Role of coronary artery calcium score for risk stratification in patients with non significant perfusion defects by myocardial perfusion single photon emission computed tomography

Background: Myocardial perfusion scintigraphy (MPS) is an important diagnostic tool in the management of patients with suspected coronary artery disease (CAD). However, the presence of mild-moderate perfusion defects can be challenging and may lead to unnecessary cardiac catheterization. The coronary artery calcium (CAC) score is a method with excellent negative predictive value in the evaluation of CAD, but its role in this setting of patients has not been fully defined. This study aims to assess the potential of CAC in the prediction of cardiac adverse events in patients with suspected CAD with mild-moderate perfusion by MPS. Methods and results: We conducted a cohort study in 292 patients presenting with mild-moderate perfusion defects by MPS undergoing a CAC measurement. The patients were followed for a mean of 34 months for occurrence of major cardiac adverse events (MACE). The majority of the patients (64.7%) were male, mean age of 57.9 ± 12.6 years. During the follow-up there were 37 MACE. In multivariate Cox proportional hazards model, hypertension and CAC were independent predictors of MACE. The patients who presented a CAC score of ≥ 400 had a high risk of MACE (HR 20.9; 95% CI 4.79–91.42; p < 0.001). Kaplan-Meier curve showed a significant difference (log-rank c2; p< 0.001) using CAC scores in predicting MACE. Conclusions: CAC score carries a powerful prognostic value in predicting adverse events in patients with suspected CAD and MPS with mild-moderate perfusion defects and may be useful in risk stratification of these patients

Left Ventricular Regional Wall Motion Abnormality is a Strong Predictor of Cardiotoxicity in Breast Cancer Patients Undergoing Chemotherapy

Abstract Background: Chemotherapeutic agents of anthracyclines class and humanized monoclonal antibodies are effective treatments for breast cancer, however, they present a potential risk of cardiotoxicity. Several predictors have been recognized as predictors in the development of cardiac toxicity, and the evaluation of left ventricular segmental wall motion abnormalities (LVSWMA) has not been studied. Objective: To analyze prospectively the role of LVSWMA among echocardiographic parameters in the prediction of development of cardiotoxicity in breast cancer patients undergoing treatment with chemotherapy. Methods: Prospective cohort of patients diagnosed with breast cancer and in chemotherapy treatment with potential cardiotoxicity medications including doxorubicin and trastuzumab. Transthoracic echocardiograms including speckle tracking strain echocardiography were performed at standard times before, during and after the treatment to assess the presence (or lack thereof) of cardiotoxicity. Cardiotoxicity was defined by a 10% decrease in the left ventricular ejection fraction, on at least one echocardiogram. Multivariate logistic regression models were used to verify the predictors related to the occurrence of cardiotoxicity over time. Results: Of the 112 patients selected (mean age 51,3 ± 12,9 years), 18 participants (16.1%) had cardiotoxicity. In the multivariate analysis using the logistic regression model, those with LVWMA (OR = 6.25 [CI 95%: 1.03; 37.95], p < 0,05), LV systolic dimension (1.34 [CI 95%: 1.01; 1.79], p < 0,05) and global longitudinal strain by speckle tracking (1.48 [CI 95%: 1.02; 2.12], p < 0,05) were strongly associated with cardiotoxicity. Conclusion: In the present study, we showed that LVWMA, in addition to global longitudinal strains, were strong predictors of cardiotoxicity and could be useful in the risk stratification of these patients

Value of the radiological study of the thorax for diagnosing left ventricular dysfunction in Chagas' disease

OBJECTIVE: To determine the value of the radiological study of the thorax for diagnosing left ventricular dilation and left ventricular systolic dysfunction in patients with Chagas' disease. METHODS: A cross-sectional study of 166 consecutive patients with Chagas' disease and no other associated diseases. The patients underwent cardiac assessment with chest radiography and Doppler echocardiography. Sensitivity, specificity, and positive and negative predictive values of chest radiography were calculated to detect left ventricular dysfunction and the accuracy of the cardiothoracic ratio in the diagnosis of left ventricular dysfunction with the area below the ROC curve. The cardiothoracic ratio was correlated with the left ventricular ejection fraction and the left ventricular diastolic diameter. RESULTS: The abnormal chest radiogram had a sensitivity of 50%, specificity of 80.5%, and positive and negative predictive values of 51.2% and 79.8%, respectively, in the diagnosis of left ventricular dysfunction. The cardiothoracic ratio showed a weak correlation with left ventricular ejection fraction (r=-0.23) and left ventricular diastolic diameter (r=0.30). The area calculated under the ROC curve was 0.734. CONCLUSION: The radiological study of the thorax is not an accurate indicator of left ventricular dysfunction; its use as a screening method to initially approach the patient with Chagas' disease should be reevaluated

Índice cronotrópico-metabólico na doença de Chagas

A insuficiência cronotrópica constitui achado comum entre os pacientes chagásicos. Novas metodologias estão sendo empregadas na avaliação da resposta cronotrópica em vários grupos de pacientes. O índice cronotrópico-metabólico, um desses novos métodos, quantifica a relação entre o aumento da freqüência cardíaca e o consumo máximo de oxigênio (VO2 max) durante o teste ergométrico. A resposta normal é linear, com índice em torno de 1,0. Objetivamos avaliar a resposta cronotrópica e em indivíduos saudáveis e pacientes chagásicos com e sem disfunção ventricular esquerda, utilizando-se do índice cronotrópico-metabólico. Foram avaliados 171 pacientes com doença de Chagas sem doenças associadas e 24 controles submetidos a protocolo clínico e ao teste ergométrico máximo. Os chagásicos foram divididos em dois grupos: Ch1= pacientes com fração de ejeção (FE) > 39% e Ch 2= FE<40%. A análise e o cálculo do índice cronotrópico-metabólico foram feitos pelo método de Wilkoff. Os pacientes chagásicos apresentaram maior idade e maior prevalência de bloqueio completo de ramo direito, assim como menor VO2 max ao teste ergométrico. Ambos os grupos de chagásicos apresentaram menor inclinação do índice cronotrópico-metabólico (Ch1: 0,91±0,10, Ch2: 0,89±0,08) do que os controles (1,0±0,12, p< 0,001). Pacientes com doença de Chagas com e sem disfunção ventricular esquerda podem apresentar resposta cronotrópica deprimida, manifesta por menor inclinação do índice cronotrópico-metabólico

Atividade fí­sica e pressão arterial em crianças obesas

This study aimed to evaluate the chronic effect of an exercise program in resting blood pressure values of school children aged six to nine years old with overweight and obesity in public schools of the city of OuroPreto, Minas Gerais - Brazil, comparing the systolic and diastolic blood pressure of these students before and after an intervention program. Method: This is a randomized clinical study of intervention, quasi-experimental, double-blind, pragmatic, with the study of the individual unit. Seventy-nine children participated in the interventional study and were considered a convenient sample. These subjects were allocated by randomization into two groups: the intervention group (n = 40) and the control group (n = 39) practised physical activity three times a week for 50 minutes and were followed for 4 months. The exercise intensity was determined by open-circuit spirometry. Blood pressure was measured three times consecutively and the average was used. Results: After the intervention, there was no evidence of significant chronic effects of a regular program of exercises on basal levels of blood pressure of obese children between 6 and 9 years old. Conclusion: In this study, there was no evidence of significant effects from a program of regular physical activity on basal levels of blood pressure of obese children between 6 and 9 years old.Objetivo: o presente estudo tem como objetivo avaliar o efeito crônico de um programa de atividade fí­sica nos valores de pressão arterial basal de escolares de seis a nove anos com sobrepeso e obesidade das escolas públicas do municí­pio de Ouro Preto, Minas Gerais. Método: Trata-se de um estudo clí­nico aleatorizado de intervenção, quase-experimental, duplo-cego, pragmático, tendo como unidade de estudo o indiví­duo. Foram alocadas por aleatorização inconsciente em dois grupos: o grupo-intervenção (n=40) submetido í  atividade fí­sica três vezes por semana de 50 minutos de duração e o grupo-controle (n=39) e acompanhados por quatro meses. A intensidade do exercí­cio foi determinada por meio de espirometria de circuito aberto. A pressão arterial foi aferida três vezes, consecutivamente e a media foi utilizada. Setenta e nove crianças participaram do estudo intervencional. Resultado: Após a intervenção, não foram evidenciados efeitos significativos de um programa regular de atividade fí­sica sobre os ní­veis basais da Pressão Arterial de crianças obesas entre 6 e 9 anos. Conclusão: No presente estudo, não foram evidenciados efeitos significativos de um programa regular de atividade fí­sica sobre os ní­veis basais da Pressão Arterial de crianças obesas entre 6 e 9 anos