Cardiology referral during the COVID-19 pandemic

OBJECTIVES: This study presents the cardiology referral model adopted at the University of Sa˜o Paulo-Hospital das Clı´nicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS: In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS: Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with inhospital mortality. CONCLUSIONS: A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease

Usefulness of ECG criteria do detect left ventricular hypertrophy in patients with advanced age

Introdução: Embora o eletrocardiograma (ECG) seja utilizado rotineiramente para detecção da hipertrofia ventricular esquerda (HVE), os critérios utilizados apresentam baixa sensibilidade. Poucos estudos que embasam a prática clínica incluíram pacientes idosos e a performance diagnóstica do ECG nesta população é incerta. Recentemente proposto, o critério de Peguero-Lo Presti (PLP) apresentou uma maior acurácia que critérios tradicionais do ECG, mas não incluiu uma amostra representativa de idosos. Ademais, poucos estudos avaliaram a performance diagnóstica do ECG em pacientes com bloqueio de ramo esquerdo (BRE). Objetivo: i) comparar a performance do critério de PLP com critérios tradicionais do ECG em pacientes idosos; ii) avaliar a capacidade do ECG para detectar HVE em pacientes com BRE; iii) analisar a utilidade clínica do ECG em ambos os cenários (com BRE e sem BRE). Métodos: Entre janeiro de 2017 e março de 2018, 4.621 pacientes foram avaliados, com inclusão de 660 pacientes (592 na análise sem BRE e 68 com BRE) com ECG e ecocardiograma realizado com intervalo menor que 180 dias. Duas análises totalmente separadas foram realizadas de acordo com a presença ou não de BRE (definido pelo critério de Strauss). Para pacientes sem BRE, a performance diagnóstica, através da avaliação de sensibilidade, especificidade, escore F1 e área sob a curva (AUC) do critério de PLP foi comparada a dos critérios de Cornell voltagem (CV), Sokolow-Lyon (SL) e Rohmilt-Estes (com cortes de 4 e 5 pontos, RE4 e RE5, respectivamente). Em pacientes com BRE, sensibilidade, especificidade, valores preditivos, razões de verossimilhança, AUC e escore Brier de dez critérios do ECG foram analisados para avaliar o desempenho no diagnóstico da HVE. Nos dois cenários (com e sem BRE), HVE foi definida pelo ecocardiograma transtorácico e uma análise de curva de decisão foi feita para avaliar a utilidade clínica do ECG. Resultados: Em pacientes sem BRE, o critério de PLP obteve a maior sensibilidade comparado ao SL, CV (p < 0,001) e RE5 (p = 0,042), nominalmente a maior AUC (0,70 [IC 95% 0,65-0,74) dos critérios analisados e a maior acurácia diagnóstica avaliada pelo escore F1 (58,3%). Os critérios de SL e CV apresentaram maior especificidade que PLP (0,93 [IC 95% 0,89-0,95] e 0,90 [IC 95% 0,86-0,93], versus 0,82 [IC 95% 0,78-0,86], respectivamente; p < 0,05 para ambas as comparações). Em pacientes com BRE, nenhum dos dez critérios obteve desempenho diagnóstico satisfatório evidenciado pelo desequilíbrio entre sensibilidade e especificidade, e com baixo poder de discriminação (AUC entre 0,54 e 0,67). A análise da curva de decisão evidenciou que para os limiares de probabilidade testados, houve benefício líquido do ECG somente na população sem BRE, e o critério de PLP apresentou o maior benefício líquido. Conclusão: O critério de PLP obteve a maior acurácia diagnóstica e capacidade de informar a decisão de solicitar ou não exame complementar para avaliação de HVE, em pacientes idosos e sem BRE. Na subpopulação com BRE, nenhum dos critérios eletrocardiográficos tem capacidade discriminatória suficiente para recomendar seu uso para diagnóstico da HVE nem utilidade clínicaBackground: Electrocardiography (ECG) criteria has low sensitivity for left ventricular hypertrophy (LVH) detection and data in patients with advanced age patients is limited. The recently published Peguero-Lo Presti (PLP) criteria had improved accuracy compared with other ECG criteria but with very few patients 70 years. Also, overall performance of ECG criteria in patients with left bundle branch block (LBBB) is also unknown. Methods: Retrospective single-center study including patients 70 years with ECG and echocardiogram less than 180 days apart from January 2017 to March 2018. From 4,621 screened patients, 660 were included, 592 without and 68 with LBBB, yielding two entirely separate analysis. LBBB was defined according to Strauss criteria. For patients without LBBB, the Peguero-Lo Presti (PLP) criteria was compared against Cornell voltage (CV), Sokolow-Lyon voltage (SL) and Romhilt-Estes criteria (cutoffs of 4 and 5 points, RE4 and RE5, respectively), with sensitivities and specificities compared by the Mc Nemars test, and diagnostic performance by the F1 score and diagnostic area under the receiver operating characteristic curve (AUC). For patients with LBBB defined by the stricter criteria proposed by Strauss - sensitivity, specificity, predictive values, likelihood ratios, AUC, and the Brier score were used to evaluate diagnostic performance of the ECG. For both analyses, LVH defined by the echocardiogram was the gold standard and a decision curve analysis was performed to evaluate the clinical benefit of the ECG to inform decision-making. Objective: i) to compare the PLP diagnostic performance to more traditional ECG criteria in patients 70 years; ii) to analyse the overall performance of ECG criteria to diagnose LVH in patients with LBBB; and iii) to evaluate the clinical applicability of ECG criteria for LVH detection in patients with and without LBBB. Results: In patients without LBBB, the PLP had increased sensitivity compared with both the SL, CV (p < 0.001 for both comparisons) and RE5 (p=0.042), also AUC of the PLP was higher than the CV, RE and SL (respectively, 0.70 [95%CI 0.65-0.74] vs 0.66 [95%CI 0.62-0.71] vs 0.64 [95%CI 0.60-0.69 vs 0.67 [95%CI: 0.62-0.71]). SL and CV had higher specificity compared to the PLP (respectively, 0.93 [95%CI 0.89-0.95] vs 0.90 [95%CI 0.86-0.93] vs 0.82 [95%CI 0.78-0.86], all p < 0.05). Overall, the PLP criteria had the highest F1 accuracy score (58.3). In patients with LBBB, none of the tested ECG criteria provided an accurate discrimination of LVH (AUC range, 0.54 to 0.67) nor had a balanced tradeoff between sensitivity and specificity, indicating poor overall performance. In the decision curve analysis, for most probability threshold range, ECG criteria had net benefit only in patients without LBBB, with the PLP achieving the highest net benefit in this scenario. Conclusions: In older individuals without LBBB, the Peguero-Lo Presti criteria had the highest diagnostic accuracy, can potentially be used to inform the clinical decision to ordering for echocardiogram ordering, but cannot rule out LVH consistently due to low sensitivity. in patients with LBBB defined by stricter criteria, ECG-based criteria for LVH diagnosis lack diagnostic accuracy or clinical utilit

Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019

sem informação113344966

Seminário de Dissertação (2024)

Página da disciplina de Seminário de Dissertação (MPPP, UFPE, 2022) Lista de participantes == https://docs.google.com/spreadsheets/d/1mrULe1y04yPxHUBaF50jhaM1OY8QYJ3zva4N4yvm198/edit#gid=

Núcleos de Ensino da Unesp: artigos 2007

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq