) was independent risk factors for TRAS. DM and CIT showed a tendency towards TRAS. The compound discriminatory capacity of the multivariable model (AUC = 0.775; 95% CI 0.718-0.831) is significantly higher than systolic blood pressure and creatinine alone (AUC = 0.62; 95% CI 0.558-0.661). In body artery stenosis subgroup, DGF (OR = 1.86; 95% CI 1.04-3.36; p = 0.03) and Diabetes Mellitus (DM) (OR = 2.44; 95% CI 1.31-4.60; p = 0.005) were independent risk factors for TRAS. Conclusion: In our transplant population, DGF increased more than 3-fold the risk of TRAS. In the subgroup analysis, both DGF and DM increases the risk of body artery stenosis. The addition of other factors to hypertension and renal dysfunction may increase diagnostic accuracy.

Resumo Fundamento A intervenção coronária percutânea primária é considerada o “padrão-ouro” para reperfusão coronária. Entretanto, quando não disponível, a estratégia fármaco-invasiva é método alternativo, e o eletrocardiograma (ECG) tem sido utilizado para identificar sucesso na reperfusão. Objetivos Nosso estudo teve como objetivo examinar alterações no segmento-ST pós-lise e seu poder de prever a recanalização, usando os escores angiográficos TIMI e blush miocárdio (MBG) como critério de reperfusão ideal. Métodos Foram estudados 2.215 pacientes com infarto agudo do miocárdio com supra-ST submetidos à fibrinólise [(Tenecteplase)-TNK] e encaminhados para angiografia coronária em até 24 h pós-fibrinólise ou imediatamente encaminhados à terapia de resgate. O ECG foi realizado pré-TNK e 60 min-pós. Os pacientes foram categorizados em dois grupos: aqueles com reperfusão ideal (TIMI-3 e MBG-3) e aqueles com reperfusão inadequada (fluxo TIMI <3). Foi definido o critério de reperfusão do ECG pela redução do segmento ST >50%. Consideramos p-valor <0,05 para as análises, com testes bicaudais. Resultados O critério de reperfusão pelo ECG apresentou valor preditivo positivo de 56%; valor preditivo negativo de 66%; sensibilidade de 79%; e especificidade de 40%. Houve fraca correlação positiva entre a redução do segmento-ST e os dados angiográficos de reperfusão ideal (r = 0,21; p <0,001) e baixa precisão diagnóstica, com AUC de 0,60 (IC-95%; 0,57-0,62). Conclusão Em nossos resultados, a redução do segmento-ST não conseguiu identificar com precisão os pacientes com reperfusão angiográfica apropriada. Portanto, mesmo pacientes com reperfusão aparentemente bem-sucedida devem ser encaminhados à angiografia brevemente, a fim de garantir fluxo coronário macro e microvascular adequados.

Abstract Background Primary percutaneous coronary intervention is considered the “gold standard” for coronary reperfusion. However, when not available, the drug-invasive strategy is an alternative method and the electrocardiogram (ECG) has been used to identify reperfusion success. Objectives Our study aimed to assess ST-Segment changes in post-thrombolysis and their power to predict recanalization and using the angiographic scores TIMI-flow and Myocardial Blush Grade (MBG) as an ideal reperfusion criterion. Methods 2,215 patients with ST-Segment Elevation Myocardial Infarction (STEMI) undergoing fibrinolysis [(Tenecteplase)-TNK] and referred to coronary angiography within 24 h post-fibrinolysis or immediately referred to rescue therapy were studied. The ECG was performed pre- and 60 min-post-TNK. The patients were categorized into 2 groups: those with ideal reperfusion (TIMI-3 and MBG-3) and those with inadequate reperfusion (TIMI and MBG <3). The ECG reperfusion criterion was defined by the reduction of the ST-Segment >50%. A p-value <0.05 was considered for the analyses, with bicaudal tests. Results The ECG reperfusion criterion showed a positive predictive value of 56%; negative predictive value of 66%; sensitivity of 79%; and specificity of 40%. There was a weak positive correlation between ST-Segment reduction and ideal reperfusion angiographic data (r = 0.21; p <0.001) and low diagnostic accuracy, with an AUC of 0.60 (95%CI: 0.57-0.62). Conclusion The ST-Segment reduction was not able to accurately identify patients with adequate angiographic reperfusion. Therefore, even patients with apparently successful reperfusion should be referred to angiography soon, to ensure adequate macro and microvascular coronary flow.

Resumo Fundamento: A escolha de próteses mecânicas ou biológicas para pacientes com doença de válvula cardíaca ainda não é um consenso. Objetivo: Determinar os desfechos clínicos de próteses mecânicas e biológicas nesses pacientes. Métodos: Conduzimos uma revisão sistemática e metanálise e estudos controlados randomizados (RCTs) que compararam próteses mecânicas e biológicas em pacientes com doenças de válvulas cardíaca, e avaliamos seus resultados. A busca por RCTs foi feita nas bases de dados MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS e Web of Science (do início a novembro de 2014). As metanálises foram realizadas usando variação inversa com modelos de efeitos aleatórios. Usamos o sistema GRADE para avaliar a qualidade da evidência. Um valor menor que 0,05 foi considerado significativo. Resultados: Um total de quatro RCTs foi incluído na metanálise (1528 pacientes) com acompanhamento de 2 a 20 anos. Em três estudos, foram utilizadas próteses mecânicas e biológicas mais antigas, e em um estudo próteses contemporâneas. Não foi observada diferença de mortalidade entre os pacientes que receberam próteses mecânicas e biológicas (risco relativo, RR = 1,07; IC95% 0,99-1,15). O risco de sangramento foi significativamente mais baixo nos pacientes que receberam próteses biológicas que naqueles com próteses mecânicas (RR = 0,64; IC95% 0,52-0,78). Contudo, as reoparações foram mais frequentes em pacientes com próteses biológicas (RR = 3,60; IC95% 2,44-5,32). Não houve diferenças estatisticamente significativas entre pacientes com próteses biológicas e mecânicas em relação à embolia arterial sistêmica e endocardite infecciosa (RR = 0,93; IC95% 0,66-1,31; RR = 1,21; IC95% 0,78-1,88, respectivamente). Resultados entre os estudos com próteses modernas e antigas foram similares. Conclusões: A taxa de mortalidade e o risco de eventos tromboembólicos e endocardite foram similares entre os pacientes que receberam próteses biológicas e mecânicas. O risco de sangramentos foi aproximadamente um terço menor nos pacientes com próteses biológicas que mecânicas, ao passo que o risco de reoperação foi mais que três vezes maior nos pacientes com próteses biológicas.

Abstract Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

OBJECTIVES: To evaluate cardiovascular involvement in children and adolescents with End Stage Renal Disease (ESRD) and to characterize the main risk factors associated with this outcome. METHODS: Cross-sectional study of 69 children and adolescents at renal transplantation and 33 healthy individuals matched by age and gender. The study outcomes were left ventricular mass z-score (LVMZ) and carotid artery intima-media thickness (CIMT). The potential risk factors considered were age, gender, CKD etiology, use of oral vitamin D and calcium-based phosphate binders, systolic and diastolic blood pressure, body mass index z-score, time since diagnosis, dialysis duration, serum levels of ionic calcium, phosphorus, parathyroid hormone, fibroblast growth factor (FGF 23), uric acid, homocysteine, cholesterol, triglycerides, C-reactive protein (CRP), vitamin D and hemoglobin. RESULTS: In the multivariate analysis, the factors associated with LVMZ were dialysis duration, age, systolic blood pressure, serum hemoglobin and HDL cholesterol levels. Regarding CIMT, in the multivariate analysis, systolic blood pressure was the only factor associated with the outcome. CONCLUSION: Children exhibited important cardiovascular involvement at the time of the renal transplantation. Both of the studied outcomes were independently associated with systolic blood pressure. For this reason, controlling blood pressure seems to be the main therapy to minimize cardiovascular involvement in children with ESRD.

FUNDAMENTO: Alguns pacientes apresentam fração de ejeção do ventrículo esquerdo (FEVE) superestimada na cintilografia miocárdica com sincronização eletrocardiográfica (gated SPECT). OBJETIVO: Estabelecer a relação entre fatores biológicos e FEVE superestimada. MÉTODOS: Selecionamos 3.838 pacientes que realizaram gated SPECT entre 20/5/2000 e 16/9/2005, com imagens normais de perfusão e FEVE >50%. Analisamos as variáveis: sexo (29,4% feminino e 70,6% masculino), idade (de 20 a 94 anos - média: 56 anos), peso (de 33,5 a 150 kg - média: 79,6 kg), altura (de 138 a 220 cm - média: 171 cm) e IMC (de 13,9 a 54 - média: 27,2). Em um subgrupo de 1.002 pacientes que realizaram ecocardiograma, incluímos as variáveis diâmetros diastólico (de 36 a 68 mm - média 47,5 mm) e sistólico (de 22 a 41 mm - média 29,8 mm). Dividimos os pacientes em dois grupos: FEVE normal (<80%) e superestimada (>80%). A Razão de Chances (RC) para apresentar FEVE superestimada foi calculada para cada variável por regressão logística. RESULTADOS: Encontramos as seguintes Razões de Chances (p < 0,005): sexo feminino RC = 3,585 (IC95%: 2,745 a 4,683), idade em anos RC = 1,020 (IC95%: 1,011 a 1,029) e altura em cm RC = 0,893 (IC95%: 0,829 a 0,962). O peso e o IMC não se associaram a FEVE significativamente (p>0,2). No subgrupo de 1.002 pacientes, encontramos influência estatisticamente significativa na obtenção da FEVE superestimada para as variáveis diâmetro sistólico, sexo e altura. CONCLUSÃO: Apesar de o diâmetro sistólico influenciar na obtenção da FEVE superestimada, as variáveis sexo e altura apresentam influência independente na superestimação da FEVE pelo gated SPECT.

BACKGROUND: Some patients present an overestimated left ventricular ejection fraction (LVEF) on electrocardiogram-gated myocardial scintigraphy (gated SPECT). OBJECTIVE: To establish the relationship between biological factors and overestimated LVEF. METHODS: We selected 3838 patients who underwent gated SPECT between May 20, 2000 and September 16, 2005 with normal perfusion images and LVEF >50%. The following variables were analyzed: gender (29.4% females and 70.6% males), age (from 20 to 94 years - mean: 56 years), weight (from 33.5 to 150 kg - mean: 79.6 kg), height (from 138 to 220 cm - mean: 171 cm) and BMI (from 13.9 to 54 - mean: 27.2). In a subgroup of 1002 patients who underwent echocardiogram, the diastolic diameter (from 36 to 68 mm - mean 47.5 mm) and systolic diameter (from 22 to 41 mm - mean 29.8 mm) variables were included. The patients were divided into two groups: normal LVEF (<80%) and overestimated LVEF (>80%). The odds ratio (OR) for presenting an overestimated LVEF was calculated for each variable using logistic regression. RESULTS: The following odds ratios were found (p < 0.005): female gender OR = 3.585 (95%CI: 2.745 to 4.683), age in years OR = 1.020 (95%CI: 1.011 to 1.029) and height in cm OR = 0.893 (95%CI: 0.829 to 0.962). Weight and BMI were not significantly associated with LVEF (p>0.2). In the subgroup of 1002 patients, a statistically significant influence was found in overestimated LVEF values for the systolic diameter, gender and height variables. CONCLUSION: Although systolic diameter influences the overestimation of LVEF, the gender and height variables have an independent influence on LVEF overestimation by gated SPECT.

OBJETIVOS: Descrever os padrões do fluxo venoso pulmonar com ecocardiograma transtorácico em crianças com diferentes malformações cardíacas congênitas com hiperfluxo pulmonar. MÉTODOS: Estudo prospectivo, de seleção consecutiva de crianças com malformações cardíacas congênitas com hiperfluxo pulmonar. Foi utilizado ecocardiograma Doppler transtorácico, plano apical, posicionando-se a amostra de volume na veia pulmonar inferior esquerda a 4 mm da sua junção com o átrio esquerdo. Os dados analisados foram: predomínio sistólico ou diastólico do fluxo venoso pulmonar, bem como as características da onda de contração atrial, sendo denominada "A" quando ausente e "R" quando reversa. RESULTADOS: Foram incluídos 29 pacientes, com idade média de 29,9±58,9 meses, com as seguintes malformações congênitas: comunicações interatrial e interventricular, persistência do canal arterial, defeito septal atrioventricular, transposição completa das grandes artérias e truncus arteriosus. Em todos, o fluxo venoso pulmonar apresentou um padrão contínuo, de maior velocidade, com predomínio da onda sistólica em 9 (31%) pacientes, diastólica em 18 (62%), e com igual amplitude em 2 pacientes (7%). A onda de contração atrial foi R em 6 pacientes (21%) e A em 23 (79%) pacientes. CONCLUSÃO: Nas doenças cardíacas congênitas com hiperfluxo pulmonar o fluxo venoso pulmonar apresenta um padrão contínuo, de alta velocidade, com alterações, principalmente no padrão reverso da contração atrial.

OBJECTIVES: To describe pulmonary venous flow patterns using transthoracic echocardiograms on children suffering from different congenital heart defects with increased pulmonary flow. METHODS: Prospective study and consecutive selection of children suffering from congenital heart defects with increased pulmonary flow. The transthoracic, apical view, Doppler echocardiogram was used, positioning the sample-volume at the lower pulmonary vein, 4mm from its junction with the left atrium. The data analyzed included: dominant systolic or diastolic pulmonary venous flow and atrial contraction waveform characteristics, designated as "A" for absent and "R" for reversed. RESULTS: The study included twenty-nine patients with a mean age of 29.9 ± 58.9 months, suffering from the following congenital heart conditions: interatrial and interventricular communication defects, patent ductus arteriosus, atrioventricular septal defects, total transposition of the great arteries and truncus arteriosus. All the patients presented a continuous pattern of high velocity pulmonary venous flow. Nine patients presented a dominant systolic waveform (31%), eighteen presented a dominant diastolic wave form (62%) and 2 patients had systolic and diastolic wave forms of equal amplitude (7%). Six patients (21%) presented a R atrial contraction waveform and 23 (79%) presented an A atrial contraction waveform. CONCLUSION: Congenital heart diseases with increased pulmonary flow present a continuous pattern of high velocity pulmonary venous flow with alterations mainly in the atrial contraction reversal pattern.

A rare association of pulmonary atresia with an intact septum was diagnosed through echocardiography in a fetus 32 weeks of gestational age. The diagnosis was later confirmed by echocardiography of the newborn infant and further on autopsy. The aortic valve was bicuspid with a pressure gradient of 81mmHg, and the right ventricle was hypoplastic, as were the pulmonary trunk and arteries, and the blood flow was totally dependent on the ductus arteriosus.

We report here a case of coronary artery fistula in a neonate with clinical signs of heart failure. The electrocardiogram showed signs of left ventricular hypertrophy and diffuse alterations in ventricular repolarization. Chest X-ray showed an enlargement of the cardiac silhouette with an increase in pulmonary flow. After echocardiographic diagnosis and angiographic confirmation, closure of the fistulous trajectory was performed with a detachable balloon with an early and late successful outcome.

São descritos os aspectos clínicos, ecocardiográficos e angiográficos de um neonato de sexo masculino, com cinco dias de vida e diagnóstico de atresia pulmonar com septo interventricular íntegro. Tanto o ecocardiograma como a aortografia mostraram ausência da origem das artérias coronárias da aorta. O ecocardiograma bidimensional e, posteriormente, a ventriculografia direita identificaram as artérias coronárias, originando-se no ventrículo direito. Não houve contrastação retrógrada da aorta ou do tronco pulmonar quando contrastadas as artérias coronárias. Este é o primeiro caso relatado com diagnóstico ecocardiográfico pré angiografia, e é um exemplo da necessidade de se avaliar as artérias coronárias em pacientes com atresia pulmonar e septo ventricular íntegro.

This report describes the clinical, echocardiographic and angiographic aspects of a five-day old boy with pulmonary atresia and intact ventricular septum. Both the echocardiogram and the aortography did not show any coronary arteries arising from the aorta. Two-dimensional echocardiography was able to identify the coronary arteries originating from the right ventricle and so did the right ventricular angiogram. No retrograde flow into the aorta or pulmonary trunk was identified after opacification of the coronary arteries. As far as we know this is the first case diagnosed by echocardiography, and is a vivid example of the necessity of identifying the coronary arteries in patients with pulmonary atresia and intact ventricular septum.