Abstract Background Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) with an onset time <12 h. However, it poses a risk of contrast-induced nephropathy (CIN), occurring in one out of five patients. In this context, the CHA2DS2-VASc score can be used as a predictor of CIN in patients with STEMI undergoing PPCI. Objectives To evaluate the role of the CHA2DS2-VASc score in predicting CIN in patients with STEMI who underwent PPCI. Methods In this retrospective cohort study, data were collected from the medical records of patients with STEMI who underwent PPCI at the department of cardiovascular medicine of our institution from January 1, 2019, to October 31, 2021. The association of CIN with the CHA2DS2-VASc and Mehran scores, the and neutrophil–lymphocyte ratio were evaluated using a logistic regression model with a p value < 0.05. Results This study included 66 patients with CIN from a total of 326 patients with STEMI who underwent PPCI. Patients with CIN showed a higher CHA2DS2-VASc score compared with those without CIN (median [interquartile range — IQR], 2 [1–3] vs. 1 [1–2], p < 0.001). The sensitivity, specificity, negative predictive value, and positive predictive value of the CHA2DS2-VASc score in predicting CIN after PPCI were 73.6%, 92.3%, 87.9%, and 82.1%, respectively. Conclusion A CHA2DS2-VASc score ≥ 2.5 is as accurate as a Mehran score ≥6.5 in predicting CIN following PPCI, suggesting that the CHA2DS2-VASc score is a practical and efficient tool for clinical use.

Abstract Cardiovascular diseases (CVDs) are associated with considerable morbidity and mortality across the world. The global financial burden caused by CVD emphasizes the importance of preventive strategies and appropriate management. Chronic coronary syndrome (CCS) is a new term recently introduced for stable coronary artery disease (CAD), which is associated with the highest cause-specific mortality in the Indian population. CCS adversely affects the quality of life (QoL) due to anxiety, fatigue, and prolonged disease course. Risk factor modification, adaptation to lifestyle changes, and pharmacotherapy are the optimal treatment options for CCS. Despite the guidelines proposed by numerous groups and societies, such as the European Society of Cardiology (ESC), the American College of Cardiology/American Heart Association (ACC/AHA), and the Taiwan Society of Cardiology, managing CCS in resource-limited situations remains challenging. Lack of awareness about CCS among patients and healthcare professionals (HCPs), limited resources, accessibility and affordability of lifesaving therapies, poor transport facilities for patients, and asymmetrical distribution are among the challenges identified. In India, the scenario of CCS is no different in rural areas and among urban poor populations due to resource constraints. The current expert opinion review based on 48 experts in the field of cardiology from eastern, western, northern, southern, and pan-India regions highlights the management of CCS in resource-constrained settings with a focus on diagnostic modalities, risk stratification, referral pathways, and medical management. Based on expert opinions and a thorough literature search, an algorithm for the management of patients with CCS in resource-constrained settings in India is also proposed.

Abstract Background Obstructive sleep apnea (OSA) promotes endothelial dysfunction and systemic inflammation, and it is associated with shorter long-term survival and unfavorable clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Objectives To investigate the factors associated with the risk of OSA in the aftermath of STEMI. Methods A cross-sectional, quantitative study conducted with 145 individuals with STEMI in a large Brazilian teaching hospital. Anthropometric measurements were performed in addition to collecting sociodemographic/clinical data and lifestyle habits. The STOP-BANG questionnaire was used to determine the risk of OSA. The results were analyzed using descriptive statistics, association tests, and logistic regression. A significance level of 5% was adopted for the statistical analysis. Results The mean age of the participants was 62 ± 12 years, with a predominance of males (71%), white individuals (57.2%), and those at high risk of OSA (58.6%). Moderate to high risk of OSA was associated with male gender, hypertension, and dyslipidemia. Gender (HR = 6.13, 95% CI [1.88, 20.03], p = 0.003) and hypertension (HR = 4.31, 95% CI [1.27, 14.63], p = 0.019) were factors influencing the risk of OSA after acute myocardial infarction. Conclusions Hypertension and male gender were significant factors for a moderate/high risk of OSA in infarcted patients.

Abstract Introduction Enoxaparin is a known alternative to the use of unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS). However, the evidence about which of these medications would have the best benefit for these patients in 48 hours and 14 days is limited. Objectives Perform a meta-analysis of randomized controlled trials (RCTs) comparing the safety of enoxaparin versus UFH in ACS without ST-segment elevation (NSTE-ACS). Methods PubMed and Scopus databases were searched for RCTs that compared enoxaparin versus UFH in patients with NSTE-ACS. Risk ratios (RRs) for binary endpoints were computed with 95% confidence intervals (CIs). Heterogeneity was examined with I2 statistics. Statistical significance was defined as P-value <0.05. Results Five RCTs with 17,644 patients were included, of whom 8,898 (50.4%) were treated with enoxaparin. There were no significant differences between groups in myocardial infarction (MI) at 48h (RR 0.87; 95% CI 0.75-1.01) and 14 days (RR 0.91; 95% CI 0.79-1.05), all-cause mortality at 48h (RR 1.02; 95% CI 0.62-1.69) and 14 days (RR 0.93; 95% CI 0.74-1.18), composite endpoint of death or MI at 48h (RR 0.87; 95% CI 0.75-1.00) and 14 days (RR 0.91; 95% CI 0.82-1.01), and urgent revascularization at 48h (RR 0.40; 95% CI 0.08-1.95). Conclusion These findings suggest that the use of enoxaparin in the treatment of NSTE-ACS presents similar results to UFH.

Abstract Duchenne muscular dystrophy (DMD) is a muscular disease genetically linked to the DMD gene, which encodes dystrophin, a protein that is crucial for the integrity of skeletal muscle and myocytes. This condition follows an X-linked inheritance pattern. Female carriers are typically asymptomatic; however, they may develop cardiomyopathy, making screening for structural heart disease advisable. We conducted a cross-sectional study to assess the prevalence of subclinical left ventricular (LV) dysfunction, defined by reduced global longitudinal strain (GLS), in asymptomatic female DMD carriers. Participants underwent 2-dimensional speckle tracking echocardiography following a standardized protocol, with GLS values ≤ 18% classified as reduced. Continuous variables were described as mean ± standard deviation and categorical variables as percentages. The association between left ventricular ejection fraction (LVEF) and GLS was assessed using Pearson's correlation coefficient. The significance level adopted was 5%. Using a convenience sample, 17 participants (mean age 39 ± 5 years) were enrolled. No significant changes were observed in LV diameters, and the mean LVEF was 62% ± 5%. Reduced GLS was identified in 3 participants, indicating a prevalence of 17.6% for subclinical LV dysfunction. A weak correlation was found between GLS and LVEF (r = 0.366). Our findings indicate that approximately 1 in 6 female DMD carriers had subclinical LV dysfunction. These results highlight the need for genetic counseling for mothers of patients with DMD, as well as early screening with sensitive methods to detect heart disease in female DMD carriers.

Abstract Background: Hypertension is the main risk factor for cardiovascular mortality worldwide. Lifestyle medicine (LM) assesses health through seven domains (diet, physical activity, substance use, sleep, social support, stress management, and environmental exposure), which also include risk factors for hypertension. Purpose: To evaluate the association between lifestyle and hypertension in Brazil and Spain. Methods: Secondary analysis of data from two web surveys conducted in 2020 in Brazil and Spain, which assessed lifestyle through a multidimensional scale. We enrolled 5224 individuals of both genders, aged > 18 years, living in Brazil and Spain, and with Internet access. The main outcome was a self-reported hypertension diagnosis. We calculated the absolute and relative frequency of the independent variables and evaluated the factors associated with hypertension in logistic regression models. Results: 76.2% of participants were women, 57.9% were > 42 years old, and 66.9% had finished higher education. Over the last 12 months, 19.6% of Brazilians and 9.2% of Spanish reported diagnosis/treatment of hypertension. Male and older groups living in Brazil, with lower education and worse lifestyles, were more likely to report hypertension. General lifestyle score was not associated with hypertension in Brazil, while hypertensive individuals had better scores in Spain (p < 0.001). Hypertensive individuals had worse lifestyle scores in physical activity (p < 0.05) and sleep (p < 0.05) in Brazil and better diet scores in Spain (p < 0.001). Environmental exposure was better among hypertensive individuals in both countries (p < 0.001). Our results point to cultural and socioeconomic differences between both countries. Conclusion: LM is an important strategy for the prevention/treatment of chronic diseases such as hypertension

Abstract Background: The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence. Objective: To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence. Methods: Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student's t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544). Results: Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables. Conclusion: Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

Abstract Background: Elderly patients are more likely to develop cardiovascular events. Tools for risk stratification serve as support to prevent threats of events and assess eligibility for statin use. Objectives: Evaluate the degree of concordance between tools for cardiovascular risk stratification in elderly patients. Methods: Cross-sectional, observational, descriptive, analytical study, with secondary data from 124 medical records of patients treated at a geriatric outpatient clinic in the South of Santa Catarina, Brazil. Variables present in the cardiovascular disease (CVD) risk stratification instrument were analyzed. Subsequently, the tools were compared. Inferential analysis was carried out with a 95% confidence interval and significance level α = 0.05. The Shapiro-Wilk and Kolmogorov-Smirnov tests were applied to determine the normal distribution of quantitative variables. The degree of concordance between CVD risk stratification instruments was calculated using the kappa concordance index. Results: Most patients were classified as high risk. There was a discrepancy regarding SCORE2/SCORE-OP, as it proved to be highly sensitive to the threat of cardiovascular events (99.2% of patients were high risk). These outcomes relate to the fact that the sample was geriatric patients, with age being an independent risk factor. There was a significant p value (p < 0.001) when comparing ACC/AHA tools and the Framingham Score. Conclusion: CVD risk estimate and its comparison in different stratification tools presented an important concordance between AHA tools and the Framingham score. However, when assessing SCORE2/SCORE-OP, lower concordance was observed.

Abstract Recent advancements in artificial intelligence (AI) have significantly enhanced the efficiency and quality of nuclear cardiology imaging. AI algorithms, such as generative adversarial networks (GAN) and deep learning (DL) models, are improving image acquisition by reducing noise and correcting motion to minimize radiation exposure while maintaining diagnostic accuracy. AI has also demonstrated the potential to create synthetic attenuation correction (AC) imaging, accounting for soft-tissue attenuation without added computed tomography (CT) imaging. In patients with CT attenuation imaging, AI can automate the segmentation of coronary artery calcification (CAC), epicardial adipose tissue (EAT), and other structures to maximize the clinical information obtained from these added studies. Furthermore, machine learning (ML) models that combine clinical, imaging, and stress test data are advancing risk prediction for coronary artery disease (CAD) and ischemia, assisting clinicians in decision-making and improving patient outcomes. While many of these applications have been developed using myocardial perfusion imaging (MPI), they are increasingly applied to other nuclear cardiology studies. This review explores these AI applications and their impact on diagnostic accuracy, workflow efficiency, and risk stratification while also highlighting potential future directions and challenges.

Abstract Background Angiotensin-converting enzyme inhibitors (ACEI) are a class of drugs fundamental to hypertension treatment; however, the individual medications within this class vary in their effectiveness at controlling Blood Pressure (BP). Objectives To analyze BP values obtained through casual measurements and home blood pressure monitoring (HBPM) in patients using ACEI as monotherapy or in dual combinations, focusing on BP control and goal achievement in a Brazilian population. Methods A cross-sectional study evaluating adult patients using ACEI between 2017 and 2020 included in the TeleHBPM platform. SBP and diastolic blood pressure (DBP) values were assessed by casual and home measurements. Those using three or more HBPMs were excluded. Paired t-tests, chi-square tests, and ANOVA were used, with a significance level of 5% (p < 0.05). Results 3,466 patients who met the criteria were selected, 54% in a dual drug combination. The mean BP values obtained via casual measurement and HBPM, respectively, were 131.6 ± 18.7 mmHg and 125.5 ± 14.8 mmHg for SBP (p < 0.001), and 83.4 ± 11.3 mmHg and 79.1 ± 9.4 mmHg for DBP (p < 0.001). The combination of ACEI with calcium channel antagonists prevailed (29%). Enalapril had similar BP means to ACEI with longer half-lives. Captopril monotherapy and in combinations had higher SBP and DBP means. Conclusion Enalapril was the most commonly used ACEI, demonstrating a similar BP-lowering effect, both as monotherapy and in combination, when compared to other drugs in the same class with longer half-lives.

Abstract Background The success of acute myocardial infarction with ST-segment elevation (STEMI) treatment is time-dependent, requiring prompt access, diagnosis, and immediate medical intervention. The COVID-19 pandemic has significantly impacted the care of patients with STEMI. Objective To analyze delay times and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) before and during the COVID-19 pandemic. Methods This retrospective observational study included patients with STEMI undergoing PPCI from June 2019 to July 2022. The COVID-19 pandemic period was divided into 3 time groups. Pandemic I referred to the interval from March to August 2020, pandemic II from September 2020 to July 2021, and pandemic III from August 2021 to July 2022. Delay times, clinical characteristics, and in-hospital mortality were analyzed. The chi-square, Fisher’s exact, Student’s t and one-way ANOVA tests were applied, with p values less than 0.05 being considered statistically significant. Results Comparing the periods, the total ischemic time to PPCI was 346.3 versus 448.4 versus 398.4 versus 348.4 minutes (p = 0.47); onset-to-door time 253.1 versus 421.1 versus 377.4 versus 370.6 minutes (p = 0.42); first medical contact (FMC)-to-balloon time 243.9 versus 313.0 versus 239.5 versus 279.4 minutes (p = 0.38); and door-to-balloon time 71.8 versus 76.8 versus 58.03 versus 88 minutes (p = 0.9). Mortality significantly increased in pandemic I compared to pre-pandemic (29.4% versus 5.0%, p = 0.01), with a marginal difference compared to pandemic II and III combined (12.2%, p = 0.05). Conclusion There was a trend toward increased onset-to-door time and FMC-to-balloon time in STEMI care during the pandemic compared to the pre-pandemic period, although not statistically significant. Higher mortality in STEMI was observed in the first months of the COVID-19 pandemic.

Abstract Background Coronary artery disease (CAD) is prevalent worldwide, presenting significant morbidity and mortality. Despite the advances in the management of CAD, the primary focus continues to be risk factor reduction, lifestyle changes, and medication adherence, all of which contribute considerably to favorable outcomes. Long-term CAD outcomes tend to be poor, especially in developing countries, due to medication non-compliance, a lack of education, and appropriate measures for the modification of risk factors. Objectives The present study aims to investigate the use of digital technology in assessing medication compliance, modifying risk factors, and evaluating clinical outcomes in patients with acute coronary syndrome (ACS). Methods A prospective, randomized study will be conducted with patients diagnosed with ACS at the Sri Jayadeva Institute of Cardiovascular Disease and Research, Mysore, and JSS Medical College, Mysore, India. A total of 522 patients will be randomized in a 1:1 ratio into either the digital intervention group or the control group. Digital technology registration will be completed during hospitalization, with guidance from the research team. Follow-up assessments will occur every three months for one year. Statistical analysis will be conducted at a 5% significance level. Categorical variables will be analyzed using the Z test for proportions or the Chi-square test, while continuous variables will be assessed using the independent sample t-test. Results The results will be presented after data collection and statistical analysis. This study aims to focus on clinical outcomes in patients with ACS, highlighting the importance of lifestyle modification, adherence to medications, and modifications of risk factors by digital technology, bridging the gap between patients and healthcare providers. Conclusions We intend for the outcomes of this study to produce an initiative for larger randomized control trials regarding web application in the management of ACS. Favorable outcomes could significantly impact the management of ACS, and web applications can be recommended as part of a routine standard of care established by societal guidelines.