Signal averaged electrocardiogram in top deficient athletes

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Cardiac involvement in total generalized lipodystrophy (Berardinelli- Seip syndrome)

Total generalized lipodystrophy (Berardinelli--Seip Syndrome) is a rare hereditary disease characterized by insulin-resistant diabetes mellitus and a small quantity of adipose tissue and is of unknown origin. Common cardiovascular alterations related to this syndrome are cardiac hypertrophy and arterial hypertension. This article reports a case of Berardinelli--Seip syndrome and reviews the literature with special emphasis on the cardiovascular manifestations of this syndrome.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Use of transesophageal echocardiography during implantation of aortic endoprosthesis (stent). Initial experience

OBJECTIVE: To report the role played by transesophageal echocardiography during implantation of self-expanding aortic endoprostheses (stent) at a hemodynamics laboratory. METHODS: Thirteen patients underwent stent implantation in the descending thoracic aorta with the aid of transesophageal echocardiography during the entire procedure. Indications for stenting were as follows: 8 aortic dissections, 2 true aneurysms, 2 penetrating atherosclerotic ulcers, and 1 traumatic pseudoaneurysm. RESULTS: No complications resulting from the use of transesophageal echocardiography were observed. In 12 patients, the initial result was considered appropriate, with total or partial resolution of the major lesion confirmed by a posterior examination. In 1 patient, the procedure was suspended after transesophageal echocardiography and angiography showed that the proximal aortic diameter was inappropriate. Transesophageal echocardiography contributed to clarifying relevant points, such as aortic diameter, anatomic detail of the intimal lesion, and location and size of the communicating orifice. In addition, it facilitated placing the stent in the target lesion, reduced the time of exposure to radiation and the use of contrast medium, and provided rapid identification of intercurrent events, possibly reducing the total duration of the procedure. CONCLUSION: The use of transesophageal echocardiography during placement of aortic stents seems appropriate. The actual advantages of the procedure will be defined in a comparative prospective study.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Existe relação entre o número de microêmbolos e a evolução neurológica nas cirurgias de revascularização miocárdica?

Coronary artery bypass surgery (CABG) without cardiopulmonary bypass (CPB) may potentially reduce the number of microembolic signals (MES) associated with aortic manipulation or generated by the pump circuit, resulting in a better neurologic outcome after surgery. Our aim was to compare the frequency of MES and neurologic complications in CABG with and without CPB. Twenty patients eligible to routine CABG without CPB were randomized to surgery with CPB and without CPB and continuously monitored by transcranial Doppler. Neurologic examination was performed in all patients before and after surgery. The two groups were similar with respect to demographics, risk factors, grade of aortic atheromatous disease and number of grafts. The frequency of MES in the nonCPB group was considerably lower than in CPB patients, however, we did not observe any change in the neurologic examination during the early postoperative period. Neurologic complications after CABG may be related to the size and composition of MES rather than to their absolute numbers. A large prospective multicentric randomized trial may help to elucidate this complex issue.A cirurgia de revascularização miocárdica sem circulação extracorpórea (CEC) pode estar relacionada com uma potencial redução no número dos microêmbolos (ME) associados com a manipulação da aorta ou gerados pelo equipamento, com consequente redução do risco de complicações neurológicas nestes pacientes. Nosso objetivo foi comparar a frequência de ME e de complicações neurológicas em pacientes operados sem e com CEC. Vinte pacientes selecionados para revascularização miocárdica eletiva sem CEC foram randomizados para cirurgia com e sem CEC. A monitorização contínua com Doppler transcraniano foi realizada durante todo o procedimento nos dois grupos e os pacientes foram examinados antes e após a cirurgia. Os grupos não apresentaram diferenças significativas em relação aos aspectos demográficos, fatores de risco, grau de ateromatose de aorta e número de pontes realizadas. A frequência de ME no grupo operado sem CEC foi significativamente menor do que no grupo operado com CEC, entretanto, nenhum paciente apresentou alterações no exame neurológico no período pós-operatório inicial. Esta observação pode sugerir que as complicações neurológicas possam estar mais relacionadas com o tamanho e a composição, do que com o número de ME. Somente um estudo prospectivo com maior número de pacientes poderá esclarecer este assunto.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of NeurologyUNIFESP, EPM, Department of NeurologySciEL

Three-dimensional echocardiographic analysis of electromechanical synchrony: comparison with three-dimensional and two-dimensional ejection fraction for evaluation of left ventricular systolic performance

Objective: To compare the three-dimensional echocardiographic analysisof left ventricular (LV) synchrony to LV ejection fraction (LVEF) as measuredby two-dimensional (2D) and three-dimensional (3D) echocardiography(ECHO). Methods: This is a prospective study of 71 patients (41 males,aged 49 ± 11 years), 40 of whom with normal cardiac anatomy (ECHO) andelectrocardiography (ECG) (Group N), and 31 with dilated cardiomyopathy(Group DCM). LVEF, volumes and 16-segment dyssynchrony index % (DI)were measured using 3D-ECHO. LVEF (Simpson’s rule) and volumes weremeasured using 2D-ECHO. Data were compared using Pearson correlationcoefficient (r), 95% CI, linear regression equation and Bland-Altman analysis,p < 0.05. Results: DI% ranged from 0.32 to 21.7% (5.94 ± 6.46), 3D LVEFfrom 0.16 to 0.73 (0.51 ± 0.15); and 2D LVEF from 0.2 to 0.7 (0.47 ± 0.17).The correlation coefficient (r) for DI and 3D LVEF was (r): -0.8203, p <0.0001, CI = -0.8844 to -0.7259, linear regression for DI% (x) and 3D LVEF(y) was y = 63.4515 + (-2.0233) x, p < 0.0001. The correlation coefficient(r) for DI% and 2D LVEF was (r): -0.7046, p < 0.0001, CI = -0.7675 to-0.5824, linear regression for DI% (x) and 2D EF (y) was y = 59.345 +(-3.8721) x, p < 0.0001. Conclusions: Good negative correlation betweenLV synchrony (3D-ECHO) and echocardiographic LVEF (2D and 3D) wasobserved in this series

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data