Abstract Amyloidosis results from deposition of insoluble fibrillar protein compounds in various organs, including the heart. Cardiac involvement occurs in both atria and ventricles, leading to restrictive cardiomyopathy, heart failure (HF), and arrhythmias. Five amyloid proteins affect cardiac tissue: light and heavy chain forms of immunoglobulin, transthyretin (TTR), apolipoprotein 1, and amyloid A. Approximately 95% of cardiac involvement stems from light chain of immunoglobulin and TTR deposition in heart. Chamber stiffness and rhythm disturbances occur in cardiac amyloidosis (CA), encompassing from HF to atrial and ventricular arrhythmias (VA), and both can compromise each other. It is known that conduction system disorders and VA increase sudden death risk, as amyloid infiltration, inflammation, and fibrosis alter myocardial electrophysiology. Beyond the heart, autonomous nerve systems suffer amyloid deposition, contributing to syncope manifestation and increasing the risk of death and poor prognosis. In this context, our review sheds light on the importance of recognizing syncope and rhythm disturbances as crucial markers in the early identification and management of CA, potentially offering avenues for prompt intervention and improved patient outcomes. organs ventricles cardiomyopathy HF, , (HF) tissue TTR, (TTR) 1 A 95 CA (CA) VA, (VA) other infiltration inflammation electrophysiology prognosis context outcomes (HF (TTR 9 (CA (VA

Abstract Background: Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care. Objective: The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease. Methods: This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e' ratio ranged from 0 to 9 points. The level of statistical significance was p<0.05. Results: HFpEF was diagnosed in 58(14.4%). Among patients with H2FPEF≥4, 30% had HFpEF and in those with a score≤4, HFpEF was present in 12%. Patients with HFpEF and H2FPEF≥4 had 53% of outcomes, whereas patients with HFpEF and a score ≤4 had a 21% of outcomes. BNP values were higher in patients with HFpEF compared to those without HFpEF(p<0.0001). Conclusion: H2FPEF≥4 indicated a worse prognosis in patients with HFpEF assisted in primary care. H2FPEF may be a simple and useful tool for risk stratification in patients with HFpEF at the primary care.

Resumen Antecedentes: La hipertensión es responsable de un gran número de muertes debido a cardiopatías e ictus. Un paso esencial para su control es la identificación de factores modificables predictivos de la hipertensión. Objetivos: Calcular la relación entre ingesta de sal, ácido úrico sérico e hipertensión incidental en un centro de atención primaria. Métodos: Cohorte retrospectiva del estudio CAMELIA, en el que se incluyó una muestra no aleatorizada de 1.098 participantes con edades ≥ 20 años, obtenida de un programa de atención primaria. Originalmente, la muestra incluía sujetos hipertensos, diabéticos y no diabéticos/no hipertensos. Para el análisis, se estudiaron 258 participantes con presión arterial (PA) inferior a 140/90 mm Hg, sin prescripción de fármacos antihipertensivos, y no diabéticos. Transcurridos cinco años de la primera visita, se revisaron sus historias médicas. Se dividió a los pacientes en dos grupos, con arreglo a su PA en la primera visita: grupo con PA normal (PA sistólica ≤ 120 mm Hg y PA diastólica ≤ 80 mm Hg), y grupo con PA alta-normal BP (PA sistólica 121-139 mm Hg y/o PA diastólica 81-89 mm Hg). Resultados: En el análisis multivariante, la PA alta-normal, hiperuricemia e ingesta de sal ≥ 6 g/día predijeron la hipertensión incidental. En los participantes del grupo de PA normal, la ingesta elevada de sal confirió el mayor riesgo. En el grupo de PA alta-normal, el tabaquismo y el ácido úrico sérico fueron los factores más importantes. Conclusión: En una población sana, multiétnica y normotensa, procedente de un programa de atención primaria urbana la PA alta-normal, hiperuricemia e ingesta elevada de sal constituyeron los factores predictivos de la hipertensión incidental.

Abstract Background: Hypertension is responsible for a substantial number of deaths due to cardiovascular disease and stroke. A crucial step toward its control is the identification of modifiable predictors of hypertension. Objectives: To estimate the relationship between salt intake, serum uric acid and incident hypertension in a primary care setting. Methods: Retrospective cohort of the CAMELIA study in which a non-randomized sample of 1098 participants who were ≥ 20 year-old was recruited from a primary care program. Originally, the sample consisted of hypertensive, diabetic and non-diabetic/non-hypertensive subjects. For the analysis, 258 participants with blood pressure (BP) lower than 140/90 mm Hg not using antihypertensive drugs and without diabetes mellitus were included. Five years after the first visit, their medical records were reviewed. Patients were divided into two groups according to BP in the first visit: normal BP group (systolic BP ≤ 120 mm Hg and diastolic BP ≤ 80 mm Hg) and high-normal BP group (systolic BP 121-139 mm Hg and/or diastolic BP 81-89 mm Hg). Results: In multivariate analysis, high-normal BP, hyperuricemia and salt intake ≥ 6 g/day predicted incident hypertension. In participants of thenormal BP group, high salt intake conferred the highest risk. In the high-normal BP group, smoking and serum uric acid were found to be the most important ones. Conclusion: In a healthy, multiethnic, and normotensive population from an urban primary care program, high-normal BP, hyperuricemia and high salt intake were found to be predictors of incident hypertension.

Abstract The heart and lung are target organs in systemic sclerosis (SSc) and similar symptoms (dyspnea and cough) may make the differential diagnosis between the two lesions difficult. In addition, complete atrioventricular block (CAVB) is a rare complication of this disease. This case report is about a patient with SSc and pulmonary fibrosis who was admitted to the emergency room with CAVB, heart failure (HF) and progressive worsening of the underlying disease.

Resumo Os recentes avanços ao nível de hardware e a crescente exigência de personalização dos cuidados associados às necessidades urgentes de criação de valor para os pacientes contribuíram para que a Inteligência Artificial (IA) promovesse uma mudança significativa de paradigma nas mais diversas áreas do conhecimento médico, em particular em Cardiologia, por sua capacidade de apoiar a tomada de decisões e melhorar o desempenho diagnóstico e prognóstico. Nesse contexto, o presente trabalho faz uma revisão não-sistemática dos principais trabalhos publicados sobre IA em Cardiologia, com foco em suas principais aplicações, possíveis impactos e desafios.

Abstract The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Resumo Os recentes avanços ao nível de hardware e a crescente exigência de personalização dos cuidados associados às necessidades urgentes de criação de valor para os pacientes contribuíram para que a Inteligência Artificial (IA) promovesse uma mudança significativa de paradigma nas mais diversas áreas do conhecimento médico, em particular em Cardiologia, por sua capacidade de apoiar a tomada de decisões e melhorar o desempenho diagnóstico e prognóstico. Nesse contexto, o presente trabalho faz uma revisão não-sistemática dos principais trabalhos publicados sobre IA em Cardiologia, com foco em suas principais aplicações, possíveis impactos e desafios.

Abstract The recent advances at hardware level and the increasing requirement of personalization of care associated with the urgent needs of value creation for the patients has helped Artificial Intelligence (AI) to promote a significant paradigm shift in the most diverse areas of medical knowledge, particularly in Cardiology, for its ability to support decision-making and improve diagnostic and prognostic performance. In this context, the present work does a non-systematic review of the main papers published on AI in Cardiology, focusing on its main applications, potential impacts and challenges.

Resumo Fundamento e objetivos: A cardiomiopatia cirrótica tem sido usada para descrever a disfunção cardíaca crônica em pacientes cirróticos sem doença cardíaca estrutural prévia. Além disso, o prolongamento do intervalo QT é uma das alterações cardíacas mais importantes relacionadas à cirrose. Estudos prévios sugerem que o prolongamento QT está associado com uma taxa de mortalidade mais alta em pacientes cirróticos. O objetivo deste estudo foi analisar intervalos QTs segundo a gravidade da cirrose, medida pela classificação Child-Plugh. Materiais e métodos: Em um estudo transversal, um total de 67 pacientes com cirrose não alcoólica submeteu-se à avaliação clínica e eletrocardiográfica. A gravidade da cirrose foi classificada de acordo com o escore Child-Pugh. O intervalo QT foi medido por um eletrocardiograma de 12 derivações. Resultados: Os intervalos QTs foram mais longos em pacientes no grupo Child-Plugh C que nos grupos Child-Pugh A e B (459 ± 33 vs 436 ± 25 e 428 ± 34 ms, respectivamente, p = 0,004). Houve uma correlação positiva entre o intervalo QT e o escore Child-Pugh em indivíduos com escore Child-Pugh ≥ 7 (r = 0,50; p < 0,05) e intervalos QT ≥ 440 ms (r = 0,46, p < 0,05). Conclusão: O presente estudo mostrou que pacientes com cirrose Child-Plugh C apresentam intervalos QTs mais longos, o que reforçou a relação entre a gravidade da cirrose e achados eletrocardiográficos da cardiomiopatia cirrótica. Além disso, esse resultado foi encontrado em pacientes sem sintomas cardíacos, o que destacou a importância de um método simples e não invasivo, como o eletrocardiograma, para identificar pacientes cirróticos com cardiomiopatia. (Int J Cardiovasc Sci. 2017; [online].ahead print, PP.0-0)

Abstract Background and aims: Cirrhotic cardiomyopathy has been used to describe chronic cardiac dysfunction in cirrhotic patients with no previous structural heart disease. Additionally, QT prolongation is one of the most important cardiac alterations related to cirrhosis. Previous studies suggest that QT prolongation is associated with a higher mortality rate among cirrhotic patients. The aim of this study was to analyze QT intervals according to cirrhosis severity as measured by the Child-Pugh classification. Materials and methods: In a cross-sectional study, a total of 67 patients with nonalcoholic cirrhosis underwent clinical and electrocardiographic evaluation. Cirrhosis severity was classified according to the Child-Pugh score. The QT interval was measured by a 12-lead electrocardiogram. Results: The QT intervals were longer in patients in the Child-Pugh C group than those in the Child-Pugh A and B groups (459 ± 33 vs 436 ± 25 and 428 ± 34 ms, respectively, p = 0.004). There was a positive correlation between the QT interval and the Child-Pugh score in individuals with Child-Pugh scores ≥ 7 (r = 0.50, p < 0.05) and QT intervals ≥ 440 ms (r = 0.46, p < 0.05). Conclusion: The present study showed longer QT intervals in patients with Child-Pugh C cirrhosis, which reinforced the relationship between the severity of cirrhosis and electrocardiographic findings of cirrhotic cardiomyopathy. Moreover, this finding emerged in patients with no cardiac symptoms, which highlighted the importance of a simple and noninvasive method (ECG) to identify cirrhotic patients with cardiomyopathy.

Resumo Fundamentos: Estudos sugerem que as estatinas possuem efeitos pleotrópicos, como melhora da função endotelial, da rigidez vascular e redução da pressão arterial. Objetivo: Analisar se o uso prévio de estatina influenciou o efeito sobre a pressão arterial, a função endotelial e a rigidez vascular de drogas inibidoras do sistema renina-angiotensina-aldosterona. Métodos: Pacientes hipertensos e diabéticos com pressão arterial de consultório sistólica ≥ 130 mmHg e/ou diastólica ≥ 80 mmHg tiveram suas medicações anti-hipertensivas substituídas por anlodipino durante 6 semanas. Em seguida, foram randomizados para associação de benazepril ou losartana por mais 12 semanas. Pressão arterial (através da monitorização ambulatorial da pressão arterial), função endotelial (dilatação mediada por fluxo da artéria braquial) e rigidez vascular (velocidade da onda de pulso) foram avaliados antes e após o tratamento combinado. Neste trabalho, uma análise post-hoc foi realizada para comparar pacientes que vinham (grupo CE) ou não (grupo SE) em uso de estatina. Resultados: O grupo CE apresentou maior redução na pressão arterial sistólica nas 24 horas (134 para 122 mmHg, p = 0,007) e na dilatação mediada por fluxo da artéria braquial (6,5 para 10,9%, p = 0,003) quando comparado com o grupo SE (137 para 128 mmHg, p = 0,362, e 7,5 para 8,3%, p = 0,820). Não houve diferença estatisticamente significante na velocidade de onda de pulso (grupo CE 9,95 para 9,90 m/s, p = 0,650 e grupo SE 10,65 para 11,05 m/s, p = 0,586). Conclusão: O uso combinado de estatinas, anlodipino e inibidores do sistema renina-angiotensina-aldosterona melhora a resposta anti-hipertensiva e a função endotelial em pacientes hipertensos e diabéticos.

Abstract Background: Studies suggest that statins have pleiotropic effects, such as reduction in blood pressure, and improvement in endothelial function and vascular stiffness. Objective: To analyze if prior statin use influences the effect of renin-angiotensin-aldosterone system inhibitors on blood pressure, endothelial function, and vascular stiffness. Methods: Patients with diabetes and hypertension with office systolic blood pressure ≥ 130 mmHg and/or diastolic blood pressure ≥ 80 mmHg had their antihypertensive medications replaced by amlodipine during 6 weeks. They were then randomized to either benazepril or losartan for 12 additional weeks while continuing on amlodipine. Blood pressure (assessed with ambulatory blood pressure monitoring), endothelial function (brachial artery flow-mediated dilation), and vascular stiffness (pulse wave velocity) were evaluated before and after the combined treatment. In this study, a post hoc analysis was performed to compare patients who were or were not on statins (SU and NSU groups, respectively). Results: The SU group presented a greater reduction in the 24-hour systolic blood pressure (from 134 to 122 mmHg, p = 0.007), and in the brachial artery flow-mediated dilation (from 6.5 to 10.9%, p = 0.003) when compared with the NSU group (from 137 to 128 mmHg, p = 0.362, and from 7.5 to 8.3%, p = 0.820). There was no statistically significant difference in pulse wave velocity (SU group: from 9.95 to 9.90 m/s, p = 0.650; NSU group: from 10.65 to 11.05 m/s, p = 0.586). Conclusion: Combined use of statins, amlodipine, and renin-angiotensin-aldosterone system inhibitors improves the antihypertensive response and endothelial function in patients with hypertension and diabetes.

O Prêmio Nobel foi criado por Alfred Nobel. Os primeiros prêmios foram entregues em 1901, e o primeiro ganhador na área da medicina foi Emil Adolf von Behring, por seus trabalhos com soro antidiftérico. Na cardiologia, o conhecimento da história do Prêmio Nobel ajuda a entender a importância dos avanços fisiopatológicos, diagnósticos e terapêuticos realizados ao longo dos últimos 120 anos. O objetivo do presente estudo foi revisar as principais descobertas científicas contempladas pelo Prêmio Nobel, que contribuíram para avanços no estudo da cardiologia. Além disso, apresentamos a hipótese pela qual Carlos Chagas, um dos nossos mais importantes cientistas, não recebeu o Prêmio Nobel em duas ocasiões. A partir de uma revisão não sistemática sobre os Prêmios Nobel, foram selecionados, entre os laureados, os principais estudos com relevância para as doenças cardíacas. No período entre 1901 e 2013, 204 pesquisadores, em 104 prêmios, foram premiados na categoria Medicina ou Fisiologia, dos quais 16 estudos (15%) tiveram importância na área da cardiologia. Foram 33 (16%) premiados, sendo apenas duas (6%) mulheres. Em relação ao local de nascimento, 14 (42%) eram norte-americanos, 15 (45%) europeus e quatro (13%) de outros países. Apenas um laureado nasceu no Brasil: Peter Medawar, cuja carreira se deu toda na Inglaterra. A revisão da história do Prêmio Nobel na área de medicina ou fisiologia possibilitou identificar pesquisadores e estudos que contribuíram para avanços no diagnóstico, prevenção e tratamento das doenças cardiovasculares. A maioria dos laureados eram norte‑americanos e europeus, e do sexo masculino.

The Nobel Prize was created by Alfred Nobel. The first prize was awarded in 1901 and Emil Adolf von Behring was the first laureate in medicine due to his research in diphtheria serum. Regarding cardiology, Nobel Prize’s history permits a global comprehension of progress in pathophysiology, diagnosis and therapeutics of various cardiac diseases in last 120 years. The objective of this study was to review the major scientific discoveries contemplated by Nobel Prizes that contributed to cardiology. In addition, we also hypothesized why Carlos Chagas, one of our most important scientists, did not win the prize in two occasions. We carried out a non-systematic review of Nobel Prize winners, selecting the main studies relevant to heart diseaseamong the laureates. In the period between 1901 and 2013, 204 researches and 104 prizes were awarded in Nobel Prize, of which 16 (15%) studies were important for cardiovascular area. There were 33 (16%) laureates, and two (6%) were women. Fourteen (42%) were American, 15 (45%) Europeans and four (13%) were from other countries. There was only one winner born in Brazil, Peter Medawar, whose career was all in England. Reviewing the history of the Nobel Prize in physiology or medicine area made possible to identify which researchers and studies had contributed to advances in the diagnosis, prevention and treatment of cardiovascular diseases. Most winners were North Americans and Europeans, and male.

Descrevemos o caso de um paciente de 67 anos, portador de doença arterial coronariana obstrutiva, o qual, em avaliação pré-operatória para cirurgia de herniorrafia inguinal, realizou ecocardiograma demonstrando um volumoso tumor em átrio esquerdo, móvel, não-obstrutivo, com pedículo proveniente da veia pulmonar superior direita. O paciente realizou cineangiocoronariografia com ventriculografia esquerda, evidenciando lesão obstrutiva grave em terço médio da artéria descendente anterior, moderada em terço proximal da artéria circunflexa, no local de saída do primeiro ramo marginal, e coronária direita com lesão não-obstrutiva em terço distal. Havia, ainda, disfunção ventricular esquerda moderada. O paciente foi então submetido a cirurgia para retirada do tumor e revascularização do miocárdio. O exame histopatológico mostrou tratar-se de um mixoma.

We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.