Abstracts: This is a Document from de Chilean Society of Cardiology and Cardiovascular Surgery, along with the Chilean Society of Physical Therapy of Cardiology and Cardiovascular Surgery.

Abstract Background: Despite advances in cardiovascular disease management and the development of minimally invasive approaches, open cardiac surgery is still a preferred intervention in complicated cases. Phase I Cardiac Rehabilitation decreases complications associated with this intervention. Globally, cardiac rehabilitation is widely recommended. However, in Chile the implementation of this intervention has been slow and there are scarce reports of its result. Objective: To describe the progression according to steps and post-surgery days in cardiac rehabilitation phase I patients in the public hospital in Temuco, Chile. Methodology: We analyzed a series of cases of patients in cardiac rehabilitation phase I, participants of a protocol based on six-step motor levels: (S1) on-bed mobilization, (S2) sitting on the edge of the bed, (S3) Bipedal exercise and 35 meter walking, (S4) 100 meter walking, (P5) 200 meter walking plus going up one floor and down stairs, and (S6) 300 meter walking plus going two floors up and down stairs. Results: 243 patients were included, and 1,033 sessions were performed) Mean age was 65.9years-old (SD 9.5) and hospital stay run for a median of 6 days. From all sessions, on day one, 53% of patients reached S1. On day 2, 51% reached S2 and 36% walked (S3). On day 3, 44.78% reached ≥S4. On day 4, 37.75% reached ≥S4. On days 5-7, approximately 50% achieved ≥S5. Conclusion: the step progression is proportional to number of days after surgery, faster in men than compared to women. At discharge, 75 % of patients show functional independency that allows them to walk two blocks and go one floor up and down stairs.

Resumen: Antecedentes: La Rehabilitación Cardíaca disminuye las complicaciones de la cirugía cardíaca y es mundialmente reconocida. A pesar de esto, en Chile su desarrollo ha sido lento y el reporte de experiencias bajo. Objetivo: Describir la progresión de acuerdo los pasos de rehabilitación y días postoperatorios en pacientes de rehabilitación cardíaca fase I en un hospital público de Temuco, Chile. Metodología: Se analizó una serie de casos de pacientes en rehabilitación cardíaca fase I, participantes de un protocolo basado en hitos motores de seis pasos: movilización en cama (P1); sedente borde cama (P2); marcha de 35 mts (P3); marcha hasta 100 mts (P4); marcha hasta 200 metros más subir/bajar un piso de escaleras (P5); marcha de 300 metros más subir/bajar dos pisos de escaleras (P6). Resultados: Se incluyeron 243 pacientes (1.033 sesiones) con una media de 65.9 años (DS 9.5), mediana de hospitalización 6 días. Del total de atenciones realizadas el día 1, en 53% de ellas se alcanzó el P1; en el día 2, en un 51% se alcanzó el P2 y en un 42% un paso ≥P3; en el día 3, en 44.78% se alcanzó paso ≥P4; en el día 4, en 37.75% se alcanzó ≥P4. En los días 5-7, aproximadamente 50% logró ≥P5. Conclusión: La progresión de los pasos es proporcional al día postcirugía y es más rápida en hombres. Al momento del alta, 75% de los pacientes alcanza una independencia funcional que les permite caminar dos cuadras y subir/bajar un piso de escaleras.

ABSTRACT Objective Metabolic syndrome (MetS) is associated with hypertension, obesity and dyslipidemia. Thus, genetic variants related with these conditions may modulate its development. We evaluated the effect of polymorphisms in the renin-angiotensin system (RAS) on metabolic syndrome risk in a cohort of Chilean subjects. Subjects and methods A total of 152 subjects, 83 with MetS (51.2 ± 9.6 years) and 69 without MetS (49.5 ± 9.3 years) of both genders were included, according to the ATP III update criteria. The rs4340 Insertion/Deletion (I/D), rs699 (T>C) and rs5186 (A>C) of the ACE, AGT and AGTR1 genes, respectively, were genotyped. Results After adjusting for age and gender, we observed the DD genotype of rs4340 associated with MetS (p = 0.02). Specifically, the DD genotype was associated with MetS risk in women (OR = 4.62, 95%CI, 1.41 – 15.04; p < 0.01). In males, the AA genotype for rs5186 variant was associated with an increased risk for developing MetS when compared with women carrying the same genotype (OR = 3.2; 95%CI, 1.03 – 9.89; p = 0.04). In subjects without MetS, DD genotype was associated with increased waist circumference (p = 0.023) while subjects with MetS carrying the rs5186 TT genotype showed higher levels of HDL-cholesterol (p = 0.031). Conclusion The present study contributes data highlighting the role for RAS polymorphisms in predisposing to metabolic syndrome in Chilean subjects.

Background: A successful cardiovascular prevention program should induce a reduction of risk factors along time. Aim: To assess changes in cardiovascular risk factors among males aged between 35 and 65 years living in Southern Chile. Material and Methods: The results of two cross sectional household surveys, with a probability sampling stratified by socioeconomic status, were analyzed. Two hundred males were evaluated in 1989 and 800 in 2011-12, paired by age for selection. Results: In the second survey, a mean weight increase of 4.5 kg was recorded. Body mass index increased from 27.1 to 28.6 kg/m² (p < 0.01), especially in men younger than 45 years old. No changes in smoking prevalence were observed. The prevalence of hypertension and hypertensive patients in treatment increased from 32.7 to 38.1% and from 17 to 33%, respectively. The number of treated hypertensive patients with a well-controlled blood pressure did not change significantly. In 1989 and 2011-12, mean total cholesterol values were 192 and 201 mg/dl respectively (p < 0.01). The figures for mean non-HDL cholesterol were 152 and 160 mg/dl (p = 0.03). The frequency of people with total cholesterol over 240 mg/dl or using statins increased from 15 to 25% (p < 0.01). The estimated 10 years risk of myocardial infarction and coronary death using Framingham tables was 9,0 in both periods (p = 0.95). Conclusions: In a 22 years period an increase in the prevalence of obesity and elevated total cholesterol was observed. There was a higher proportion of individuals treated for hypertension and dyslipidemia, but without reduction in the estimated cardiovascular risk.

Background: Metabolic syndrome is becoming an important public health problem in affluent societies. Aim: To identify factors associated to metabolic syndrome in a Southern Chilean city. Material and methods: Using a case control design, 200 participants, aged 35 to 70 years with at least three criteria for metabolic syndrome according to the National Cholesterol Education Program (NCEP_ATPIII) and 200 subjects with less than three criteria, were studied. Both groups were compared in terms of ethnic background, educational level, family history of diabetes and coronary artery disease, menopausal status, smoking, stress and depression, physical activity, changes in body mass index in the last five years and diet. Results: Among subjects aged more than 54 years, among males and among overweight individuals, having a Mapuche origin was a risk factor with odds ratios (OR) of 7.2; 88 and 3.9 respectively. Among subjects aged more than 54 years, among women and among overweight individuals, a family history of diabetes was a risk factor with OR of 17.7; 3.2 and 3.9 respectively. Among subjects aged more than 54 years and among women a change in body mass index of more than three points was a risk factor with OR of 12.5 and 7.4, respectively. Depression also was a risk factor among subjects aged more than 54 years (OR 3.3). Regular consumption of wine was a protective factor among participants of more than 54 years, with an OR of 0.17. Conclusions: The risk factors for metabolic syndrome detected in this group of participants, were having a Mapuche origin, a family history of diabetes mellitus and depression. Wine consumption was associated with a lower risk.

Background: Several genes and their polymorphisms have been associated with atherosclerotic plaque formation and subsequent development of cardiovascular disease. One of them is the C-reactive protein (CRP) encoding gene, CRP being a recognized important pro-inflammatory and inflammatory marker. Biallelics and triallelics single nucleotide polymorphisms (SNPs) in the promoter region of this gene have been identified. The rs3040244 C>T>A is known as the variant most strongly associated with high hs-CRP levels. However, the results between populations are contradictory. Thus, the purpose of this study was to investigate the possible association between the rs3091244 polymorphism and serum levels of hs-CRP in Southern Chilean individuals. Methods: We determined the serum hs-CRP in 157 unrelated adult subjects. The rs3091244 polymorphism was detected by PCR-RFLP. Results: The genotype distribution for the rs3091244 polymorphism of the CRP gene was as follows: CC 11.5%, CT 45.2%, TT 31.2%, CA 5.0% and TA 7.0%. Individuals carrying the TT and TA genotypes showed higher serum hs-CRP when compared to the reference CC genotype (p = 0.030 and p = 0.002, respectively). Conclusion: Our data shows that the rs3091244 SNP of the CRP gene contributes to increase the hs-CRP levels, which may imply an increased cardiovascular risk.

Introducción: Múltiples genes y sus polimorfismos han sido asociados al origen de la formación de la placa aterosclerótica y subsecuentemente el desarrollo de enfermedad cardiovascular. Uno de estos genes implicados, es el que codifica para la proteína C reactiva (CRP), importante marcador proinflamatorio y de inflamación. Entre las variantes identificadas en este gen, el polimorfismo rs3040244 C>T>A ha sido asociado a elevados niveles de CRP-hs. Sin embargo, los resultados obtenidos entre poblaciones son contradictorios. Objetivo: investigar la asociación entre el polimorfismo rs3091244 y niveles séricos de CRP-hs en individuos de la región de La Araucanía. Métodos: Se determinó la concentración sérica de CRP-hs a 157 sujetos adultos sin parentesco entre ellos. La genotipificación del polimorfismo rs3091244 se realizó mediante la técnica de PCR-RFLP Resultados: La distribución de genotipos para el polimorfismo rs3091244 del gen CRP fue la siguiente: CC 11.5%, CT 45.2%, TT 31.2%, CA 5.0% y TA 7.0%. Los portadores de los genotipos TT y TA presentaron elevadas concentraciones séricas de CRP-hs cuando comparadas al genotipo de referencia CC (p=0.030 y p=0.002, respectivamente). Conclusión: Nuestros datos demuestran que el polimorfismo rs3091244 del gen CRP contribuye para el aumento de los niveles séricos de CRP-hs, y por tanto incrementa el riesgo cardiovascular.

Background: Physical activity plays a crucial role in the protection against cardiovascular diseases. Aim: To assess the level of physical activity in a group of subjects living in urban Temuco. Material and Methods: Cross sectional study in a random sample of 1091 women aged 52 ± 10 years and 444 men aged 54 ± 10 years , living in Temuco, Chile. The level of physical activity was measured using the long form of the International Physical Activity Questionnaire (IPAQ). Age, gender, educational and socioeconomic level were also determined in study subjects. Results: Median energy expenditure was 2150 and 1600 MET-minute/ week in men and women, respectively (p = 0,001). It decreased with age from a median of 1965 MET-minute/ week in those younger than 50 years old to 1647 MET-minute/ week among subjects aged between 51 and 60 years old and to 1485 MET-minute/ week among those older than 60 years. (p = 0,001). The frequency of high, moderate and low physical activity levels were 15.6, 66 and 18.4 % respectively. These levels were associated with gender, age, educational and socioeconomic level. Conclusions: There was a high frequency of low and moderate levels of physical activity in the urban population of Temuco, associated with female gender, advanced age and middle socioeconomic level.

PREGUNTA DE INVESTIGACIÓN: ¿Existe asociación entre cuestionario simplificado de actividad física y cuestionario de recuento de actividades, aplicado en una población urbana, laboralmente activa de la ciudad de Temuco, Chile? OBJETIVOS: Demostrar si existe asociación entre actividad física (CSAF) y cuestionario de recuento de actividades (CRA). Determinar prevalencia de niveles de actividad física según ambos instrumentos. Reportar resultados de análisis por categorías. Determinar gasto energético por categorías DISEÑO: Estudio de corte transversal. LUGAR: Facultad de Medicina. Universidad de La Frontera. Temuco, Chile. POBLACION: 65 individuos sanos pertenecientes a ambos géneros, con residencia urbana, profesionales, laboralmente activos, edades comprendidas entre 28 y 64 años. METODO: La muestra se obtuvo a través de aleatorización simple. Encuestadores aplicaron el CSAF y posteriormente el CRA. Para el análisis estadístico se utilizó coeficiente de Fisher, cálculo de prevalencias y t de student. RESULTADOS: Se analizó asociación entre ambos cuestionarios y prevalencia de nivel de actividad física, determinándose que no hay asociación entre CSAF y CRA(coeficiente Fisher 0,1). La prevalencia de los distintos niveles de actividad física según ambos cuestionarios es diferente. Según el CSAF 70,91% de la población es sedentaria, 12,73% medianamente activa y 16,36% altamente activa. El CRA determinó que 45,5% de la población es sedentaria, 27,27% realiza actividad suave, 3,64% actividad moderada, 14,55% actividad moderadamente pesada y 9,09% actividad pesada. CONCLUSIONES: El CRA no se asocia con el CSAF. El análisis de prevalencia de niveles de actividad física muestra una mayor prevalencia de sedentarismo; el CRA permite discriminar mejor entre distintos niveles de actividad física pudiendo ser útil para estudios poblacionales posteriores. A partir de este estudio se visualiza la necesidad de validar en nuestra realidad nacional el CRA permitiendo medir la magnitud del sedentarismo como factor de riesgo cardiovascular y así iniciar una línea de investigación de impacto de actividad física sobre la enfermedad cardiovascular.

RESEARCH QUESTION: Is there an association between simplified questionnaires and physical activity recall questionnaire applied to an urban, working population in Temuco city, Chile? OBJETIVES: To demonstrate if there is an association between simplified questionnaires (SQ) and physical activity recall questionnaire (PARQ). To measure prevalence of physical activity level reported by each questionnaire. To report data given by each category. To report energy expenditure by each category. DESIGN: cross sectional study. PLACE: Facultad de Medicina. Universidad de La Frontera. Temuco, Chile. POPULATION: The sample was simple randomized. Both questionnaires were applied by interviewers. Statistical analysis was performed using Fisher’s exact, prevalence calculation and student’s t. METODO: La muestra se obtuvo a través de aleatorización simple. Encuestadores aplicaron el CSAF y posteriormente el CRA. Para el análisis estadístico se utilizó coeficiente de Fisher, cálculo de prevalencias y t de student. RESULTS: Association between questionnaires and prevalence of physical activity levels was analyzed. The results indicated that there is no association between SQ and PARQ (Fisher’s exact 0,1).The resulting prevalence is different comparing both questionnaires. Prevalence obtained by SQ shows 70.91% sedentary, 12.73% moderate physically active and 16.36% highly physically active. Prevalence obtained by PARQ shows 45.5% sedentariness, 27.27% performes light physical activity, 3.64% moderate physical activity, 14.55% relatively heavy physical activity and 9.09% heavy physical activity. CONCLUSIONS: SQ and PARQ does not associate. Prevalence analysis reveales a greater prevalence of sedentariness; PARQ allows _ a better discrimination between different levels of physical activity which can be very useful for further investigations. From this study can be visualized _the need to validate in our national reality the PARQ in order to measure sedentariness as a cardiovascular risk, starting then a research project on the impact of physical activity on cardiovascular disease.

Chronic respiratory diseases are an important problem in Chile, causing disability and worsening the quality of life. Aim: To validate the Spanish version of the Chronic Respiratory Questionnaire (CRQ) to be used in Chilean population. Material and methods: The CRQ was applied to 38 patients with chronic respiratory diseases. At the same time the functional and physiologic status of patients (the 6 Minute Walking Test and spirometry) was assessed in an independent and blinded fashion. Results: CRQ scores were associated with 6 Minute Walking Test and forced expiratory volume results (p <0.01 adjusted by age, sex and smoking). The Internal Consistency analysis showed a Cronbach a between 0.60 and 0.89. Conclusions: Considering the construct validation as an on-going process, the present results give additional evidence supporting the use of the CRQ in Chilean population to evaluate the health-related quality of life of patients with chronic respiratory diseases (Rev Méd Chile 2003; 131: 1243-50).