TRANSTORNOS RESPIRATÓRIOS DO SONO E CARDIOPATIA

Acumularam-se evidências da associação entre transtornos respiratórios do sono (TRS), mais especificamente a síndrome das apnéias-hipopnéias obstrutivas do sono (SAHOS), e cardiopatias. Entretanto, a multiplicidade de pontos ainda por esclarecer torna este tópico atraente como área de pesquisa. Neste artigo, revisam-se os principais TRS e seu papel na hipertensão arterial sistêmica e pulmonar, nas arritmias, na cardiopatia isquêmica e na insuficiência cardíacacongestiva. Descrevem-se, também, as linhas de pesquisa sobre TRS em andamento no Serviço de Cardiologia do Hospital de Clínicas de Porto Alegre (HCPA). O consenso das instituições internacionais que analisam a evidência existente é de que os TRS devem ser insistentemente investigados em pacientes com cardiopatia, principalmente nos casos com roncar no sono, relato de apnéias e sonolência excessiva diurna. O diagnóstico de TRS, em larga escala, entre pacientes com cardiopatias, provavelmente evoluirá para métodosportáteis, facilmente utilizáveis. No presente, não existiriam recursos instalados para realizar polissonografia em todos os casos de enfermidades cardíacas com suspeita de TRS. A eficácia do tratamento da SAHOS como abordagem preventiva e terapêutica nas cardiopatias permanece como importante dúvida.Unitermos: Síndrome das apnéias obstrutivas do sono, hipertensão arterial sistêmica, hipertensão arterial pulmonar, insuficiência cardíaca congestiva, arritmia

Effect of diuretics and sodium-restricted diet on sleep apnea severity : study protocol for a randomized controlled trial

Background: Obstructive sleep apnea occurs as a result of increased collapsibility of the upper airway. Overnight fluid displacement from the legs to the neck causes pharyngeal narrowing and increased apnea severity. Sodium intake is associated with apnea severity. We hypothesized that interventions that decrease bodily fluid content might reduce the severity of sleep apnea. Methods/design: This is a randomized clinical trial including men with an apnea-hypopnea index greater than 30 events/hour, previously diagnosed by full-night in-laboratory polysomnography. A total of 54 men will be included and randomly assigned to three groups: Diuretic (n = 18), sodium-restricted diet (n = 18), and control (n = 18). The intervention will last one week. Intention-to-treat and per-protocol analyses will be performed. The diuretic group will receive combined spironolactone 100 mg plus furosemide 20 mg daily, taken in the morning. The diet group will receive a regimen with a maximum intake of 3 g of sodium per day. The control group will receive a placebo pill and will maintain all eating habits while keeping a recall diary of their dietary behavior. The primary outcome measure will be change in apnea-hypopnea index. The secondary outcome measures will be variations of: anthropometric and bioelectrical impedance variables, office blood pressure, respiratory variables from in-home level III polysomnography, excessive daytime sleepiness, glycolipid profile, C-reactive protein, 24 h urinary variables, and adverse events. Discussion: Despite the high efficacy of continuous positive airway pressure to reverse upper airway obstruction in sleep apnea, partial adherence to this form of treatment reduces its efficiency. Thus, additional forms of treating apnea need to be investigated. If the results of this proof-of-concept trial show that decreases in bodily fluid content, either by diuretic or dietary intervention, reduces the severity of sleep apnea, further investigation will be necessary before these results can be translated and adopted as an adjunct apnea therapy

The effects of a flavonoid-rich diet on oxidative stress, inflammation, and lipid profile after elective percutaneous coronary intervention : a randomized clinical trial

Antioxidant-rich foods may decrease oxidative stress and have a direct impact on atherosclerosis by reducing low-density lipoprotein (LDL) oxidation. Our aim was to assess the impact of a flavonoid-rich diet on oxidative stress, inflammatory response, and lipid profile in patients with coronary artery disease submitted to elective percutaneous coronary intervention (PCI). Thirty-three patients submitted to elective PCI were randomly allocated to follow either a flavonoid rich antioxidant (AOX) diet or a control diet based on National Cholesterol Education Program Adult Treatment Panel III recommendations. Patients were followed for 6 months. Dietary intake was recorded at the start and at the end of the follow-up period, as were oxidative stress markers (ferric reducing ability of plasma and protein sulphydryl) and Creactive protein (CRP). Patients randomized to follow the AOX diet had a reduction in energy, carbohydrate, and lipid intake, as well as increased flavonoid intake. Compared to the control group, there were no changes in oxidative stress markers or CRP in the patients following the AOX diet, but these patients had a significant decrease in LDL cholesterol levels. In conclusion, the findings of this study suggest that a flavonoid-based antioxidant-rich diet is not associated with reductions in oxidative stress or inflammatory markers 6 months after percutaneous coronary intervention. Nonetheless, patients in the intervention group experienced significant reductions in LDL cholesterol, which may indicate cardiovascular benefits of AOX diets despite of inflammation and oxidative stress markers

Serum ferritin levels may have a pro-atherosclerotic role in coronary artery disease patients with sleep disordered breathing

Elevated ferritin levels may lead to oxidative stress, and are associated with coronary artery disease (CAD). Sleep disordered breathing (SDB) is frequently present in atherosclerosis patients, and causes endothelial dysfunction leading to atherosclerotic plaque progression. Hypoxic conditions, such as SDB, may upregulate ferritin. The aim of this study was to evaluate ferritin levels in CAD patients and to correlate ferritin levels with parameters related to CAD progression, including SDB. We studied 27 patients with CAD (defined as >30% coronary narrowing) and 29 controls. We found that ferritin was increased in CAD patients, and was positively correlated with the apnea–hypopnea index (AHI), age, Creactive protein (CRP), transferrin, hemoglobin, and testosterone levels, and was negatively correlated with O2 saturation. Nitrites and nitrates, an indirect measure of nitric oxide ( NO) concentration, were lower in CAD patients, and were negatively correlated with ferritin. The increase in ferritin may be related to oxidative stress, suggesting a possible pro-atherosclerotic role of increased ferritin in CAD patients with SDB

Incidência de eventos adversos em uma coorte de hipertensos

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An overview of care changes in the last 6 year in primary pci in st-elevation myocardial infarction in a tertiary university Brazilian hospital

Background: Although new studies and guidelines can be considered useful tools, it does not necessarily mean they are put into clinical practice. Objective: The aim of the current analysis was to assess the changes in primary percutaneous coronary intervention (PCI) and mortality in a tertiary university hospital in southern Brazil during a six-year period. Methods: We have included consecutive patients with ST-elevation myocardial infarction (STEMI) who underwent primary PCI between March 2011 and February 2017. Previous clinical history, characteristics of the procedure, and reperfusion strategies were collected. In-hospital, short and long-term mortalities were also evaluated. The significance level adopted for all tests was 5%. Results: There was an increase in the use of radial access in patients from 20.0% in 2011 to 62.7% in 2016 (ptrend 0.05). However, a lower in-hospital mortality was observed in patients treated through radial access (p < 0.001). Cardiogenic shock occurred in 11.1%, without statistical differences in the period (ptrend = 0.39), while long-term mortality rate decreased from 80.0% in 2011 to 27.3% in 2016 in this patient group (ptrend = 0.29). Conclusions: During a 6-year follow-up period, primary PCI characteristics underwent important modifications. Radial access became widely used, with a decrease in mortality with the use of this route, while aspiration thrombectomy became a rare procedure. The incidence of cardiogenic shock remained stable, but has shown a reduction in its mortality

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

Objective As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation. Methods Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected. Results Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series. Conclusions Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications