SUMMARY OBJECTIVE: COVID-19 can cause lung damage and may present with pneumonia in patients. In the present study, the correlation between the severity of pneumonia and electrocardiography parameters of COVID-19 were examined. METHODS: A total of 93 COVID-19 patients and a control group consisting of 62 volunteers were studied. Computed thorax tomography evaluation was performed; each lung was divided into three zones. For each affected zone, scores were given. The main computed thorax tomography patterns were described in line with the terms defined by the Fleischner Society and peer reviewed literature on viral pneumonia. We compared Computed thorax tomography of patients with corrected QT (QTc) and P wave dispersion (Pd) time. RESULTS: There is a significant difference between the patient and control groups in terms of QTc values (413.5±28.8 msec vs. 395.6±16.7 msec p<0.001). Likewise, the Pd value of the patient group is statistically significantly higher than that of the control group (50.0±9.6 ms computed thorax tomography ec vs. 41.3±5.8 msec p<0.001). In the patient group, a reverse correlation was detected between computed thorax tomography score and Pd value according to partial correlation coefficient analysis (correlation coefficient: −0.232, p=0.027). In the patient group, the correlation between computed thorax tomography score and QTc value was similarly determined according to partial correlation coefficient analysis (Correlation coefficient:0.224, p=0.017). CONCLUSIONS: COVID-19 prolongs QTc and P wave dispersion values; and as the severity of pneumonia increases, QTc value increases. However, whereas the severity of pneumonia increases, P wave dispersion value decreases.

FUNDAMENTO: A função endotelial braquial tem sido associada ao fluxo lento coronário (FLC). O aumento do fluxo sanguíneo para a artéria braquial faz com que o endotélio libere óxido nítrico (ON), com subsequente vasodilatação. Além de sua atividade com betabloqueador, o nebivolol provoca vasodilatação, aumentando a liberação endotelial de ON. OBJETIVO: Avaliar os efeitos do nebivolol na função endotelial vascular em pacientes com FLC. MÉTODOS: 46 pacientes com FLC e 23 indivíduos com artérias coronárias epicárdicas normais foram examinados com ecocardiografia transtorácica e ultrassonografia da artéria braquial. Os pacientes foram reavaliados dois meses após o tratamento com aspirina ou aspirina e nebivolol. RESULTADOS: Os pacientes com FLC apresentaram maior índice de massa corporal (26,5 ± 3,3 vs. 23,8 ± 2,8, p < 0,001), tempo de relaxamento isovolumétrico (TRIV) de influxo mitral (114,9 ± 18,0 vs. 95,0 ± 22,0 mseg, p < 0,001), menor fração de ejeção do ventrículo esquerdo (FEVE) (63,5 ± 3,1% vs. 65,4 ± 2,2, p = 0,009), colesterol HDL (39,4 ± 8,5 vs. 45,8 ± 7,7 mg/dL, p = 0,003) e dilatação fluxo-mediada da artéria braquial (DFM) (6,1 ± 3,9% vs. 17,6 ± 4,5%, p <0,001). Houve correlações significativas entre a DFM e a presença de FLC (r = 0,800, p < 0,001) e o colesterol HDL (r = 0,349, p = 0,003). Dos pacientes com FLC, apesar de os valores médios de DFM em pré-tratamento terem sido semelhantes (6,1 ± 4,3% vs. 6,0 ± ,6%, p = 0,917), em comparação com a DFM do grupo em pós-tratamento apenas com aspirina, a DFM apresentou valores significativamente maiores do que os pacientes tratados com aspirina e nebivolol (6,0 ± 3,5% vs. 8,0 ± 2,9%, p = 0,047). Constatou-se que o tratamento com nebivolol está associado a um significativo aumento na DFM (6,0 ± 3,6 a 8,0 ± 2,9 %, p = 0,030), ao passo que o tratamento apenas com aspirina não apresentou a mesma associação. CONCLUSÃO: A função endotelial pode ser comprometida nas artérias coronárias e braquiais em pacientes com FLC, e o nebivolol pode ser eficaz na melhora da função endotelial em pacientes com FLC.

BACKGROUND: Brachial endothelial function has been associated with coronary slow flow (CSF). Increasing blood flow to brachial artery provokes endothelium to release nitric oxide (NO) with subsequent vasodilatation. Besides its β1-blocker activity, nebivolol causes vasodilatation by increasing endothelial NO release. OBJECTIVE: To assess the effects of nebivolol on vascular endothelial function in patients with CSF. METHODS: Forty-six patients with CSF and 23 individuals with normal epicardial coronary arteries were examined with transthoracic echocardiography and brachial artery ultrasonography. The patients were reevaluated two months after treatment with aspirin or aspirin plus nebivolol. RESULTS: Patients with CSF had higher body mass index (26.5 ± 3.3 vs. 23.8 ± 2.8, p < 0.001), mitral inflow isovolumetric relaxation time (IVRT) (114.9 ± 18.0 vs. 95.0 ± 22.0 msec, p < 0.001) and lower left ventricular ejection fraction (LVEF) (63.5 ± 3.1% vs. 65.4 ± 2.2, p = 0.009), HDL-cholesterol (39.4 ± 8.5 vs. 45.8 ± 7.7 mg/dL, p = 0.003) and brachial flow-mediated dilatation (FMD) (6.1 ± 3.9% vs. 17.6 ± 4.5%, p < 0.001). There were significant correlations between FMD and the presence of CSF (r = 0.800, p < 0.001) and HDL-cholesterol (r = 0.349, p = 0.003). Among Patients with CSF, although pretreatment mean FMD values were similar (6.1 ± 4.3% vs. 6.0 ± ,6%, p = 0.917) compared to aspirin alone group, posttreatment FMD was significantly higher in patients treated with aspirin plus nebivolol (6.0 ± 3.5% vs. 8.0 ± 2.9%, p = 0.047). Treatment with nebivolol was associated with a significant increase in FMD (6.0 ± 3.6 to 8.0 ± 2.9 %, p = 0.030) whereas treatment with aspirin alone was not. CONCLUSION: Endothelial function may be impaired in both coronary and brachial arteries in patients with CSF and nebivolol may be effective in the improvement of endothelial function in patients with CSF.

OBJECTIVES: The association between P wave dispersion and iron deficiency anemia has not been documented in the literature. In this study, we evaluated P wave dispersion in patients with iron deficiency anemia and the possible relationships between P wave dispersion and other echocardiographic parameters. INTRODUCTION: The iron status of an individual may play an important role in cardiovascular health. Anemia is an independent risk factor for adverse cardiovascular outcomes. P wave dispersion is a simple electrocardiographic marker that has a predictive value for the development of atrial fibrillation. Apart from cardiovascular diseases, several conditions, such as seasonal variation, alcohol intake and caffeine ingestion, have been demonstrated to affect P wave dispersion. METHODS: The study included 97 patients who had iron deficiency anemia and 50 healthy subjects. The cases were evaluated with a clinical examination and diagnostic tests that included 12-lead electrocardiography and transthoracic echocardiography. RESULTS: Compared to the control group, patients with iron deficiency anemia showed significantly longer maximum P wave duration (Pmax) (91.1±18.0 vs. 85.8±6.7 msec, p=0.054), P wave dispersion (PWD) (48.1±7.7 vs. 40.9±5.6 msec, p<0.001), mitral inflow deceleration time (DT) (197.5±27.9 vs. 178.8±8.9 msec, p<0.001) and isovolumetric relaxation time (IVRT) (93.3±9.2 vs. 77.4±8.2 msec, p<0.001); they also showed increased heart rate (85.7±16.1 vs. 69.0±4.4, p<0.001) and frequency of diastolic dysfunction (7 (7.2%) vs. 0). Correlation analysis revealed that PWD was significantly correlated with IVRT, DT, heart rate, the presence of anemia and hemoglobin level. CONCLUSIONS: Iron deficiency anemia may be associated with prolonged P wave duration and dispersion and impaired diastolic left ventricular filling.

FUNDAMENTO: Tem sido demonstrado que diminuições na variabilidade da frequência cardíaca (VFC) estão relacionadas com o prognóstico na insuficiência cardíaca (IC). A administração crônica de trimetazidina, além da terapia convencional, tem melhorado a classe funcional e a função ventricular esquerda de pacientes com IC. OBJETIVO: Avaliar os efeitos da trimetazidina na VFC em pacientes com IC de origem isquêmica, recebendo tratamento otimizado. MÉTODOS: Trimetazidina 20 mg 3 vezes/dia foi adicionada à terapia de 30 pacientes com IC tratados com inibidores da enzima conversora de angiotensinogênio ou bloqueadores do receptor da angiotensina, carvedilol, espironolactona, digital e furosemida. A etiologia da IC era doença arterial coronariana em todos os pacientes. Os pacientes foram avaliados através de ecocardiografia e análise da VFC de 24-horas antes e 3 meses depois da adição de trimetazidina. RESULTADOS: A fração de ejeção ventricular esquerda (FEVE) média aumentou significantemente após a adição da trimetazidina (33,5±5,1% para 42,5±5,8%, p<0,001). Dos parâmetros da VFC, o DPNN (97,3±40,1 to 110,5±29,2 msegs, p=0,049) e DPTNN (80,5±29,0 to 98,3±30,5 msegs) aumentaram significantemente após o tratamento com trimetazidina. O DPNN basal apresentou uma correlação significante com o FEVE basal (r=0,445, p=0,023, p=0,008) e o incremento no DPNN correlacionou-se com o aumento na FEVE (r=0,518, p=0,007). CONCLUSÕES: A trimetazidina, quando adicionada ao tratamento médico otimizado de pacientes com IC de origem isquêmica, pode melhorar a VFC, além de melhorar a fração de ejeção ventricular esquerda.

BACKGROUND: Reduced measures of heart rate variability (HRV) have been shown to be related with prognosis in heart failure. Chronic administration of trimetazidine in addition to the conventional therapy has been shown to improve functional class and left ventricular functions of heart failure patients. OBJECTIVE: To assess the effects of trimetazidine on HRV in optimally treated patients with heart failure of ischemic origin. METHODS: Trimetazidine 20 mg three times/day was added to therapy of 30 patients with heart failure being treated with angiotensinogen converting enzyme inhibitors or angiotensin receptor blockers, carvedilol, spironolactone, digitalis and furosemide. The etiology of heart failure was coronary artery disease in all patients. Patients were evaluated with echocardiography and 24-hour heart rate variability analysis before and 3 months after addition of trimetazidine. RESULTS: Mean left ventricular ejection fraction (LVEF) significantly increased after the addition of trimetazidine (33.5±5.1% to 42.5±5.8%, p<0.001). Of the HRV parameters, SDNN (97.3±40,1 to 110.5±29,2 msecs, p=0.049) and SDANN (80.5±29,0 to 98.3±30,5 msecs) were significantly increased after trimetazidine treatment. Baseline SDNN was significantly correlated with baseline LVEF (r=0.445, p=0.023, p=0.008) and the increment in SDNN was correlated with increase in LVEF (r=0.518, p=0.007). CONCLUSIONS: Adding trimetazidine to optimal medical therapy in patients with heart failure of ischemic origin may improve heart rate variability in association with improved left ventricular ejection fraction.

FUNDAMENTO: Se ha demostrado que disminuciones en la variabilidad de la frecuencia cardíaca (VFC) están relacionadas con el pronóstico en la insuficiencia cardíaca (IC). La administración crónica de trimetazidina, además de la terapia convencional, ha mejorado la clase funcional y la función ventricular izquierda de pacientes con IC. OBJETIVO: Evaluar los efectos de la trimetazidina en la VFC en pacientes con IC de origen isquémico, recibiendo tratamiento optimizado. MÉTODOS: Se agregó trimetazidina 20 mg 3 veces/día a la terapia de 30 pacientes con IC tratados con inhibidores de la enzima conversora de angiotensinógeno o bloqueadores del receptor de la angiotensina, carvedilol, espironolactona, digital y furosemida. La etiología de la IC era enfermedad arterial coronaria en todos los pacientes. Los pacientes fueron evaluados mediante ecocardiografía y análisis de la VFC de 24-horas antes y 3 meses después de la adición de trimetazidina. RESULTADOS: La fracción de eyección ventricular izquierda (FEVI) media aumentó significativamente después de la adición de la trimetazidina (33,5±5,1% para 42,5±5,8%, p<0,001). De los parámetros de la VFC, la SDNN (97,3±40,1 a 110,5±29,2 msegs, p=0,049) y la SDANN (80,5±29,0 a 98,3±30,5 msegs) aumentaron significativamente después del tratamiento con trimetazidina. La SDNN basal presentó una correlación significativa con la FEVI basal (r=0,445, p=0,023, p=0,008) y el incremento en la SDNN se correlacionó con el aumento en la FEVI (r=0,518, p=0,007). CONCLUSIÓN: Cuando se agrega trimetazidina al tratamiento médico optimizado de pacientes con IC de origen isquémico, puede mejorar la VFC, además de mejorar la fracción de eyección ventricular izquierda.

FUNDAMENTO: A variabilidade da frequência cardíaca (VFC) está associada com aumento do fator de risco cardíaco em várias condições. As concentrações de ferro apresentadas por um indivíduo podem ter um papel importante na saúde cardiovascular. OBJETIVO: Avaliar a VFC em pacientes com anemia ferropriva. MÉTODOS: Vinte e três pacientes com anemia ferropriva (hemoglobina (Hb) média = 8,6±2,2 g/dl) e 10 indivíduos saudáveis ( Hb média = 13,9±1,2 g/dl) foram avaliados através de monitoramento ambulatorial por 24 horas (Sistema Holter) durante estadia hospitalar com atividade física limitada. RESULTADOS: Embora a frequência cardíaca (FC) média tenha sido significantemente mais alta em pacientes com anemia, não houve diferença significativa em relação aos parâmetros da VFC quando comparados ao grupo saudável. CONCLUSÃO: Não há diferença significativa nos parâmetros da VFC entre pacientes com anemia ferropriva e indivíduos saudáveis.

BACKGROUND: Heart rate variability (HRV) is associated with increased cardiac risk factor in several conditions. The iron status of an individual may play an important role in cardiovascular health. OBJECTIVE: To evaluate heart rate variability in patients with iron deficiency anemia. METHODS: Twenty-three patients with iron deficiency anemia (mean hemoglobin (Hb) 8.6±2.2 g/dl) and 10 healthy people (mean Hb 13.9±1.2 g/dl) were assessed with 24-hour ambulatory Holter recordings during in hospital course having limited physical activity. RESULTS: Although mean heart rate was significantly higher in patients with anemia, there was no significant difference regarding HRV parameters compared to the healthy group. CONCLUSION: There was no significant difference in HRV parameters between patients with iron deficiency anemia with limited physical activity and healthy ambulatory people.

FUNDAMENTO: La variabilidad de la frecuencia cardiaca (VFC) está asociada al aumento del factor de riesgo cardiaco en varias condiciones. Las concentraciones de hierro presentadas por un individuo pueden ejercer un rol importante para la salud cardiovascular. OBJETIVO: Evaluar la VFC en pacientes con anemia ferropriva. MÉTODOS: Se evaluaron a 23 pacientes con anemia ferropriva (hemoglobina [Hb] media = 8,6±2,2 g/dL) y a 10 individuos sanos (Hb media = 13,9±1,2 g/dL) por medio de monitoreo ambulatorio por 24 horas (Sistema Holter) durante estadía hospitalaria con actividad física limitada. RESULTADOS: Aunque la frecuencia cardiaca (FC) media fue significantemente más alta en pacientes con anemia, no hubo diferencia significante respecto a los parámetros de la VFC en comparación con el grupo de individuos sanos. CONCLUSIONES: No hay diferencia significante en los parámetros de la VFC entre pacientes con anemia ferropriva e individuos sanos.

FUNDAMENTO: Devido à sobreposição de sintomas e inadequada capacidade de exercícios, o diagnóstico não-invasivo da doença arterial coronariana (DAC) pode ser sub ou superestimado em pacientes com doença pulmonar obstrutiva crônica (DPOC). OBJETIVO: Avaliar os resultados de angiografias coronarianas em pacientes com DPOC dependendo das características clínicas basais. MÉTODOS: Os registros médicos de 157 pacientes com DPOC e 157 pacientes sem DPOC pareados por características clínicas basais, que haviam sido submetidos a angiografia coronariana diagnóstica pela primeira vez, foram revisados, retrospectivamente. RESULTADOS: A frequência de DAC era significantemente mais baixa em pacientes com DPOC do que no grupo controle (52,8% vs. 80,2%, p<0,001). As frequências dos fatores de risco para DAC (idade avançada, hipertensão, diabete, histórico de fumo) eram significantemente mais comuns entre os pacientes com DPOC que tinham DAC significativa. Entre os pacientes que reportavam angina pectoris estável, DAC significativa foi detectada em 32,7% dos pacientes com DPOC e em 71,0% dos pacientes sem DPOC (p<0,001). Entretanto, para os pacientes com diagnóstico de angina pectoris instável, DAC significativa foi detectada em 87,5% dos pacientes com DPOC e 90,2% dos pacientes sem DPOC (p=0,755). CONCLUSÃO: O diagnóstico de DAC pacientes com DPOC através da sintomatologia, somente, pode ser difícil. Entretanto, o diagnóstico clínico de DAC no quadro de angina instável é acurado na maioria dos pacientes com DPOC. Assim, outros métodos diagnósticos não-invasivos ou seguimento cuidadoso podem ser mais apropriados para pacientes com DPOC que reportam angina pectoris estável.

BACKGROUND: Due to overlapping symptoms and inadequate exercise capacity, noninvasive diagnosis of coronary artery disease (CAD) may be under- or overestimated in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To assess outcomes of coronary angiography in COPD patients depending on baseline clinical characteristics. METHODS: Medical records of 157 patients with COPD and 157 patients without COPD matched for baseline clinical characteristics who had undergone diagnostic coronary angiography for the first time were reviewed retrospectively. RESULTS: The frequency of significant CAD was significantly lower in COPD patients than in the control group (52.8% vs. 80.2%, p<0.001). Frequencies of CAD risk factors (older age, hypertension, diabetes, smoking history) were significantly more frequent among COPD patients having significant CAD. Among patients reporting stable angina pectoris, significant CAD was detected in 32.7% of COPD patients and 71.0% of non-COPD patients (p<0.001). However, among the patients with a diagnosis of unstable angina pectoris, significant CAD was detected in 87.5% of COPD patients and 90.2% of non-COPD patients (p=0.755). CONCLUSION: Diagnosis of CAD in COPD patients by symptomatology may be difficult. However, clinical diagnosis of CAD in the setting of unstable angina is accurate in most of the COPD patients. Therefore, further noninvasive diagnostic methods or careful follow up may be more appropriate for COPD patients reporting stable angina pectoris.

FUNDAMENTO: A causa de la superposición de síntomas e inadecuada capacidad de ejercicios, el diagnóstico no-invasivo de la enfermedad arterial coronaria (EAC) se puede sub o superestimar en pacientes con enfermedad pulmonar obstructiva crónica (EPOC). OBJETIVO: Evaluar los resultados de angiografías coronarias en pacientes con EPOC dependiendo de las características clínicas basales. MÉTODOS: Se revisaron retrospectivamente los registros médicos de 157 pacientes con EPOC y 157 pacientes sin EPOC distribuidos en grupos según características clínicas basales, que se habían sometido a angiografía coronaria diagnóstica por primera vez. RESULTADOS: La frecuencia de EAC era significantemente más baja en pacientes con EPOC que en el grupo control (52,8% vs. 80,2%, p<0,001). Las frecuencias de los factores de riesgo para EAC (edad avanzada, hipertensión, diabetes, histórico de fumo) eran significantemente más comunes entre los pacientes con EPOC que tenían EAC significante. Entre los pacientes que reportaban angina de pecho estable, se detectó EAC significante en un 32,7% de los pacientes con EPOC y el 71,0% de los pacientes sin EPOC (p<0,001). Sin embargo, para los pacientes con diagnóstico de angina de pecho inestable, se detectó EAC significante en un 87,5% de los pacientes con EPOC y un 90,2% de los pacientes sin EPOC (p=0,755). CONCLUSIONES: El diagnóstico de EAC pacientes con EPOC solamente mediante la sintomatología puede ser difícil. Sin embargo, el diagnóstico clínico de EAC en el cuadro de angina inestable resulta preciso en la mayoría de los pacientes con EPOC. Así, otros métodos diagnósticos no-invasivos o seguimiento cuidadoso pueden ser más apropiados para pacientes con EPOC que refieren angina de pecho estable.