ABSTRACT Purpose: To evaluate the profile of graduates of the Postgraduate Program (PGP) in Cardiology of a public federal university, according to sociodemographic factors and professional trajectory. Methods: The variables were collected from databases from the observed institution and digital platforms. The analysis of differences between the various levels of degrees was carried out in three cohorts: the entire historical series (graduates from 1978–2021), the first 20 years (1978–1997) and the second 20 years (1998–2018). Results: The results demonstrated that most students from the PGP completed a PhD and are men over 30 years old, they came from public universities and the Southeast region. In the first 20 years, significant differences were observed in the distribution of masters and doctors working professionally at the institution analyzed, as well as in the age of the students. In the 20 years of the second half, there were differences between masters and PhD working professionally in the institution itself, as they came from private universities, they are women and PhD. Conclusions: The changes in the profile of masters and PhD that graduated from this PGP in cardiology reflect transformations that occurred in the job market and academy over the decades. Purpose (PGP university trajectory Methods platforms cohorts 1978–2021, 19782021 1978–2021 , 1978 2021 1978–2021) 2 1978–1997 19781997 1997 (1978–1997 1998–2018. 19982018 1998–2018 . 1998 2018 (1998–2018) Results 3 old region analyzed half itself Conclusions decades 1978202 1978–202 197 202 1978–199 1978199 199 (1978–199 1998201 1998–201 201 (1998–2018 197820 1978–20 19 1978–19 197819 (1978–19 199820 1998–20 (1998–201 19782 1978–2 1 1978–1 19781 (1978–1 19982 1998–2 (1998–20 1978– (1978– 1998– (1998–2 (1978 (1998– (197 (1998 (19 (199 (1 (

Abstract Background Weight gain can trigger mechanisms that increase blood pressure. Nevertheless, obesity causes structural changes in the myocardium, including increased ventricular mass, atrial dilatation, and diastolic and systolic dysfunction. Additionally, blood pressure variations, like morning surge (MS) in obese hypertensive patients may have clinical relevance in cardiovascular events. Although morning blood pressure surge is a physiological phenomenon, excess MS can be considered an independent risk factor for cardiovascular events. Objective To evaluate MS values and their association with left ventricular hypertrophy (LVH) and nocturnal dipping (ND) in obese and non-obese hypertensive patients. Methods A cross-sectional study that evaluated BP measurements by ambulatory blood pressure monitoring (ABPM) and the presence of LVH by echocardiography in 203 hypertensive outpatients, divided into two groups: 109 non-obese and 94 obese hypertensives patients. The significance level was set at 0.05 in two-tailed tests. Results A MS above 20 mmHg by ABPM was detected in 59.2% of patients in the non-obese group and 40.6% in the obese group. LVH was found in 18.1% and 39.3% of patients in the non-obese and obese groups, respectively, p<0.001. In the “obese group”, it was observed that a MS>16 mmHg was associated with LVH, [prevalence ratio: 2.80; 95%CI (1.12–6.98), p=0.03]. For the non-obese group, the cut-off point of MS for this association was >22 mmHg. Conclusion High MS was positively associated with LVH, with a particular behavior in the hypertensive obese group. Nevertheless myocardium mass dilatation dysfunction Additionally variations (MS events phenomenon (LVH ND (ND nonobese non crosssectional cross sectional (ABPM outpatients groups 10 9 005 0 05 0.0 twotailed tailed tests 2 592 59 59.2 406 40 6 40.6 181 18 1 18.1 393 39 3 39.3 respectively p0001 p 001 p<0.001 , group” MS16 16 MS>1 prevalence ratio 2.80 280 80 95CI CI 95 1.12–6.98, 112698 1.12–6.98 12 98 (1.12–6.98) p=0.03. p003 p=0.03 . 03 p=0.03] cutoff cut off 22 >2 00 0. 5 59. 4 40. 18. 39. p000 p<0.00 MS1 MS> 2.8 28 8 11269 1.12–6.9 (1.12–6.98 p00 p=0.0 > p<0.0 2. 1126 1.12–6. (1.12–6.9 p0 p=0. p<0. 112 1.12–6 (1.12–6. p=0 p<0 11 1.12– (1.12–6 p= p< 1.12 (1.12– 1.1 (1.12 1. (1.1 (1. (1 (

Resumo Fundamento O aumento do peso frequentemente desencadeia mecanismos que elevam a pressão arterial. A obesidade causa mudanças estruturais no miocárdio, incluindo aumento da massa ventricular, dilatação atrial, bem como disfunções diastólicas e sistólicas. Além disso, variações pressóricas nos hipertensos obesos, como a ascensão matinal (AM), podem ter relevância clínica na prevenção dos eventos cardiovasculares. A AM da pressão arterial é um fenômeno fisiológico, que quando elevada pode ser considerada um fator de risco independente para eventos cardiovasculares. Objetivo Avaliar valores da elevação da AM e sua associação com a hipertrofia ventricular esquerda (HVE) e com o Descenso do Sono (DS) em obesos e não obesos hipertensos. Métodos Estudo transversal que avaliou medidas pressóricas à monitorização ambulatorial da pressão arterial (MAPA) e a presença de HVE, avaliada pela ecocardiografia, em 203 pacientes hipertensos em tratamento ambulatorial, separados em dois grupos: 109 não obesos e 94 hipertensos obesos. O nível de significância adotado foi de 0,05 em testes bicaudais. Resultados A AM acima de 20 mmHg à MAPA foi detectada em 59,2% dos pacientes do grupo “não obesos” e em 40,6% no grupo “obesos”. A HVE foi encontrada em 18,1% no grupo dos não-obesos e em 39,3% no grupo de obesos, p<0,001. No grupo “obesos” foi observado que AM >16 mmHg esteve associada à HVE, com [razão de prevalência: 2,80; IC95% (1,12–6,98), p=0,03]. Para o grupo dos “não obesos”, o ponto de corte da AM para essa associação foi >22 mmHg. Conclusão A AM elevada associou-se positivamente com HVE, com comportamento peculiar na população de hipertensos e obesos. miocárdio atrial sistólicas disso AM, , (AM) cardiovasculares fisiológico (HVE DS (DS (MAPA ecocardiografia grupos 10 9 005 0 05 0,0 bicaudais 2 592 59 59,2 406 40 6 40,6 . 181 18 1 18,1 nãoobesos 393 39 3 39,3 p0001 p 001 p<0,001 “obesos 16 >1 razão prevalência 2,80 280 80 IC95 IC 1,12–6,98, 112698 1,12–6,98 12 98 (1,12–6,98) p=0,03. p003 p=0,03 03 p=0,03] 22 >2 associouse associou se (AM 00 0, 5 59, 4 40, 18, 39, p000 p<0,00 > 2,8 28 8 IC9 11269 1,12–6,9 (1,12–6,98 p00 p=0,0 p<0,0 2, 1126 1,12–6, (1,12–6,9 p0 p=0, p<0, 112 1,12–6 (1,12–6, p=0 p<0 11 1,12– (1,12–6 p= p< 1,12 (1,12– 1,1 (1,12 1, (1,1 (1, (1 (

Abstract Atherosclerosis has been defined as an inflammatory disease. Three decades of research have pointed to a pivotal role of interleukin 6 for many aspects of cardiovascular disease, not the least of which is atherosclerosis. In this review, experimental and clinical studies are reported on a timeline, exploring mechanisms and possible explanations that form the basis of current knowledge. Some successful clinical trials were proof of concept studies, showing that not only inflammatory biomarkers are related to cardiovascular outcomes, but also that decreasing inflammation can reduce cardiovascular events. Great advances have been made in the management of residual cardiovascular risk due to cholesterol, thrombosis, and metabolic diseases, but the next frontier now seems to be targeting inflammation. In the upcoming years, the importance of inflammation will be evaluated in high-risk patients with chronic kidney disease, after acute coronary heart disease or heart failure with preserved ejection fraction. Inflammation seems to precede the development of cardiovascular risk factors. Moreover, counseling for a heathy lifestyle and, when necessary, the use of cardiometabolic therapies capable of decreasing inflammation, might be important. atherosclerosis review timeline knowledge outcomes events cholesterol thrombosis diseases years highrisk high fraction factors Moreover necessary important

Abstract Salmonella enterica serovar Heidelberg (SH), often isolated from broiler chicken samples, damages the entire production chain due to its high resistance in the environment. The search for sustainable disinfectant agents has intensified, focusing on the action of essential oils. This work's objective was to evaluate the in vitro, effect of Thymus vulgaris essential oil (TEO) and thymol in SH isolated from broilers, and the cytotoxicity in animal cells. Four different concentrations of TEO (0.1%, 0.2%, 0.4%, and 0.8%, (v/v)) were used against five SH isolates obtained from broilers and ATCC 8326. Thymol was evaluated at the concentrations of 0.023%, 0.047%, 0.071%, and 0.094% (v/v). In vitro antibacterial assays were performed by quantifying viable planktonic cells in the broth microdilution test. The MTT technique was used to assess the cytotoxicity in IEC-6 intestinal cells and NCTC fibroblasts. IC50 was assessed testing the concentrations of 0.0625%, 0.125%, 0.25%, and 0.5% of TEO and thymol in 24 hours. The bacterial activity was observed from the 0.2% concentration of TEO since no colony-forming units were observed. Thymol in the concentration of 0.094% controlled 83.33% of the bacteria. TEO presented an IC50 of 0.14% and 1.22%, while the IC50 for thymol was 0.068% and 0.001% for the IEC-6 and NCTC cells, respectively. On the other hand, TEO showed low cytotoxicity in fibroblasts and a potential action capacity to eliminate SH strains in vitro. SH, , (SH) samples environment intensified oils works work s (TEO 0.1%, 01 0 1 (0.1% 02 2 04 4 0.4% 08 8 0.8% v/v vv v (v/v) 8326 0023 023 0.023% 0047 047 0.047% 0071 071 0.071% 0094 094 0.094 v/v. . test IEC6 IEC 6 IEC- IC IC5 00625 0625 0.0625% 0125 125 0.125% 025 25 0.25% 05 5 0.5 hours 0.2 colonyforming colony forming 8333 83 33 83.33 bacteria 014 14 0.14 122 22 1.22% 0068 068 0.068 0001 001 0.001 respectively hand (SH 0.1% (0.1 0.4 0.8 (v/v 832 002 0.023 004 0.047 007 07 0.071 009 09 0.09 0062 062 0.0625 012 12 0.125 0.25 0. 833 3 83.3 0.1 1.22 006 06 0.06 000 00 0.00 (0. 0.02 0.04 0.07 0.0 0.062 0.12 83. 1.2 (0 1. (

Abstract Background Pharmacoinvasive strategy is an alternative when primary percutaneous coronary intervention (PCI) is not feasible. Objectives This study aimed to evaluate the effects of early pharmacoinvasive strategy on the infarct size and left ventricular ejection fraction in elderly and non-elderly patients. The role of inflammatory markers was also examined. Methods Patients (n=223) with ST segment elevation myocardial infarction (STEMI) were prospectively included and submitted to pharmacological thrombolysis in the first six hours, and underwent coronary angiogram and PCI when necessary, in the first 24 hours. Blood samples were collected in the first day (D1) and after 30 days (D30). Cardiac magnetic resonance imaging (cMRI) was performed at D30. Significance was set at p<0.05. Results Elderly and non-elderly patients showed similar percentage of infarcted mass (13.7 [6.9-17.0] vs. 14.0 [7.3-26.0], respectively, p=0.13) (median [interquartile range]). However, elderly patients had better left ventricular ejection fraction (53 [45-62] vs. 49 [39-58], p=0.025). Titers of interleukin (IL)1beta, IL-4, IL-6, and IL-10 did not differ between D1 and D30, but elderly patients had higher titers for IL-18 at D1 and D30. Absolute numbers of B and T lymphocytes were similar in both groups at D1 and D30, but elderly patients had higher neutrophil/lymphocyte ratio at D30. Multivariate linear regression analysis of cMRI outcomes in the whole population showed that the independent predictors were not different between elderly and non-elderly patients. Conclusion Pharmacoinvasive strategy in elderly patients was associated with small differences in inflammatory parameters, similar infarct size and better left ventricular function than non-elderly patients. (PCI feasible nonelderly non examined n=223 n223 n 223 (n=223 STEMI (STEMI hours necessary 2 D (D1 3 D30 . (D30) (cMRI p005 p 0 05 p<0.05 13.7 137 13 7 (13. 6.917.0 69170 6.9 17.0 6 9 17 [6.9-17.0 vs 140 14 14. 7.326.0, 73260 7.3 26.0 , 26 [7.3-26.0] respectively p=0.13 p013 median interquartile range. range range]) However 53 (5 4562 45 62 [45-62 4 3958, 3958 39 58 [39-58] p=0.025. p0025 p=0.025 025 p=0.025) IL1beta, IL1beta ILbeta IL 1beta, 1beta beta (IL)1beta IL4, IL4 4, IL-4 IL6, IL6 6, IL-6 IL10 10 IL-1 IL18 18 neutrophillymphocyte neutrophil lymphocyte parameters n=22 n22 22 (n=22 (D D3 (D30 p00 p<0.0 13. 1 (13 917 6.917. 6917 69 6. 170 17. [6.9-17. 326 7.326.0 7326 73 7. 260 26. [7.3-26.0 p=0.1 p01 range] 5 ( 456 [45-6 395 [39-58 p002 p=0.02 02 IL- IL1 n=2 n2 (n=2 (D3 p0 p<0. (1 91 6.917 691 [6.9-17 32 7.326. 732 [7.3-26. p=0. [45- [39-5 p=0.0 n= (n= p<0 6.91 [6.9-1 7.326 [7.3-26 p=0 [45 [39- (n p< [6.9- 7.32 [7.3-2 p= [4 [39 [6.9 [7.3- [ [3 [6. [7.3 [6 [7. [7

Resumo Fundamento A estratégia farmacoinvasiva é uma alternativa na inviabilidade da intervenção coronária percutânea primária (ICP). Objetivos Este estudo teve como objetivo avaliar os efeitos da estratégia farmacoinvasiva precoce sobre o tamanho da área infartada e a fração de ejeção ventricular esquerda em pacientes idosos e não idosos. O papel dos marcadores inflamatórios também foi avaliado. Métodos Pacientes (n=223) com infarto do miocárdio com elevação do segmento ST (IAMCSST) foram prospectivamente incluídos e submetidos à trombólise medicamentosa nas primeiras seis horas, e à angiografia coronariana e à ICP, quando necessária, nas primeiras 24 horas. As amostras de sangue foram coletadas no primeiro dia (D1) e 30 dias após (D30). A ressonância magnética cardíaca foi realizada no D30. O nível de significância estatística foi estabelecido em p<0,05. Resultados Pacientes idosos e não idosos apresentaram porcentagem similares de massa infartada [13,7 (6,9-17,0) vs. 14,0 (7,3-26,0), respectivamente p=0,13)] [mediana (intervalo interquartil)]. No entanto, os pacientes idosos apresentaram maior fração de ejeção ventricular esquerda [53 (45-62) vs. 49 (39-58), p=0,025)]. As concentrações de interleucina (IL)1beta, IL-4, IL-6, e IL-10 não foram diferentes entre D1 e D30, mas pacientes idosos apresentaram níveis mais elevados de IL-18 em D1 e D30. O número absoluto de linfócitos B e T foram similares em ambos os grupos em D1 e D30, porém, pacientes idosos apresentaram uma razão neutrófilo-linfócito mais alta em D30. A análise de regressão linear multivariada dos desfechos de RMC de toda a população do estudo mostrou que os preditores independentes não foram diferentes entre pacientes idosos e não idosos. Conclusão A estratégia farmacoinvasiva em pacientes idosos foi associada a pequenas diferenças nos parâmetros inflamatórios, tamanho do infarto similar, e melhor função ventricular esquerda em comparação a pacientes não idosos ICP. ICP . (ICP) avaliado n=223 n223 n 223 (n=223 IAMCSST (IAMCSST horas necessária 2 D (D1 3 D30 (D30) p005 p 0 05 p<0,05 13,7 137 13 7 [13, 6,917,0 69170 6,9 17,0 6 9 17 (6,9-17,0 vs 140 14 14, 7,326,0, 73260 7,3 26,0 , 26 (7,3-26,0) p=0,13 p013 p=0,13) mediana intervalo interquartil. interquartil interquartil)] entanto 53 [5 4562 45 62 (45-62 4 3958, 3958 39 58 (39-58) p=0,025. p0025 p=0,025 025 p=0,025)] IL1beta, IL1beta ILbeta IL 1beta, 1beta beta (IL)1beta IL4, IL4 4, IL-4 IL6, IL6 6, IL-6 IL10 10 IL-1 IL18 18 porém neutrófilolinfócito neutrófilo linfócito similar (ICP n=22 n22 22 (n=22 (D D3 (D30 p00 p<0,0 13, 1 [13 917 6,917, 6917 69 170 17, (6,9-17, 326 7,326,0 7326 73 7, 260 26, (7,3-26,0 p=0,1 p01 interquartil) 5 [ 456 (45-6 395 (39-58 p002 p=0,02 02 p=0,025) IL- IL1 n=2 n2 (n=2 (D3 p0 p<0, [1 91 6,917 691 (6,9-17 32 7,326, 732 (7,3-26, p=0, (45- (39-5 p=0,0 n= (n= p<0 6,91 (6,9-1 7,326 (7,3-26 p=0 (45 (39- (n p< (6,9- 7,32 (7,3-2 p= (4 (39 (6,9 (7,3- ( (3 (6, (7,3 (6 (7, (7

Abstract Background ST-segment elevation myocardial infarction (STEMI) is defined by symptoms accompanied by typical electrocardiogram changes. However, the characterization of ischemic symptoms is unclear, especially in subgroups such as women and the elderly. Objectives To analyze the typification of ischemic symptoms, temporal metrics and observe the occurrence of in-hospital outcomes, in the analysis of predictive scores, in patients with STEMI, in a drug-invasive strategy. Methods Study involving 2,290 patients. Types of predefined clinical presentations: typical pain, atypical pain, dyspnea, syncope. We measured the time between the onset of symptoms and demand for care and the interval between arrival at the medical unit and thrombolysis. Odds-ratios (OR; CI-95%) were estimated in a regression model. ROC curves were constructed for mortality predictors. The adopted significance level (alpha) was 5%. Results Women had a high prevalence of atypical symptoms; longer time between the onset of symptoms and seeking care; delay between arrival at the emergency room and fibrinolysis. Hospital mortality was 5.6%. Risk prediction by Killip-Kimball classification: AUC: [0.77 (0.73-0.81)] in class ≥II. Subgroups studied [OR (CI-95%)]: women [2.06 (1.42-2.99); p=0.01]; chronic renal failure [3.39 (2.13-5.42); p<0.001]; elderly [2.09 (1.37-3.19) p<0.001]; diabetics [1.55 (1.04-2.29); p=0.02]; obese 1.56 [(1.01-2.40); p=0.04]: previous stroke [2.01 (1.02-3.96); p=0.04] correlated with higher mortality rates. Conclusion Despite higher mortality rates in some subgroups, significant disparity persists in women, with delays in symptom recognition and prompt thrombolysis. We highlight the applicability of the Killip-Kimball score in prediction, regardless of the clinical presentation. STsegment ST segment STEMI (STEMI changes However unclear inhospital hospital outcomes scores druginvasive drug invasive strategy 2290 2 290 2,29 presentations pain dyspnea syncope thrombolysis Oddsratios Odds ratios OR (OR CI95% CI95 CI 95% 95 CI-95% model predictors alpha (alpha 5 5% fibrinolysis 56 6 5.6% KillipKimball Killip Kimball classification AUC 0.77 077 0 77 [0.7 0.730.81 073081 0.73 0.81 73 81 (0.73-0.81) II ≥II (CI-95%)] 2.06 206 06 [2.0 1.422.99 142299 1.42 2.99 1 42 99 (1.42-2.99) p=0.01 p001 p 01 p=0.01] 3.39 339 3 39 [3.3 2.135.42 213542 2.13 5.42 13 (2.13-5.42) p<0.001 p0001 001 p<0.001] 2.09 209 09 1.373.19 137319 1.37 3.19 37 19 (1.37-3.19 1.55 155 55 [1.5 1.042.29 104229 1.04 2.29 04 29 (1.04-2.29) p=0.02 p002 02 p=0.02] 156 1.5 1.012.40 101240 1.01 2.40 40 [(1.01-2.40) p=0.04 p004 2.01 201 1.023.96 102396 1.02 3.96 96 (1.02-3.96) presentation 229 2,2 CI9 9 CI-95 5.6 0.7 07 7 [0. 730 0.730.8 07308 073 081 0.8 8 (0.73-0.81 (CI-95%) 2.0 20 [2. 422 1.422.9 14229 142 1.4 299 2.9 4 (1.42-2.99 p=0.0 p00 3.3 33 [3. 135 2.135.4 21354 213 2.1 542 5.4 (2.13-5.42 p<0.00 p000 00 373 1.373.1 13731 137 1.3 319 3.1 (1.37-3.1 15 [1. 042 1.042.2 10422 104 1.0 2.2 (1.04-2.29 1. 012 1.012.4 10124 101 240 2.4 [(1.01-2.40 023 1.023.9 10239 102 396 3.9 (1.02-3.96 22 2, CI-9 5. 0. [0 0.730. 0730 08 (0.73-0.8 (CI-95% 2. [2 1.422. 1422 14 (1.42-2.9 p=0. p0 3. [3 2.135. 2135 21 54 (2.13-5.4 p<0.0 1.373. 1373 31 (1.37-3. [1 1.042. 1042 10 (1.04-2.2 1.012. 1012 24 [(1.01-2.4 1.023. 1023 (1.02-3.9 CI- [ 0.730 (0.73-0. (CI-95 1.422 (1.42-2. p=0 2.135 (2.13-5. p<0. 1.373 (1.37-3 1.042 (1.04-2. 1.012 [(1.01-2. 1.023 (1.02-3. (0.73-0 (CI-9 (1.42-2 p= (2.13-5 p<0 (1.37- (1.04-2 [(1.01-2 (1.02-3 (0.73- (CI- (1.42- (2.13- p< (1.37 (1.04- [(1.01- (1.02- (0.73 (CI (1.42 (2.13 (1.3 (1.04 [(1.01 (1.02 (0.7 (1.4 (2.1 (1. (1.0 [(1.0 (0. (2. (1 [(1. (0 (2 ( [(1 [(

Resumo Fundamento O infarto do miocárdio com elevação do segmento-ST (IAMCSST) é definido por sintomas acompanhados por alterações típicas do eletrocardiograma. Entretanto, a caracterização dos sintomas isquêmicos não é clara, principalmente em subgrupos, como mulheres e idosos. Objetivos Analisar a tipificação dos sintomas isquêmicos, métricas temporais e observar a ocorrência de desfechos intra-hospitalares, em análise dos escores preditivos, em pacientes com IAMCSST, em estratégia fármaco-invasiva. Métodos Estudo envolvendo 2.290 pacientes. Tipos de apresentações clínicas pré-definidas: dor típica, dor atípica, dispnéia, sincope. Medimos o tempo entre o início dos sintomas à demanda pelo atendimento e o intervalo entre a chegada à unidade-médica e trombólise. Odds-ratios (OR; IC-95%) foram estimadas em modelo de regressão. Curvas ROCs foram construídas para preditores de mortalidade. Nível de significância adotado (alfa) foi de 5%. Resultados Mulheres apresentaram alta prevalência de sintomas atípicos; maior tempo entre o início dos sintomas e a procura por atendimento; atraso entre a chegada ao pronto-socorro e a fibrinólise. A mortalidade hospitalar foi de 5,6%. Predição de risco pela classificação Killip-Kimball: AUC: [0,77 (0,73-0,81)] em classe ≥II. Subgrupos estudados [OR (IC-95%)]: mulheres [2,06 (1,42-2,99); p=0,01]; insuficiência renal crônica [3,39 (2,13-5,42); p<0,001]; idosos [2,09 (1,37-3,19) p<0,001]; diabéticos [1,55 (1,04-2,29); p=0,02]; obesos 1,56 [(1,01-2,40); p=0,04]; acidente vascular cerebral prévio [2,01 (1,02-3,96); p=0,04] correlacionaram-se com maiores taxas de mortalidade. Conclusão Apesar das mais altas taxas de mortalidade em alguns subgrupos, disparidade significativa persiste nas mulheres, com atrasos no reconhecimento dos sintomas e trombólise imediata. Destaca-se a aplicabilidade do escore Killip-Kimball na predição, independentemente da apresentação clínica. segmentoST segmento ST IAMCSST (IAMCSST eletrocardiograma Entretanto clara subgrupos intrahospitalares, intrahospitalares intra hospitalares, hospitalares intra-hospitalares preditivos fármacoinvasiva. fármacoinvasiva fármaco invasiva. invasiva fármaco-invasiva 2290 2 290 2.29 prédefinidas pré definidas pré-definidas típica atípica dispnéia sincope unidademédica unidade médica Oddsratios Odds ratios OR (OR IC95% IC95 IC 95% 95 IC-95% regressão alfa (alfa 5 5% atípicos prontosocorro pronto socorro fibrinólise 56 6 5,6% KillipKimball Killip Kimball AUC 0,77 077 0 77 [0,7 0,730,81 073081 0,73 0,81 73 81 (0,73-0,81) II ≥II (IC-95%)] 2,06 206 06 [2,0 1,422,99 142299 1,42 2,99 1 42 99 (1,42-2,99) p=0,01 p001 p 01 p=0,01] 3,39 339 3 39 [3,3 2,135,42 213542 2,13 5,42 13 (2,13-5,42) p<0,001 p0001 001 p<0,001] 2,09 209 09 1,373,19 137319 1,37 3,19 37 19 (1,37-3,19 1,55 155 55 [1,5 1,042,29 104229 1,04 2,29 04 29 (1,04-2,29) p=0,02 p002 02 p=0,02] 156 1,5 1,012,40 101240 1,01 2,40 40 [(1,01-2,40) p=0,04 p004 2,01 201 1,023,96 102396 1,02 3,96 96 (1,02-3,96) correlacionaramse correlacionaram se imediata Destacase Destaca predição clínica 229 2.2 IC9 9 IC-95 5,6 0,7 07 7 [0, 730 0,730,8 07308 073 081 0,8 8 (0,73-0,81 (IC-95%) 2,0 20 [2, 422 1,422,9 14229 142 1,4 299 2,9 4 (1,42-2,99 p=0,0 p00 3,3 33 [3, 135 2,135,4 21354 213 2,1 542 5,4 (2,13-5,42 p<0,00 p000 00 373 1,373,1 13731 137 1,3 319 3,1 (1,37-3,1 15 [1, 042 1,042,2 10422 104 1,0 2,2 (1,04-2,29 1, 012 1,012,4 10124 101 240 2,4 [(1,01-2,40 023 1,023,9 10239 102 396 3,9 (1,02-3,96 22 2. IC-9 5, 0, [0 0,730, 0730 08 (0,73-0,8 (IC-95% 2, [2 1,422, 1422 14 (1,42-2,9 p=0, p0 3, [3 2,135, 2135 21 54 (2,13-5,4 p<0,0 1,373, 1373 31 (1,37-3, [1 1,042, 1042 10 (1,04-2,2 1,012, 1012 24 [(1,01-2,4 1,023, 1023 (1,02-3,9 IC- [ 0,730 (0,73-0, (IC-95 1,422 (1,42-2, p=0 2,135 (2,13-5, p<0, 1,373 (1,37-3 1,042 (1,04-2, 1,012 [(1,01-2, 1,023 (1,02-3, (0,73-0 (IC-9 (1,42-2 p= (2,13-5 p<0 (1,37- (1,04-2 [(1,01-2 (1,02-3 (0,73- (IC- (1,42- (2,13- p< (1,37 (1,04- [(1,01- (1,02- (0,73 (IC (1,42 (2,13 (1,3 (1,04 [(1,01 (1,02 (0,7 (1,4 (2,1 (1, (1,0 [(1,0 (0, (2, (1 [(1, (0 (2 ( [(1 [(

ABSTRACT Objective Investigate pulse wave velocity and central systolic blood pressure among pediatric population with chronic kidney disease. Methods In this cross-sectional study, 57 patients (61.4% male) aged 6.2 to 17.5 years old, 44 with nondialysis chronic kidney disease and 13 on chronic dialysis, were included in the analysis. The pulse wave velocity and the central systolic blood pressure were measured with an oscillometric device with an inbuilt ARC SolverⓇ algorithm and were compared with previously established percentiles. Results The prevalence of elevated pulse wave velocity was 21.1% (95%Cl: 11.4-33.9) and elevated central systolic blood pressure was 28.1% (95%CI: 17.0-41.5). According to the generalized linear model, there was a higher risk of elevated pulse wave velocity in patients undergoing chronic dialysis treatment than nondialysis chronic kidney disease patients (adjPR=4.24, 95%CI: 1.97-9.13, p=<0.001). Hypertensive patients (stage 2) had a higher risk of elevated pulse wave velocity than normotensive ones (adjPR=2.70, 95%CI: 1.05-6.95, p=0.040), as did patients younger than 12 years than the older patients (adjPR=2.95, 95%CI: 1.05-8.40, p=0.041). Hypertensive patients had a higher risk of elevated central systolic blood pressure than normotensives (adjPR=3.29, 95%Cl: 1.36-7.94), as did patients undergoing chronic dialysis treatment when comparing to nondialysis chronic kidney disease patients (adjPR=2.08, 95%Cl: 1.07-4.02). Conclusion Younger age, dialysis, and hypertension in children are independently associated with higher pulse wave velocity. Hypertension and dialysis are independently associated with higher central systolic blood pressure.

Resumo Fundamento: A hipertrofia ventricular esquerda (HVE) é um importante fator de risco cardiovascular, independente da hipertensão arterial. Apesar da evolução dos exames de imagem, o eletrocardiograma (ECG) ainda é o mais utilizado na avaliação inicial, porém, com baixa sensibilidade. Objetivo: Avaliar o desempenho dos principais critérios eletrocardiográficos para HVE em indivíduos hipertensos idosos e muito idosos. Métodos: Em coorte de hipertensos foram realizados ECGs e EcoDopplercardiogramas (ECO), e separados em três grupos etários: <60 anos, Grupo I; 60-79 anos Grupo II; e ≥80 anos, Grupo III. Os critérios eletrocardiográficos mais utilizados foram aplicados para o diagnóstico da HVE: Perúgia; Peguero-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duração; Cornell voltagem; Cornell voltagem duração; Sokolow-Lyon voltagem; R de aVL ≥11 mm; RaVL duração. Na avaliação do desempenho desses critérios, além da sensibilidade (Sen) e especificidade (Esp), foram analisadas as “Odds Ratios diagnóstico” (DOR). Consideramos p-valor <0,05 para as análises, com testes bi-caudais. Resultados: Em 2.458 pacientes, a HVE estava presente pelo ECO em 781 (31,7%). Nos Grupos I e II, os melhores desempenhos foram para os critérios de Narita, Perúgia, (Rm+Sm) x duração, sem diferenças estatísticas entre eles. No Grupo III (muito idosos) os critérios de Perúgia e (Rm+Sm) x duração tiveram os melhores desempenhos: Perúgia [44,7/89,3; (Sen/Esp)] e (Rm+Sm) duração [39,4%/91,3%; (Sen/Esp), p<0,05)], com os melhores resultados de DOR:6,8. Isto sugere que nessa população de muito idosos esses critérios têm maior poder discriminatório para separar pacientes com HVE. Conclusão: Nos hipertensos muito idosos os critérios eletrocardiográficos de Perúgia e (Rm+Sm) x duração apresentaram os melhores desempenhos diagnósticos para HVE.

Abstract Background: Left ventricular hypertrophy (LVH) is an important cardiovascular risk factor, regardless of arterial hypertension. Despite the evolution of imaging tests, the electrocardiogram (ECG) is still the most used in the initial evaluation, however, with low sensitivity. Objective: To evaluate the performance of the main electrocardiographic criteria for LVH in elderly and very elderly hypertensive individuals. Methods: In a cohort of hypertensive patients, ECGs and doppler echocardiographies (ECHO) were performed and separated into three age groups: <60 years, Group I; 60-79 years Group II; and ≥80 years, Group III. The most used electrocardiographic criteria were applied for the diagnosis of LVH: Perugia; Pegaro-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duration; Cornell voltage; Cornell voltage duration; Sokolow-Lyon voltage; R of aVL ≥11 mm; RaVL duration. In evaluating the performance of these criteria, in addition to sensitivity (Sen) and specificity (Esp), the “Diagnostic Odds Ratios” (DOR) were analyzed. We considered p-value <0.05 for the analyses, with two-tailed tests. Results: In 2,458 patients, LVH was present by ECHO in 781 (31.7%). In Groups I and II, the best performances were for the criteria of Narita, Perugia, (Rm+Sm) x duration, with no statistical differences between them. In Group III (very elderly) the Perugia criteria and (Rm+Sm) x duration had the best performances: Perugia [44,7/89.3; (Sen/Esp)] and (Rm+Sm) duration [39.4%/91.3%; (Sen/Esp), p<0.05)], with the best PAIN results:6.8. This suggests that in this very elderly population, these criteria have greater discriminatory power to separate patients with LVH. Conclusion: In very elderly hypertensive patients, the Perugia electrocardiographic criteria and (Rm+Sm) x duration showed the best diagnostic performance for LVH.