O uso de computadores entre os estudantes do curso de graduação em medicina da Universidade Federal de Santa Catarina,1999.

Trabalho de Conclusão de Curso - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Departamento de Clínica Médica, Curso de Medicina, Florianópolis, 199

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Assessment of known or suspected coronary arterial disease using myocardial perfusion scintigraphy combined to multidetector computed tomography

Introdução: A presença de cálcio nas artérias coronárias identifica a existência de aterosclerose coronariana, mesmo em fases precoces. Por outro lado, a decisão quanto à melhor forma de tratamento dessa entidade baseia-se no uso de exames funcionais, em especial, a cintilografia de perfusão do miocárdio (CPM). Existem dúvidas quanto à correlação desses dois exames, o que poderia ser, ao menos em parte, explicada pelo fato dos testes avaliarem fases distintas dessa entidade. Este estudo pretende avaliar o uso de uma abordagem anatômica e funcional combinada por meio da (CPM) e tomografia computadorizada coronária com multidetectores (TCMD) na determinação do escore de cálcio (CACS) e da presença de estenoses e isquemia e examinar a associação de seus resultados entre si e com outras variáveis demográficas, clínicas e funcionais em uma população brasileira com doença arterial coronária (DAC) suspeita ou conhecida. Métodos: foram analisados, retrospectivamente, 413 pacientes que se submeteram à CPM e TCMD por indicação clínica do médico assistente, durante o ano de 2009, com intervalo menor de 90 dias, entre os dois estudos. CACS foi definido automaticamente pelo software dedicado e o escore de Agatston foi calculado de forma semiquatitativa. Na CPM e na TCMD, os resultados foram obtidos por quantificação visual semiobjetiva. A correlação dos resultados dos exames foi analisada e foram obtidos dados da evolução tardia, baseados no contato com o médico assistente ou pela análise dos registros hospitalares. Procurou-se definir os preditores da ocorrência de eventos cardiovasculares adversos na evolução. Resultados: Foram selecionados 303 pacientes (73,3% homens, média de idade de 55,8 ± 10,6 anos, intervalo: 32-86 anos). Destes, 73,3% apresentaram estudos de perfusão normal, 71,6% tinham cálcio coronário e 45,2% tinha perfusão normal e TCDM com cálcio. No grupo sem suspeita de DAC (177), houve associação entre os resultados de TCMD e SPECT com: diabetes (DM) (p=0,045), hipertensão (HAS) (p=0,032), dislipidemia (p=0,030) testes funcionais, resultado do teste (p=0,022), percentil escore de cálcio (p 400 e percentil igual ou superior a 75% foram associados com SPECT anormal e cálcio na MDCT. A MDTC combinada ao SPECT foi capaz de detectar isquemia em pacientes com estenose coronariana conhecida, mas não havia associações entre o grau de estenose ou a presença, ou ausência de isquemia e sua extensão, com os resultados combinados. Houve uma baixa taxa de eventos no subgrupo de acompanhamento.Background: The calcium in coronary arteries identifies the presence of coronary atherosclerosis, even in early stages. On the other hand, the decision about the best form of treatment this entity is based on the use of functional tests, in particular the myocardial perfusion scintigraphy (SPECT). There are doubts about the correlation between the results of these two exams, what could be, at least in part explained by the fact of these tests assess distinct phases of this entity. This study aims to evaluate the use of a combined functional and anatomical approach through SPECT and coronary computed tomography with multi-detectors (MDCT) in determining the calcium score (CACS),presence of stenosis or ischemia and examine the combined results with other demographic, clinical and functional variables, in a Brazilian population with suspected or known coronary artery disease (CAD). Methods: we retrospectively analyzed 413 patients who underwent to SPECT and MDCT by their physician indications during the year 2009, with less than 90 days interval between the two studies. CACS was automatically defined by dedicated software and the Agatston score was semi-automatically calculated. SPECT and MDCT results were evaluated by semi-objective visual quantification. The correlations of both tests results were analyzed and follow-up data were obtained through contact with assistant physician or analysis of hospital records. Results: We included 303 patients with suspect or known DAC who underwent to both, SPECT and MDCT (75.9 % men, mean age 55.8 ± 10.6 years; range:32-86 years); it was observed that 73,3% had normal perfusion studies, CAC was present 71,6% patients and 48.2% had normal perfusion and MDCT with calcium. In 177 patients without DAC there were association between MDCT and SPECT results and following variables: diabetes (DM) (p=0.045), hypertension (HAS) (p=0.032), dyslipidemia (p=0.030), functional test results (p=0.022), percentile of calcium score (p400 and percentile equal or above 75% were associate with abnormal SPECT and calcium on MDCT. MDCT combined to SPECT was able to detect ischemia in patients with known coronary stenosis, but there were no associations between the degree of stenosis, or the presence or absence of ischemia and its extent with the combined results. There was a low event rate in the follow-up subgroup

Comparative trial of the use of antiplatelet and oral anticoagulant in thrombosis prophylaxis in patients undergoing total cavopulmonary operation with extracardiac conduit: echocardiographic, tomographic, scintigraphic, clinical and laboratory analysis

Objetivo: Comparar a eficácia do AAS e da Varfarina na profilaxia da trombose em pacientes submetidos a operação cavopulmonar total. Avaliar se fatores de coagulação (VII, VIII e Proteína C), dados clínicos, fenestração ou fatores hemodinâmicos, interferem na trombose no pós-operatório. Métodos: Estudo prospectivo e randomizado de 30 pacientes, randomizados em Grupo I (Varfarina) e Grupo II (AAS), submetidos à derivação cavopulmonar total com tubo extracardíaco, entre 2008 e 2011, com seguimento de dois anos. Foram realizadas consultas clínicas que avaliavam efeitos colaterais e aderência. Realizado ecocardiograma transesofágico no pós-operatório imediato, 3, 6,12 e 24 meses; angiotomografia aos 6, 12 e 24 meses de pós-operatório para avaliação de alterações na parede interna do tubo ou trombos e cintilografia pulmonar, para avaliar possível TEP. Resultados: Dois óbitos no grupo I; 33,3% dos pacientes apresentaram trombo (46,7% no Grupo II). A ocorrência prévia de trombo e baixos níveis de proteína C da coagulação foram os únicos fatores que influenciaram no tempo livre de trombo (P=0,035 e 0,047). Avaliação angiotomográfica: 35,7% dos pacientes do grupo II tinham atapeteamento maior que 2 mm (P=0,082). Cintilografia: dois pacientes apresentaram TEP no grupo II. Cinco pacientes tiveram dificuldade de aderência, 4 no grupo I com INR variando de 1 a 6,4. Conclusão: A ocorrência prévia de trombo é um fator de risco para trombose no pós-operatório. Pacientes em uso de AAS tendem a depósito de material na parede do tubo. O número reduzido da amostra não permitiu concluir qual a droga mais eficaz na prevenção da trombose na população estudada

Sincronia ventricular em portadores de miocardiopatia dilatada e indivíduos normais: avaliação através da ventriculografia radioisotópica Ventricular synchrony in patients with dilated cardiomyopathy and normal individuals: assessment by radionuclide ventriculography

OBJETIVO: Estabelecer parâmetros de sincronia intra- e interventricular em indivíduos normais e compará-los aos de pacientes com miocardiopatia dilatada com e sem distúrbios de condução ao eletrocardiograma (ECG). MÉTODOS: Três grupos de pacientes foram incluídos no estudo: 18 indivíduos (G1) sem cardiopatia e com ECG normal (52+/-12 anos, 29% masculinos); 50 portadores de miocardiopatia dilatada e disfunção ventricular esquerda grave, sendo 20 pacientes (G2) com QRS < 120 ms (51+/-10 anos, 75% masculinos) e 30 pacientes (G3) com QRS > 120 ms (57+/-12 anos, 60% masculinos). Todos foram submetidos à ventriculografia radioisotópica (VR). Para avaliar dissincronia intraventricular esquerda foi estudada a largura do histograma de fase e para avaliar dissincronia interventricular foi medida a diferença da média do ângulo de fase entre o ventrículo direito e o esquerdo (DifDE). RESULTADOS: As frações de ejeção do ventrículo esquerdo (FEVE)s foram: 62±6% (G1), 27±6% (G2) e 22±7% (G3) e do VD foram: 46 ± 4% (G1), 38±9%(G2) e 37±9% (G3). A avaliação da largura do histograma de fase foi de: 89±18 ms (G1), 203±54 ms (G2) e 312±130 ms (G3), p<0,0001. A medida da difVDVE foi de: 14±11 ms (G1), 39±40 ms (G2) e 87±49 ms (G3); quando se compararam G1 x G2 e G1 x G3, p<0,0001 e G2 x G3, p=0,0007. CONCLUSÃO: Os parâmetros analisados discriminam os três grupos de pacientes de acordo com o grau de sincronia ventricular. Pacientes com miocardiopatia dilatada e sem bloqueio de ramo ao ECG (QRS < 120 ms) podem apresentar dissincronia, porém em menor grau que os pacientes com QRS alargado.<br>OBJECTIVE: To establish the parameters of intra- and interventricular synchrony in normal individuals and to compare them with patients with dilated cardiomyopathy with and without conduction disorders shown in the electrocardiogram (ECG) examination. METHODS: Three groups of patients were included in this study: 18 individuals (G1) with no cardiomyopathy and with a normal ECG (52±12 years, 29% male); 50 patients with dilated cardiomyopathy and severe left ventricular dysfunction, with 20 patients (G2) presenting QRS <120ms (51±10 years, 75% male) and 30 patients (G3) with QRS >120ms (57±12 years, 60% male). All patients underwent RV. Evaluation of left intraventricular dyssynchrony was carried out with the measurement of the phase histogram width and interventricular dyssynchrony was evaluated by the difference of the mean phase angle between the right and left ventricles (RLDif). RESULTS: Left ventricle ejection fractions (LVEF)s were: 62 ± 6% (G1), 27 ± 7% (G2) and 22 ± 8% (G3) and right ventricle ejection fractions were: 46 ± 5% (G1), 41 ± 6%(G2) and 38 ± 8% (G3). Evaluation of the phase histogram width was: 89 ± 18 ms (G1), 203 ± 54 ms (G2) and 312 ± 130 ms (G3), p<0.0001. The measurement of RLDif was: 14 ± 11 ms (G1), 39 ± 40 ms (G2) and 87 ± 49 ms (G3); comparing G1 vs. G2 and G1 vs. G3, p<0.0001 and G2 vs. G3, p=0.0007. CONCLUSION: The parameters analyzed discriminate the three groups of patients according to the ventricular synchrony degree. Patients with dilated cardiomyopathy and withno branch block in ECG (QRS <120 ms) may present dyssynchrony, but at a lower degree than patients with widened QRS

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology