In comparison to the myocardial perfusion scintigraphy, a treadmill stress test is a viable, efficient and cost effective option to predict cardiovascular events in elderly patients

OBJETIVO: Definir o valor prognóstico e a custo-efetividade do teste ergométrico (TE) em comparação à cintilografia de perfusão miocárdica com dipiridamol (DIP) em indivíduos com > 75 anos de idade. MÉTODOS: Foram avaliados, consecutiva e prospectivamente, 66 pacientes (40% homens), com média de idade de 81 ± 5 anos. Desses pacientes, 57% eram hipertensos, 38% eram dislipidêmicos e 28%, diabéticos. O protocolo de Bruce para rampa foi adaptado, obtendo-se o valor prognóstico do TE pelo escore de Duke. RESULTADOS: A duração do TE, o porcentual da freqüência cardíaca máxima preconizada e o duplo produto no pico do exercício foram, respectivamente, de 7 ± 3 minutos, 95 ± 9% e 24.946 ± 4.576 (bpm x mmHg). O TE e a DIP apresentaram resultados positivos para isquemia miocárdica similares (21% vs 15%, respectivamente). A concordância entre os testes foi de 88% (Kappa 0,63, p 75 years of age. METHODS: Consecutive and prospective assessment of 66 patients (40% male) aged 81 ± 5 years of which 57% were hypertensive, 38% had dyslipidemia and 28% were diabetics. The Bruce protocol was adapted for a tilt treadmill and the TST prognostic value was obtained using the Duke treadmill score. RESULTS: The TST duration, recommended maximum heart rate percentage and double product at peak exercise were respectively: 7 ± 3 minutes, 95 ± 9% and 24,946 ± 4,576 (bpm x mmHg). The TST and DIP presented similar positive results for myocardial ischemia (21% vs 15%, respectively). The correlation between the tests was 88% (Kappa 0.63, p<0.01). During 685 ± 120 days of follow-up, nine major events occurred: 6 deaths, 2 acute coronary syndromes and 1 myocardial revascularization. The variables associated with the major events were: age (83 ± 6 vs 80 ± 4 years; p=0.048), male gender (78% vs 33%; p=0.02), ST segment depression (1 ± 1 mm vs 0.25 ± 0.6 mm; p= 0.01), high or intermediate risk determined by the Duke treadmill score - combined in one group (44% vs 2%; p=0.001) and abnormal DIP (44% vs 10%, p= 0.02). CONCLUSION: For this elderly population, the TST was an efficient and viable option with a similar diagnostic value in comparison to the DIP. However, the TST was more accurate in the prediction of major events and offers a lower cost

Idade e distúrbios psicológicos: variáveis associadas à disfunção sexual no período pós-infarto Age and psychologic disorders: variables associated to post-infarction sexual dysfunction

OBJETIVO: As informações sobre a disfunção sexual (DS) após o infarto do miocárdio (IM) são esparsas, principalmente em nosso meio e em relação aos seus preditores. Avaliamos pacientes de ambos os sexos, com vida sexual ativa e sem disfunção sexual prévia ao IM, para estudar a incidência de DS após o IM, e identificar as possíveis variáveis associadas às mesmas. MÉTODOS: Estudamos consecutivamente 43 pacientes, utilizando questionários estruturados para diagnóstico das DS e dos distúrbios psicológicos (DP). Analisamos a influência dos fatores de risco clássicos para aterosclerose, dos DP e do uso de medicamentos na ocorrência de DS até o sexto mês após o IM. RESULTADOS: Após o IM, 91% dos pacientes reiniciaram a atividade sexual. Vinte e seis pacientes (60%) apresentaram disfunção sexual até o 6º mês da alta hospitalar (9 com ejaculação precoce, 15 com disfunção erétil e 20 com desejo sexual hipoativo). Os pacientes com DP apresentaram disfunção sexual em maior freqüência que aqueles sem DP (100%x47%, p=0,001). O grupo com disfunção sexual era significativamente mais velho que o grupo sem disfunção sexual: 53&plusmn;8,9 anos versus 47&plusmn;8,7 anos (p=0,04). CONCLUSÃO: Os pacientes apresentaram significativa redução da freqüência da atividade sexual e elevada incidência de DS após o infarto agudo do miocárdio. A presença de DP e a idade mais elevada estiveram associadas à maior incidência de DS após o infarto.<br>OBJECTIVE: Data on sexual disfunction (SD) after myocardial infarction (MI) are sketchy, especially in our community and in regard to predictors. Both males and females, with active sexual life and no sexual dysfunction prior to MI were evaluated in order to investigate SD incidence after MI, as well as to identify the possible variables associated. METHODS: Forty-three patients were studied consecutively, through structured questionnaires for SD and psychological disorders (PD) diagnosis. The interference of classic risk factors was analysed for atherosclerosis, for PD and for the use of medications when SD was present up to month 6 after MI. RESULTS: After MI, 91% of patients resumed sexual activity. Twenty-six patients (60%) reported sexual dysfunction up to month 6 from hospital discharge (9 with precocious ejaculation (PE), 15 with erectile dysfunction (ED), and 20 with hypoactive sexual desire disorder (HSDD). PD patients reported sexual dysfunction at higher frequency as compared to those who did not report PD (100%x47%, p=0.001). The sexual dysfunction group was significantly older than the group not reporting sexual dysfunction: 53&plusmn;8.9 years of age versus 47&plusmn;8.7 years of age (p=0.04). CONCLUSION: Patients reported significant reduction of sexual activity frequency and high incidence of SD after acute myocardial infarction (AMI). PD and older age were shown to be associated to higher incidence of post-infarction SD

A baixa taxa de obtenção da meta do LDL-colesterol numa população de baixa renda Low rate of achieving LDL-cholesterol objective in a low income population

OBJETIVO: Avaliar o percentual de pacientes adequados às metas preconizadas pelas III Diretrizes sobre Dislipidemias da Sociedade Brasileira de Cardiologia, numa população de baixa renda. Determinar se havia diferença deste percentual, nos pacientes de alto risco, conforme a idade (75 anos). MÉTODOS: Analisamos consecutivamente 190 pacientes, divididos em dois grupos: 51 pacientes de baixo e médio risco (G I) e 139 de alto risco para doença arterial coronariana (G II). A amostra era caracterizada por pacientes de baixa renda (69% dos pacientes tinham uma renda familiar entre 1 e 2 salários mínimos), cuja terapêutica hipolipemiante era fornecida irregularmente pelo Estado. RESULTADOS: Os G I e G II apresentavam, respectivamente, 70,1&plusmn;13,7 anos e 13,7% de homens e 68,5&plusmn;10,6 anos e 62,6% de homens. Dentre os pacientes do G II, 30% apresentavam o LDL-colesterol dentro das metas preconizadas. Sendo que, a freqüência de pacientes adequados às metas foi, significativamente, menor em indivíduos com 75 anos ou mais que aqueles com menos de 75 anos (16% vs. 30%, p=0,04). CONCLUSÃO: Numa população, predominantemente, de baixa renda e sem assistência contínua do Estado para adquirir estatinas, a obtenção das metas preconizadas para o LDL- colesterol, pelas III Diretrizes sobre Dislipidemias da Sociedade Brasileira de Cardiologia, é baixa e ainda, significativamente, menor em pacientes muito idosos, com perfil de alto risco para aterosclerose.OBJECTIVE: To assess the percentage of patients suitable to the objectives preconized by III Diretrizes sobre Dislipidemias da Sociedade Brasileira de Cardiologia (3rd Guidelines on Dyslipidemia of Brazilian Society of Cardiology), in a low income population. To determine whether there was a difference of that percentage in high risk patients, according to their age (75 years old). METHODS: We analyzed, consecutively, 190 patients, divided in two groups: 51 low and middle risk patients (G I) and 139 high risk patients for coronaray artery disease (G II). The sample was characterized by low income patients (69% for the patients had a family income between 1 and 2 minimum salaries), whose hypolipidemic therapy was irregularly supplied by the State. RESULTS: G I and G II showed, respectively, 70.1&plusmn;13.7 years old and 13.7% of men and 68.5&plusmn;10.6 years old and 62.6% of men. Among patients from G II, 30% showed LDL-cholesterol within the preconized objectives. The frequency of patients suitable to the objectives was significantly lower in individuals with 75 years of age or older than among those younger than 75 years old (16% vs. 30%, p=0.04). CONCLUSION: In a predominantly low income population and without continuous assistance from the State to purchase statins, the achievement of preconized objectives for LDL-cholesterol, by 3rd Guidelines on Dyslipidemia of Brasilian Society of Cardiology, is low and also significantly lower among very old patients, with a high risk profile for atherosclerosis