The prognostic utility of the Hata angiographic classification for long-term outcomes in Takayasu arteritis (TAK) remains unclear. To evaluate the prognostic value of the Hata classification for predicting major adverse cardiovascular events (MACE) and the need for vascular interventions in patients with TAK. This single-center, retrospective cohort study included patients diagnosed with TAK between 2000 and 2025. Multivariate logistic regression analyses were performed to identify independent predictors, with statistical significance defined as p < 0.05. Of 203 patients initially identified, 18 were excluded. The final cohort included 185 patients, of whom 80.0% were women, with a median age at diagnosis of 29 years. Type V was the predominant angiographic pattern (64.9%). During a median follow-up of 10.8 years, MACE occurred in 35.7% of patients, while 37.3% required vascular intervention. The Hata classification was not associated with MACE occurrence. Independent predictors of MACE included female sex, which was protective (odds ratio [OR], 0.38; 95% CI, 0.17-0.86; p = 0.021), and longer symptom onset-to-diagnosis time, which increased risk (OR, 1.10; 95% CI, 1.03-1.18; p = 0.006). In contrast, the Hata classification independently predicted the need for vascular intervention. Hata Type I showed a strong protective association compared with Type V (OR, 0.10; 95% CI, 0.01-0.53; p = 0.029). Baseline aortic insufficiency was also independently associated with a higher likelihood of intervention (OR, 2.54; 95% CI, 1.18-5.60; p = 0.018) (Central Illustration). The Hata classification appears to be a robust predictor of vascular intervention but not MACE in TAK. Greater anatomical disease extension (Type V) and baseline aortic insufficiency were associated with increased procedural risk, whereas MACE risk was associated with diagnostic delay and male sex. The observed long-term dissociation between high rates of clinical remission (92.4%) and continued disease progression underscores the importance of imaging-based surveillance and highlights the need for prospective multicenter studies to validate these findings. A utilidade prognóstica da classificação angiográfica de Hata para desfechos em longo prazo na arterite de Takayasu (AT) permanece incerta. Avaliar o valor prognóstico da classificação de Hata na predição de eventos cardiovasculares adversos maiores (ECAM) e da necessidade de intervenções vasculares em pacientes com AT. Este estudo de coorte retrospectivo, de centro único, incluiu pacientes diagnosticados com AT entre 2000 e 2025. Análises de regressão logística multivariada foram realizadas para identificar preditores independentes, considerando-se significância estatística quando p < 0,05. Dos 203 pacientes inicialmente identificados, 18 foram excluídos. A coorte final foi composta por 185 pacientes, dos quais 80,0% eram do sexo feminino, com mediana de idade ao diagnóstico de 29 anos. O Tipo V foi o padrão angiográfico predominante (64,9%). Durante um seguimento mediano de 10,8 anos, ECAM ocorreram em 35,7% dos pacientes, enquanto 37,3% necessitaram de intervenção vascular. A classificação de Hata não apresentou associação com a ocorrência de ECAM. Os preditores independentes de ECAM incluíram sexo feminino, associado a efeito protetor (odds ratio [OR], 0,38; intervalo de confiança de 95% [IC 95%], 0,17-0,86; p = 0,021), e maior intervalo entre o início dos sintomas e o diagnóstico, associado a aumento do risco (OR, 1,10; IC 95%, 1,03-1,18; p = 0,006). Em contraste, a classificação de Hata foi preditora independente da necessidade de intervenção vascular. O Tipo I de Hata apresentou forte associação protetora em comparação ao Tipo V (OR, 0,10; IC 95%, 0,01-0,53; p = 0,029). Além disso, insuficiência aórtica basal associou-se independentemente a maior probabilidade de intervenção (OR, 2,54; IC 95%, 1,18-5,60; p = 0,018) (Figura Central). A classificação de Hata demonstrou ser um preditor robusto de necessidade de intervenção vascular, mas não de ECAM, em pacientes com AT. Maior extensão anatômica da doença (Tipo V) e insuficiência aórtica basal associaram-se a maior risco de procedimentos vasculares, enquanto o risco de ECAM esteve relacionado a atraso diagnóstico e sexo masculino. A dissociação observada em longo prazo entre elevadas taxas de remissão clínica (92,4%) e progressão contínua da doença reforça a importância do acompanhamento baseado em métodos de imagem e destaca a necessidade de estudos prospectivos multicêntricos para validação desses achados. The prognostic utility of the Hata angiographic classification for long-term outcomes in Takayasu arteritis (TAK) remains unclear. To evaluate the prognostic value of the Hata classification for predicting major adverse cardiovascular events (MACE) and the need for vascular interventions in patients with TAK. This single-center, retrospective cohort study included patients diagnosed with TAK between 2000 and 2025. Multivariate logistic regression analyses were performed to identify independent predictors, with statistical significance defined as p < 0.05. Of 203 patients initially identified, 18 were excluded. The final cohort included 185 patients, of whom 80.0% were women, with a median age at diagnosis of 29 years. Type V was the predominant angiographic pattern (64.9%). During a median follow-up of 10.8 years, MACE occurred in 35.7% of patients, while 37.3% required vascular intervention. The Hata classification was not associated with MACE occurrence. Independent predictors of MACE included female sex, which was protective (odds ratio [OR], 0.38; 95% CI, 0.17-0.86; p = 0.021), and longer symptom onset-to-diagnosis time, which increased risk (OR, 1.10; 95% CI, 1.03-1.18; p = 0.006). In contrast, the Hata classification independently predicted the need for vascular intervention. Hata Type I showed a strong protective association compared with Type V (OR, 0.10; 95% CI, 0.01-0.53; p = 0.029). Baseline aortic insufficiency was also independently associated with a higher likelihood of intervention (OR, 2.54; 95% CI, 1.18-5.60; p = 0.018) (Central Illustration). The Hata classification appears to be a robust predictor of vascular intervention but not MACE in TAK. Greater anatomical disease extension (Type V) and baseline aortic insufficiency were associated with increased procedural risk, whereas MACE risk was associated with diagnostic delay and male sex. The observed long-term dissociation between high rates of clinical remission (92.4%) and continued disease progression underscores the importance of imaging-based surveillance and highlights the need for prospective multicenter studies to validate these findings.
The spatial distribution of patients according to clinical characteristics, using geoprocessing techniques, enables the identification of disease clusters within a studied population. This approach supports the development of targeted interventions directed toward specific risk groups. To investigate geographical clusters of diseases of interest among patients attending a public tertiary hospital and to characterize their spatial distribution across the metropolitan area of São Paulo. Based on the results of a previous study, two disease groups were defined: one representing the main diseases identified at the first hospital visit and another representing the main underlying causes of death. A detailed description is provided in the online supplementary material. Disease density was calculated by dividing the frequency of cases within each disease group by the population of each city/district and multiplying the result by 100,000 to enhance data visualization. Spatial data were subsequently analyzed and mapped to illustrate the spatial patterns and relationships identified in the study. Osasco and Taboão da Serra showed the highest density of underlying causes of death related to diseases of the circulatory system. Additionally, 12 cities/districts located at the borders of the study area showed no recorded neoplastic diseases. Vargem Grande Paulista showed the highest case density for neoplasms as underlying causes of death and comorbidities. Notably, Embu das Artes, a city recognized for its extensive green areas, showed the highest density of diseases of the respiratory system. A distribuição espacial de pacientes segundo características clínicas, utilizando técnicas de geoprocessamento, permite identificar aglomerados de doenças em uma população estudada. Essa abordagem contribui para o desenvolvimento de intervenções direcionadas a grupos específicos de risco. Investigar aglomerados geográficos de doenças de interesse entre pacientes atendidos em um hospital público terciário e caracterizar sua distribuição espacial na região metropolitana de São Paulo. Com base nos resultados de um estudo prévio, foram definidos dois grupos de doenças: um representando as principais doenças identificadas na primeira consulta hospitalar e outro representando as principais causas básicas de morte. Uma descrição detalhada é apresentada no material suplementar online. A densidade das doenças foi calculada dividindo-se a frequência de casos em cada grupo de doenças pela população de cada cidade/distrito e multiplicando-se o resultado por 100.000 para melhorar a visualização dos dados. Posteriormente, os dados espaciais foram analisados e mapeados para ilustrar os padrões espaciais e as relações identificadas no estudo. Osasco e Taboão da Serra apresentaram a maior densidade de causas básicas de morte relacionadas a doenças do sistema circulatório. Além disso, 12 cidades/distritos localizados nas fronteiras da área de estudo não apresentaram registro de doenças neoplásicas. Vargem Grande Paulista apresentou a maior densidade de casos de neoplasias como causas básicas de morte e comorbidades. Destaca-se que Embu das Artes, município reconhecido por suas extensas áreas verdes, apresentou a maior densidade de doenças do sistema respiratório. The spatial distribution of patients according to clinical characteristics, using geoprocessing techniques, enables the identification of disease clusters within a studied population. This approach supports the development of targeted interventions directed toward specific risk groups. To investigate geographical clusters of diseases of interest among patients attending a public tertiary hospital and to characterize their spatial distribution across the metropolitan area of São Paulo. Based on the results of a previous study, two disease groups were defined: one representing the main diseases identified at the first hospital visit and another representing the main underlying causes of death. A detailed description is provided in the online supplementary material. Disease density was calculated by dividing the frequency of cases within each disease group by the population of each city/district and multiplying the result by 100,000 to enhance data visualization. Spatial data were subsequently analyzed and mapped to illustrate the spatial patterns and relationships identified in the study. Osasco and Taboão da Serra showed the highest density of underlying causes of death related to diseases of the circulatory system. Additionally, 12 cities/districts located at the borders of the study area showed no recorded neoplastic diseases. Vargem Grande Paulista showed the highest case density for neoplasms as underlying causes of death and comorbidities. Notably, Embu das Artes, a city recognized for its extensive green areas, showed the highest density of diseases of the respiratory system.
Most of the current evidence on valvular heart disease (VHD) comes from high-income countries. Access to treatment and the impact of VHD on quality of life may vary substantially across nations, largely due to socioeconomic differences. This study aimed to estimate the burden of VHD and its association with mortality in a middle-income country. We included participants from the ELSA-Brasil cohort who underwent transthoracic echocardiography at baseline (3,267 participants; 1,539 males; mean age 60.6 ± 8.8 years) across six Brazilian states. Participants were categorized into three groups-no VHD, trace/mild VHD, and moderate/severe VHD-and their characteristics and associated factors were analyzed. P-values < 0.05 were considered statistically significant. Among all participants, 2.4% had moderate/severe VHD (including 7 participants with prosthetic valves), and 43.6% had trace/mild VHD. The most prevalent moderate/severe VHD was mitral regurgitation, followed by aortic and tricuspid regurgitation, with 56 participants (86%) presenting isolated valvular regurgitation. Moderate/severe VHD was more common in older individuals and was associated with a higher prevalence of most cardiovascular comorbidities, but with lower obesity rates. It was also associated with greater cardiac remodeling and reduced systolic function, with phenotypic variations depending on the affected valve. Moderate/severe VHD was linked to increased 10-year mortality (HR: 3.7; 95% CI [2.17-6.31]), independent of age, sex, and hypertension. VHD is common among community-dwelling adults in this middle-income country and increases with age. Participants with moderate/severe VHD exhibited a greater burden of comorbidities, more pronounced cardiac remodeling, worse systolic function, and substantially reduced long-term survival. A maior parte das evidências atuais sobre doença valvar cardíaca (DVC) vem de países de alta renda. O acesso ao tratamento e o impacto da DVC na qualidade de vida podem variar substancialmente entre países, principalmente devido a diferenças socioeconômicas. Este estudo teve como objetivo estimar a carga de DVC e sua associação com mortalidade em um país de renda média. Incluímos participantes da coorte ELSA-Brasil que realizaram ecocardiograma transtorácico na linha de base (3.267 participantes; 1.539 homens; idade média de 60,6 ± 8,8 anos) em seis estados brasileiros. Os participantes foram categorizados em três grupos – sem DVC, DVC mínima/leve e DVC moderada/grave – e suas características e fatores associados foram analisados. Valores de p < 0,05 foram considerados estatisticamente significativos. Entre todos os participantes, 2,4% apresentavam DVC moderada/grave (incluindo sete participantes com prótese valvar) e 43,6% apresentavam DVC mínima/leve. A DVC moderada/grave mais prevalente foi a regurgitação mitral, seguida pelas regurgitações aórtica e tricúspide, com 56 participantes (86%) apresentando regurgitação valvar isolada. A DVC moderada/grave foi mais comum em indivíduos mais velhos e esteve associada a maior prevalência da maioria das comorbidades cardiovasculares, porém a menores taxas de obesidade. Também se associou a maior remodelamento cardíaco e pior função sistólica, com variações fenotípicas conforme a valva acometida. A DVC moderada/grave esteve associada a maior mortalidade em 10 anos (HR: 3,7; IC 95% [2,17–6,31]), independentemente de idade, sexo e hipertensão. A DVC é comum entre adultos em uma coorte comunitária de um país de renda média e aumenta com a idade. Participantes com DVC moderada/grave apresentaram maior carga de comorbidades, remodelamento cardíaco mais acentuado, pior função sistólica e redução substancial da sobrevida em longo prazo. Most of the current evidence on valvular heart disease (VHD) comes from high-income countries. Access to treatment and the impact of VHD on quality of life may vary substantially across nations, largely due to socioeconomic differences. This study aimed to estimate the burden of VHD and its association with mortality in a middle-income country. We included participants from the ELSA-Brasil cohort who underwent transthoracic echocardiography at baseline (3,267 participants; 1,539 males; mean age 60.6 ± 8.8 years) across six Brazilian states. Participants were categorized into three groups—no VHD, trace/mild VHD, and moderate/severe VHD—and their characteristics and associated factors were analyzed. P-values < 0.05 were considered statistically significant. Among all participants, 2.4% had moderate/severe VHD (including 7 participants with prosthetic valves), and 43.6% had trace/mild VHD. The most prevalent moderate/severe VHD was mitral regurgitation, followed by aortic and tricuspid regurgitation, with 56 participants (86%) presenting isolated valvular regurgitation. Moderate/severe VHD was more common in older individuals and was associated with a higher prevalence of most cardiovascular comorbidities, but with lower obesity rates. It was also associated with greater cardiac remodeling and reduced systolic function, with phenotypic variations depending on the affected valve. Moderate/severe VHD was linked to increased 10-year mortality (HR: 3.7; 95% CI [2.17–6.31]), independent of age, sex, and hypertension. VHD is common among community-dwelling adults in this middle-income country and increases with age. Participants with moderate/severe VHD exhibited a greater burden of comorbidities, more pronounced cardiac remodeling, worse systolic function, and substantially reduced long-term survival.
Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, underscoring the need for effective risk prediction and early detection. Although the electrocardiogram (ECG) is a widely available and low-cost diagnostic tool, its traditional interpretation is limited by subjectivity. Artificial intelligence (AI) has emerged as a promising approach, capable of extracting hidden prognostic information from ECG signals. This systematic review aimed to assess original studies applying AI techniques to ECGs for cardiovascular risk prediction and mortality. Original studies that used ECG signals as the sole input variable for AI models, focusing on cardiovascular risk outcomes, were included. A systematic search was conducted in different databases, and data were synthesized narratively. Eleven studies were included, predominantly retrospective cohorts applying convolutional neural networks (CNNs) to predict cardiovascular risk or mortality. The sample primarily consisted of adult populations in high-income countries. Primary outcomes included all-cause mortality, cardiovascular death, and major adverse cardiovascular events (MACE). Reported AUROC values ranged from 0.63 to 0.961 in training sets, with some models outperforming traditional risk scores. AI-ECG models demonstrated the potential to detect subclinical disease, enabling early risk stratification even in normal ECGs. However, challenges remain regarding population diversity, model interpretability, and prospective validation. The application of AI to ECG analysis represents a promising advancement in personalized cardiovascular risk assessment. Nonetheless, further research is needed to ensure the safety, effectiveness, and equitable clinical integration of these technologies. As doenças cardiovasculares são a principal causa de mortalidade no mundo, destacando a necessidade de estratégias eficazes de predição de risco e detecção precoce. Embora o eletrocardiograma (ECG) seja um exame amplamente disponível e de baixo custo, sua interpretação tradicional é limitada pela subjetividade. A inteligência artificial (IA) surgiu como uma abordagem promissora, capaz de extrair informações prognósticas ocultas dos sinais de ECG. Esta revisão sistemática teve como objetivo avaliar estudos originais que aplicaram técnicas de IA a ECGs para predição de risco cardiovascular e mortalidade. Foram incluídos estudos originais que utilizaram sinais de ECG como única variável de entrada para modelos de IA, com foco em desfechos de risco cardiovascular. Uma busca sistemática foi realizada em diferentes bases de dados, e os dados fora msintetizados de forma narrativa. Onze estudos foram incluídos, predominantemente coortes retrospectivas que aplicaram redes neurais convolucionais (CNNs) para prever risco cardiovascular ou mortalidade. As amostras eram majoritariamente compostas por populações adultas de países de alta renda. Os desfechos primários incluíram mortalidade por todas as causas, morte cardiovascular e eventos cardiovasculares adversos maiores (MACE). Os valores de AUROC variaram de 0,63 a 0,961 nos conjuntos de treinamento, com alguns modelos superando escores tradicionais de risco. Os modelos de IA‑ECG demonstraram potencial para detectar doença subclínica, permitindo estratificação precoce de risco mesmo em ECGs normais. No entanto, persistem desafios relacionados à diversidade populacional, interpretabilidade dos modelos e validação prospectiva. A aplicação de IA à análise de ECG representa um avanço promissor na avaliação personalizada do risco cardiovascular. Contudo, mais pesquisas são necessárias para garantir a segurança, a eficácia e a integração clínica equitativa dessas tecnologias. Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide, underscoring the need for effective risk prediction and early detection. Although the electrocardiogram (ECG) is a widely available and low-cost diagnostic tool, its traditional interpretation is limited by subjectivity. Artificial intelligence (AI) has emerged as a promising approach, capable of extracting hidden prognostic information from ECG signals. This systematic review aimed to assess original studies applying AI techniques to ECGs for cardiovascular risk prediction and mortality. Original studies that used ECG signals as the sole input variable for AI models, focusing on cardiovascular risk outcomes, were included. A systematic search was conducted in different databases, and data were synthesized narratively. Eleven studies were included, predominantly retrospective cohorts applying convolutional neural networks (CNNs) to predict cardiovascular risk or mortality. The sample primarily consisted of adult populations in high-income countries. Primary outcomes included all-cause mortality, cardiovascular death, and major adverse cardiovascular events (MACE). Reported AUROC values ranged from 0.63 to 0.961 in training sets, with some models outperforming traditional risk scores. AI-ECG models demonstrated the potential to detect subclinical disease, enabling early risk stratification even in normal ECGs. However, challenges remain regarding population diversity, model interpretability, and prospective validation. The application of AI to ECG analysis represents a promising advancement in personalized cardiovascular risk assessment. Nonetheless, further research is needed to ensure the safety, effectiveness, and equitable clinical integration of these technologies.
Patients with Wolff-Parkinson-White (WPW) syndrome frequently develop atrial fibrillation (AF); however, the factors associated with the occurrence of AF remain incompletely defined. To evaluate the prevalence and associated factors of clinical AF and electrophysiological study (EPS)-induced AF in a large consecutive cohort of patients with WPW undergoing accessory pathway (AP) ablation. This retrospective analysis included 845 consecutive patients with WPW who underwent AP ablation at a single tertiary referral center. A standardized EPS protocol was applied throughout the study period. Study outcomes included clinical AF (documented by medical history or monitoring before EPS), EPS-induced AF, and any AF (composite outcome). Multivariable logistic regression models were used to estimate adjusted odds ratio (ORa) with 95% CIs. Statistical significance was set at p < 0.05. Mean age was 33.2 ± 15.9 years, and 486 of 845 patients (57.5%) were male. Multiple APs were identified in 31 patients (3.7%). The most common AP locations were left lateral (327/845, 38.7%) and posterior (323/845, 38.2%). Clinical AF was present in 109 patients (12.9%), EPS-induced AF in 77 (9.1%), and any AF in 168 (19.9%). In multivariable analyses, a left lateral AP was independently associated with clinical AF (ORa, 2.31; 95% CI, 1.53-3.49; p < 0.001), whereas a posterior AP was associated with EPS-induced AF (ORa, 1.78; 95% CI, 1.07-2.91; p = 0.025). Female sex was associated with lower odds of EPS-induced AF (ORa, 0.56; 95% CI, 0.34-0.93; p = 0.025). Increasing age was independently associated with clinical AF (per-year ORa, 1.018; p = 0.007) and any AF (per-year ORa, 1.014; p = 0.009). In this large cohort of patients with WPW undergoing AP ablation, left lateral AP location and older age were independently associated with a higher prevalence of clinical AF. In contrast, posterior AP location and male sex were associated with a greater likelihood of EPS-induced AF. Pacientes com síndrome de Wolff-Parkinson-White (WPW) frequentemente desenvolvem fibrilação atrial (FA); no entanto, os fatores associados à ocorrência de FA permanecem incompletamente definidos. Avaliar a prevalência e os fatores associados à FA clínica e à FA induzida durante o estudo eletrofisiológico (EEF) em uma grande coorte consecutiva de pacientes com WPW submetidos à ablação de via acessória (VA). Esta análise retrospectiva incluiu 845 pacientes consecutivos com WPW submetidos à ablação de VA em um único centro terciário de referência. Um protocolo padronizado de EEF foi aplicado durante todo o período do estudo. Os desfechos incluíram FA clínica (documentada por histórico médico ou monitorização antes do EEF), FA induzida no EEF e qualquer FA (desfecho composto). Modelos de regressão logística multivariável foram utilizados para estimar odds ratios ajustados (ORa) com intervalo de confiança de 95% (IC 95%). A significância estatística foi definida como p < 0,05. A média de idade foi de 33,2 ± 15,9 anos, e 486 dos 845 pacientes (57,5%) eram do sexo masculino. Múltiplas VAs foram identificadas em 31 pacientes (3,7%). As localizações mais comuns das VAs foram lateral esquerda (327/845, 38,7%) e posterior (323/845, 38,2%). FA clínica esteve presente em 109 pacientes (12,9%), FA induzida no EEF em 77 (9,1%) e qualquer FA em 168 (19,9%). Nas análises multivariáveis, uma VA lateral esquerda esteve independentemente associada à FA clínica (ORa, 2,31; intervalo de confiança de 95% [IC 95%], 1,53-3,49; p < 0,001), enquanto uma VA posterior esteve associada à FA induzida no EEF (ORa, 1,78; IC 95%, 1,07-2,91; p = 0,025). O sexo feminino esteve associado a menores chances de FA induzida no EEF (ORa, 0,56; IC 95%, 0,34-0,93; p = 0,025). O aumento da idade esteve independentemente associado à FA clínica (ORa por ano, 1,018; p = 0,007) e a qualquer FA (ORa por ano, 1,014; p = 0,009). Nesta grande coorte de pacientes com WPW submetidos à ablação de VA, a localização lateral esquerda da VA e a maior idade estiveram independentemente associadas a maior prevalência de FA clínica. Em contraste, a localização posterior da VA e o sexo masculino estiveram associados a maior probabilidade de FA induzida no EEF. Patients with Wolff-Parkinson-White (WPW) syndrome frequently develop atrial fibrillation (AF); however, the factors associated with the occurrence of AF remain incompletely defined. To evaluate the prevalence and associated factors of clinical AF and electrophysiological study (EPS)-induced AF in a large consecutive cohort of patients with WPW undergoing accessory pathway (AP) ablation. This retrospective analysis included 845 consecutive patients with WPW who underwent AP ablation at a single tertiary referral center. A standardized EPS protocol was applied throughout the study period. Study outcomes included clinical AF (documented by medical history or monitoring before EPS), EPS-induced AF, and any AF (composite outcome). Multivariable logistic regression models were used to estimate adjusted odds ratio (ORa) with 95% CIs. Statistical significance was set at p < 0.05. Mean age was 33.2 ± 15.9 years, and 486 of 845 patients (57.5%) were male. Multiple APs were identified in 31 patients (3.7%). The most common AP locations were left lateral (327/845, 38.7%) and posterior (323/845, 38.2%). Clinical AF was present in 109 patients (12.9%), EPS-induced AF in 77 (9.1%), and any AF in 168 (19.9%). In multivariable analyses, a left lateral AP was independently associated with clinical AF (ORa, 2.31; 95% CI, 1.53-3.49; p < 0.001), whereas a posterior AP was associated with EPS-induced AF (ORa, 1.78; 95% CI, 1.07-2.91; p = 0.025). Female sex was associated with lower odds of EPS-induced AF (ORa, 0.56; 95% CI, 0.34-0.93; p = 0.025). Increasing age was independently associated with clinical AF (per-year ORa, 1.018; p = 0.007) and any AF (per-year ORa, 1.014; p = 0.009). In this large cohort of patients with WPW undergoing AP ablation, left lateral AP location and older age were independently associated with a higher prevalence of clinical AF. In contrast, posterior AP location and male sex were associated with a greater likelihood of EPS-induced AF.
Chagas disease affects millions worldwide and remains a leading cause of cardiomyopathy in Latin America. Early diagnosis remains challenging in endemic regions. Artificial intelligence (AI)-based electrocardiography (ECG) analysis may offer a low-cost strategy for large-scale screening in resource-limited settings. To evaluate the performance of an AI-ECG algorithm combined with clinical data for detecting Chagas disease in a community-based screening program conducted in a highly endemic region in Northeastern Brazil. In August 2024, 1,115 adults underwent standardized 12-lead ECG acquisition during a field campaign in Feira de Santana, Bahia, Northeast Brazil. A previously trained AI model analyzed ECG tracings and incorporated three clinical variables: i) prior residence in triatomine-infested areas, ii) poor housing conditions, and iii) family history of Chagas disease. Individuals flagged as AI-positive were classified as suspected cases. Suspected cases and matched controls (2:1) underwent point-of-care serological testing. The algorithm flagged 121 individuals (10.9%), corresponding to an estimated AI-based prevalence of Chagas disease of 7.8% (95%CI: 6.2-9.6). Among the 112 individuals who completed serological testing, 13 tested positive, all within the AI-positive suspected group; no seropositive cases were identified among controls. Sensitivity was 100% (95%CI: 69-100), specificity 40% (95%CI: 30-50), negative predictive value 100% (95%CI: 91-100), and positive predictive value 12% (95%CI: 11-14), with a diagnostic odds ratio of 6.6. An AI-ECG algorithm combined with simple clinical variables demonstrated excellent sensitivity for the detection of Chagas disease and may represent a valuable triage tool in endemic, resource-constrained settings. A doença de Chagas afeta milhões de pessoas em todo o mundo e permanece como uma das principais causas de cardiomiopatia na América Latina. O diagnóstico precoce ainda representa um desafio em regiões endêmicas. A análise de eletrocardiografia (ECG) aprimorada por inteligência artificial (IA) pode oferecer uma estratégia de baixo custo para rastreamento em larga escala em contextos com recursos limitados. Avaliar o desempenho de um algoritmo de ECG aprimorada por IA combinado com dados clínicos para a detecção da doença de Chagas em um programa de rastreamento comunitário realizado em uma região altamente endêmica do Nordeste do Brasil. Em agosto de 2024, 1.115 adultos foram submetidos à aquisição padronizada de ECG de 12 derivações durante uma campanha de campo em Feira de Santana, Bahia, nordeste do Brasil. Um modelo de IA previamente treinado analisou os traçados de ECG e incorporou três variáveis clínicas: i) residência prévia em áreas infestadas por triatomíneos, ii) condições habitacionais precárias e iii) histórico familiar de doença de Chagas. Indivíduos identificados como positivos pela IA foram classificados como casos suspeitos. Casos suspeitos e controles pareados (2:1) foram submetidos a testes sorológicos no ponto de cuidado. O algoritmo identificou 121 indivíduos (10,9%), correspondendo a uma prevalência estimada de doença de Chagas baseada em IA de 7,8% (intervalo de confiança de 95% [IC95%]: 6,2-9,6). Entre os 112 indivíduos que completaram o teste sorológico, 13 apresentaram resultado positivo, todos pertencentes ao grupo suspeito positivo pela IA; nenhum caso soropositivo foi identificado entre os controles. A sensibilidade foi de 100% (IC95%: 69-100), a especificidade de 40% (IC95%: 30-50), o valor preditivo negativo de 100% (IC95%: 91-100) e o valor preditivo positivo de 12% (IC95%: 11-14), com uma razão de chances diagnóstica de 6,6. Um algoritmo de ECG aprimorada por IA combinado com variáveis clínicas simples demonstrou excelente sensibilidade para a detecção da doença de Chagas e pode representar uma ferramenta valiosa de triagem em contextos endêmicos com recursos limitados.
Permanent pacemaker implantation is an established treatment for both sick sinus syndrome (SSS) and atrioventricular block (AVB), yet limited data exist comparing long-term clinical outcomes and cardiac remodeling patterns between these distinct bradyarrhythmic etiologies. To compare three-year clinical outcomes and cardiac structural changes between SSS and AVB patients following permanent pacemaker implantation. This retrospective observational study enrolled 192 adult patients (65 SSS, 127 AVB) who underwent pacemaker implantation between January 2018 and December 2020. Demographic data, echocardiographic parameters, pacemaker-recorded data, and clinical outcomes were assessed at baseline, one month, six months, one year, and three years. Primary outcomes included changes in cardiac structure and function, symptomatic improvement, new-onset atrial fibrillation, rehospitalization, and all-cause mortality. Both groups demonstrated significant declines in left ventricular ejection fraction over three years (SSS: 57.2±6.0% to 54.3±8.3%, p<0.001; AVB: 55.5±7.0% to 53.0±6.8%, p<0.001). Despite similar ventricular dysfunction progression, distinct remodeling patterns emerged: SSS patients exhibited significant increases in left atrial diameter (31.3 to 38.8 mm, p=0.040), left ventricular end-diastolic diameter (45.2 to 51.0 mm, p<0.001), and mitral regurgitation prevalence (26.2% to 64.6%), while AVB patients maintained stable chamber dimensions despite high ventricular pacing burden (>90%). Symptomatic improvement was comparable (SSS: 85.6% vs. AVB: 83.5%, p=0.84), as were new-onset atrial fibrillation (41.5% vs. 37.0%, p=0.54), rehospitalization (50.8% vs. 58.3%, p=0.38), and all-cause mortality (13.8% vs. 11.8%, p=0.69). Mortality predictors differed: mitral regurgitation severity in SSS versus coronary artery disease, beta-blocker therapy, and left atrial volume in AVB patients. Despite similar symptomatic benefits and clinical outcomes, SSS and AVB patients demonstrate distinct cardiac remodeling patterns and different mortality predictors, supporting the need for etiology-specific follow-up strategies in pacemaker recipients. O implante de marca-passo permanente é um tratamento estabelecido tanto para a síndrome do nó sinusal (SNS) quanto para o bloqueio atrioventricular (BAV), porém existem poucos dados comparando os resultados clínicos a longo prazo e os padrões de remodelamento cardíaco entre essas distintas etiologias bradiarrítmicas. Comparar os resultados clínicos e as alterações estruturais cardíacas em três anos entre pacientes com SNS e BAV após implante de marca-passo permanente. Este estudo observacional retrospectivo incluiu 192 pacientes adultos (65 com SNS, 127 com BAV) submetidos a implante de marca-passo entre janeiro de 2018 e dezembro de 2020. Dados demográficos, parâmetros ecocardiográficos, dados registrados pelo marca-passo e desfechos clínicos foram avaliados no início do estudo, após um mês, seis meses, um ano e três anos. Os desfechos primários incluíram alterações na estrutura e função cardíacas, melhora dos sintomas, fibrilação atrial de início recente, reinternação e mortalidade por todas as causas. Ambos os grupos demonstraram declínios significativos na fração de ejeção do ventrículo esquerdo ao longo de três anos (SNS: 57,2±6,0% para 54,3±8,3%, p<0,001; BAV: 55,5±7,0% para 53,0±6,8%, p<0,001). Apesar da progressão semelhante da disfunção ventricular, padrões distintos de remodelamento emergiram: os pacientes com SNS apresentaram aumentos significativos no diâmetro do átrio esquerdo (31,3 para 38,8 mm, p=0,040), no diâmetro diastólico final do ventrículo esquerdo (45,2 para 51,0 mm, p<0,001) e na prevalência de regurgitação mitral (26,2% para 64,6%), enquanto os pacientes com BAV mantiveram dimensões ventriculares estáveis apesar da alta carga de estimulação ventricular (>90%). A melhora dos sintomas foi comparável (SNS: 85,6% vs. BAV: 83,5%, p=0,84), assim como o surgimento de fibrilação atrial (41,5% vs. 37,0%, p=0,54), a reinternação (50,8% vs. 58,3%, p=0,38) e a mortalidade por todas as causas (13,8% vs. 11,8%, p=0,69). Os preditores de mortalidade diferiram: gravidade da regurgitação mitral em pacientes com SNS versus doença arterial coronariana, terapia com betabloqueadores e volume do átrio esquerdo em pacientes com BAV. Apesar dos benefícios sintomáticos e resultados clínicos semelhantes, pacientes com SNS e BAV demonstram padrões distintos de remodelamento cardíaco e diferentes preditores de mortalidade, o que reforça a necessidade de estratégias de acompanhamento específicas para cada etiologia em pacientes com marca-passo. Permanent pacemaker implantation is an established treatment for both sick sinus syndrome (SSS) and atrioventricular block (AVB), yet limited data exist comparing long-term clinical outcomes and cardiac remodeling patterns between these distinct bradyarrhythmic etiologies. To compare three-year clinical outcomes and cardiac structural changes between SSS and AVB patients following permanent pacemaker implantation. This retrospective observational study enrolled 192 adult patients (65 SSS, 127 AVB) who underwent pacemaker implantation between January 2018 and December 2020. Demographic data, echocardiographic parameters, pacemaker-recorded data, and clinical outcomes were assessed at baseline, one month, six months, one year, and three years. Primary outcomes included changes in cardiac structure and function, symptomatic improvement, new-onset atrial fibrillation, rehospitalization, and all-cause mortality. Both groups demonstrated significant declines in left ventricular ejection fraction over three years (SSS: 57.2±6.0% to 54.3±8.3%, p<0.001; AVB: 55.5±7.0% to 53.0±6.8%, p<0.001). Despite similar ventricular dysfunction progression, distinct remodeling patterns emerged: SSS patients exhibited significant increases in left atrial diameter (31.3 to 38.8 mm, p=0.040), left ventricular end-diastolic diameter (45.2 to 51.0 mm, p<0.001), and mitral regurgitation prevalence (26.2% to 64.6%), while AVB patients maintained stable chamber dimensions despite high ventricular pacing burden (>90%). Symptomatic improvement was comparable (SSS: 85.6% vs. AVB: 83.5%, p=0.84), as were new-onset atrial fibrillation (41.5% vs. 37.0%, p=0.54), rehospitalization (50.8% vs. 58.3%, p=0.38), and all-cause mortality (13.8% vs. 11.8%, p=0.69). Mortality predictors differed: mitral regurgitation severity in SSS versus coronary artery disease, beta-blocker therapy, and left atrial volume in AVB patients. Despite similar symptomatic benefits and clinical outcomes, SSS and AVB patients demonstrate distinct cardiac remodeling patterns and different mortality predictors, supporting the need for etiology-specific follow-up strategies in pacemaker recipients.
Arterial remodeling leading to increased arterial stiffness involves mechanisms such as oxidative stress, reactive oxygen species production, neuroendocrine alterations, and genetic predisposition. These processes are also involved in the pathophysiology of COVID-19. However, the relationship between arterial stiffness, hemodynamic parameters, and clinical-functional outcomes in post-COVID-19 patients has not yet been adequately investigated. To investigate arterial stiffness, central and peripheral hemodynamic parameters, functional performance, quality of life, fatigue, dyspnea, and sleep quality in post-COVID-19 patients. This cross-sectional study was conducted with individuals in the post-COVID-19 group (PCG) and matched individuals in the control group (n = 32). Arterial stiffness was assessed using pulse wave velocity (PWV) and the augmentation index corrected to a heart rate of 75 bpm (AIx@75). Functional performance was evaluated using the five-times sit-to-stand test, handgrip strength, quality of life (assessed with the 12-Item Short Form Survey), fatigue (assessed with the Brazilian version of the Fatigue Severity Scale), dyspnea (assessed with the modified Medical Research Council scale), and sleep quality. The PCG showed higher PWV values (Δ = 0.80 m/s; 95%CI, 0.08 to 1.52; p = 0.03) and AIx@75 (Δ = 8.34; 95%CI, 2.02 to 14.66; p = 0.01) as well as higher levels of central and peripheral blood pressure. Worse functional performance was observed (Δ = 4.39 s; 95%CI, 2.70 to 6.08; p < 0.01), along with poorer quality of life in the physical component (Δ = -9.35; 95%CI, -12.45 to -6.25; p < 0.01). Fatigue, dyspnea, and sleep quality outcomes were also significantly worse in the PCG. In the adjusted analysis, PWV was independently associated with age and systolic blood pressure, but not with post-COVID-19 status. Post-COVID-19 patients exhibit greater arterial stiffness, hemodynamic alterations, and poorer clinical-functional performance. However, arterial stiffness appears to be predominantly determined by hemodynamic factors and aging rather than by post-COVID-19 status independently, suggesting that the observed functional impairment results from multifactorial mechanisms. O remodelamento arterial que culmina no aumento da rigidez arterial envolve mecanismos como estresse oxidativo, produção de espécies reativas de oxigênio, alterações neuroendócrinas e predisposição genética. Esses processos também estão presentes na fisiopatologia da covid-19. Entretanto, a relação entre rigidez arterial, parâmetros hemodinâmicos e desfechos clínico-funcionais em pacientes pós-covid-19 ainda não foi adequadamente investigada. Investigar a rigidez arterial, os parâmetros hemodinâmicos centrais e periféricos, o desempenho funcional, a qualidade de vida, a fadiga, a dispneia e a qualidade do sono em pacientes pós-covid-19. Estudo transversal conduzido com indivíduos do grupo pós-covid-19 (GpC) e indivíduos pareados do grupo controle (n = 32). A rigidez arterial foi avaliada por meio da velocidade da onda de pulso (VOP) e do índice de aumentação corrigido para frequência cardíaca de 75 bpm (AIx@75). Foram avaliados o desempenho funcional pelo teste de sentar e levantar cinco vezes, a força de preensão manual, a qualidade de vida (avaliada pelo 12-Item Short Form Survey), a fadiga (avaliada pela Fatigue Severity Scale – versão brasileira), a dispneia (avaliada pela escala modificada do Medical Research Council) e a qualidade do sono. O GpC apresentou valores mais elevados de VOP (Δ = 0,80 m/s; intervalo de confiança de 95% [IC95%], 0,08 a 1,52; p = 0,03) e AIx@75 (Δ = 8,34; IC95%, 2,02 a 14,66; p = 0,01), além de níveis mais elevados de pressão arterial central e periférica. Observou-se pior desempenho funcional (Δ = 4,39 s; IC95%, 2,70 a 6,08; p < 0,01) e pior qualidade de vida no componente físico (Δ = −9,35; IC95%, −12,45 a −6,25; p < 0,01). Fadiga, dispneia e qualidade do sono também apresentaram resultados significativamente piores no GpC. Na análise ajustada, a VOP associou-se independentemente à idade e à pressão arterial sistólica, mas não à condição pós-covid-19. Pacientes pós-covid-19 apresentam maior rigidez arterial, alterações hemodinâmicas e pior desempenho clínico-funcional. Contudo, a rigidez arterial parece ser predominantemente determinada por fatores hemodinâmicos e pelo envelhecimento, e não pela condição pós-covid-19 de forma independente, sugerindo que o comprometimento funcional observado decorra de mecanismos multifatoriais. Arterial remodeling leading to increased arterial stiffness involves mechanisms such as oxidative stress, reactive oxygen species production, neuroendocrine alterations, and genetic predisposition. These processes are also involved in the pathophysiology of COVID-19. However, the relationship between arterial stiffness, hemodynamic parameters, and clinical-functional outcomes in post-COVID-19 patients has not yet been adequately investigated. To investigate arterial stiffness, central and peripheral hemodynamic parameters, functional performance, quality of life, fatigue, dyspnea, and sleep quality in post-COVID-19 patients. This cross-sectional study was conducted with individuals in the post-COVID-19 group (PCG) and matched individuals in the control group (n = 32). Arterial stiffness was assessed using pulse wave velocity (PWV) and the augmentation index corrected to a heart rate of 75 bpm (AIx@75). Functional performance was evaluated using the five-times sit-to-stand test, handgrip strength, quality of life (assessed with the 12-Item Short Form Survey), fatigue (assessed with the Brazilian version of the Fatigue Severity Scale), dyspnea (assessed with the modified Medical Research Council scale), and sleep quality. The PCG showed higher PWV values (Δ = 0.80 m/s; 95%CI, 0.08 to 1.52; p = 0.03) and AIx@75 (Δ = 8.34; 95%CI, 2.02 to 14.66; p = 0.01) as well as higher levels of central and peripheral blood pressure. Worse functional performance was observed (Δ = 4.39 s; 95%CI, 2.70 to 6.08; p < 0.01), along with poorer quality of life in the physical component (Δ = −9.35; 95%CI, −12.45 to −6.25; p < 0.01). Fatigue, dyspnea, and sleep quality outcomes were also significantly worse in the PCG. In the adjusted analysis, PWV was independently associated with age and systolic blood pressure, but not with post-COVID-19 status. Post-COVID-19 patients exhibit greater arterial stiffness, hemodynamic alterations, and poorer clinical-functional performance. However, arterial stiffness appears to be predominantly determined by hemodynamic factors and aging rather than by post-COVID-19 status independently, suggesting that the observed functional impairment results from multifactorial mechanisms.
The prognostic value of coronary artery calcium (CAC) score in nonobstructive coronary artery disease (NObCAD; stenosis < 50%) remains insufficiently characterized. To investigate the association between CAC score, cardiovascular risk factors, and clinical outcomes in patients with NObCAD. A total of 2,509 patients underwent coronary computed tomography angiography (CTA) and were followed for 8.9 ± 2.6 years. Plaque burden was classified according to CAD-RADS™ 2.0 into none, mild, moderate, and high/highest. The primary endpoint (PEP) was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Statistical significance was set at 5%. CAC score was 0 in 45.4% of patients, 1-99 in 36.6%, and ≥ 100 in 18.0%. Correspondingly, 38.3% of patients had no coronary lesions, 38.5% had mild lesions, 14.1% had moderate lesions, and 9.2% had high/highest lesions. Among patients with CAC = 0, the absence of coronary lesions predominated (81.2%), whereas it was rare among those with CAC ≥ 100. The PEP occurred in 4.9% of patients, predominantly driven by all-cause mortality. Among the 396 patients with serial coronary CTA (mean interval: 6.5 ± 2.6 years), CAC progression (> 2.5 increase based on the square root method) was observed in 41.9%. Plaque burden increased in parallel. CAC score showed a positive association with plaque burden and cardiovascular risk factors. In NObCAD, CAC is present in more than half of patients and is associated with both plaque burden and cardiovascular risk factors. The incidence of PEP increases in proportion to risk factor burden and CAC levels. CAC and plaque burden progress concurrently over time, supporting the role of CAC as a surrogate marker of subclinical atherosclerosis progression. O valor prognóstico da mensuração do escore de cálcio das artérias coronárias (CAC) na doença arterial coronária (DAC) não obstrutiva (definida como estenose < 50%) não está suficientemente descrito. Investigar a associação entre a mensuração do CAC, fatores de risco cardiovascular e desfechos clínicos em pacientes com DAC não obstrutiva. Ao todo, 2.509 pacientes foram submetidos à angiotomografia coronariana (angioTC) e acompanhados por 8,9 ± 2,6 anos. Conforme o CAD-RADS™ 2.0, a carga de placa foi classificada em ausente, leve, moderada e alta/muito alta. O desfecho primário foi um composto de mortalidade por todas as causas, síndrome coronariana aguda/infarto agudo do miocárdio e acidente vascular encefálico. A significância estatística foi estabelecida em 5%. O escore de CAC foi 0 em 45,4% dos pacientes, 1-99 em 36,6% e ≥ 100 em 18,0%. Correspondentemente, 38,3% dos pacientes não apresentavam lesões coronarianas, 38,5% apresentavam lesões leves, 14,1% lesões moderadas e 9,2% lesões altas/muito altas. Entre os pacientes com CAC = 0, a ausência de lesões coronarianas predominou (81,2%), enquanto foi rara entre aqueles com CAC ≥ 100. O desfecho primário ocorreu em 4,9% dos pacientes, predominantemente impulsionado pela mortalidade por todas as causas. Entre os 396 pacientes com angioTC coronariana seriada (intervalo médio: 6,5 ± 2,6 anos), a progressão do CAC (> 2,5 de aumento com base no método da raiz quadrada) foi observada em 41,9%. A carga de placa aumentou em paralelo. O escore de CAC apresentou associação positiva com a carga de placa e com fatores de risco cardiovascular. Na DAC não obstrutiva, o CAC está presente em mais da metade dos pacientes e está associado tanto à carga de placa quanto aos fatores de risco cardiovascular. A incidência do desfecho primário aumenta proporcionalmente à carga de fatores de risco e aos níveis de CAC. O CAC e a carga de placa progridem concomitantemente ao longo do tempo, sustentando o papel do CAC como marcador substituto da progressão da aterosclerose subclínica. The prognostic value of coronary artery calcium (CAC) score in nonobstructive coronary artery disease (NObCAD; stenosis < 50%) remains insufficiently characterized. To investigate the association between CAC score, cardiovascular risk factors, and clinical outcomes in patients with NObCAD. A total of 2,509 patients underwent coronary computed tomography angiography (CTA) and were followed for 8.9 ± 2.6 years. Plaque burden was classified according to CAD-RADS™ 2.0 into none, mild, moderate, and high/highest. The primary endpoint (PEP) was a composite of all-cause mortality, acute coronary syndrome/acute myocardial infarction, and stroke. Statistical significance was set at 5%. CAC score was 0 in 45.4% of patients, 1-99 in 36.6%, and ≥ 100 in 18.0%. Correspondingly, 38.3% of patients had no coronary lesions, 38.5% had mild lesions, 14.1% had moderate lesions, and 9.2% had high/highest lesions. Among patients with CAC = 0, the absence of coronary lesions predominated (81.2%), whereas it was rare among those with CAC ≥ 100. The PEP occurred in 4.9% of patients, predominantly driven by all-cause mortality. Among the 396 patients with serial coronary CTA (mean interval: 6.5 ± 2.6 years), CAC progression (> 2.5 increase based on the square root method) was observed in 41.9%. Plaque burden increased in parallel. CAC score showed a positive association with plaque burden and cardiovascular risk factors. In NObCAD, CAC is present in more than half of patients and is associated with both plaque burden and cardiovascular risk factors. The incidence of PEP increases in proportion to risk factor burden and CAC levels. CAC and plaque burden progress concurrently over time, supporting the role of CAC as a surrogate marker of subclinical atherosclerosis progression.
Sacubitril/valsartan reduced mortality and hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) compared to enalapril in pivotal clinical trials. However, real-world data under optimized dosing remain limited. To compare the outcomes of HFrEF patients treated with sacubitril/valsartan versus either enalapril or losartan at guideline-recommended maximum dosages. We analyzed data from an observational heart failure cohort (n = 2,314) including patients receiving care between August 2010 and September 2024 at six public hospitals in a large metropolitan area. The primary analysis included 254 HFrEF patients receiving the guideline-recommended maximum dosages of the investigated drugs. A sensitivity analysis included 452 patients receiving any submaximal dosages. The primary outcome was combined hospitalization or death. Baseline differences were adjusted using propensity score matching. A p-value < 0.05 was considered significant. Among 254 HFrEF patients (mean age 63.6 ± 12.3 years, 61.4% male), 115 received sacubitril/valsartan 97/103mg twice daily, 33 enalapril 20 mg twice daily, and 106 losartan 100 mg daily. Over the median follow-up of 23.9 months (interquartile range 11.9-41.1), there were 70 primary endpoint events (56 first hospitalizations, 32 deaths). Compared to equivalent dosages of enalapril or losartan, sacubitril/valsartan was not associated with significant reductions in combined hospitalization or death (odds ratio 0.650, 95% confidence interval 0.354-1.195, p = 0.165), but it was associated with functional status improvement (odds ratio 3.902, 95% confidence interval 1.745-8.726, p = 0.001). This real-world study did not demonstrate significant reductions in hospitalization or mortality for sacubitril/valsartan compared with enalapril or losartan at guideline-recommended maximum dosages; however, sacubitril/valsartan was associated with improved functional status. Sacubitril/valsartana reduziu a mortalidade e as hospitalizações em pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFEr) em comparação com enalapril em estudos clínicos pivotais. No entanto, os dados de mundo real sob doses otimizadas continuam limitados. Comparar os desfechos de pacientes com ICFEr tratados com sacubitril/valsartana versus enalapril ou losartana nas doses máximas recomendadas pelas diretrizes. Analisamos dados de uma coorte observacional de insuficiência cardíaca (n = 2.314), incluindo pacientes atendidos entre agosto de 2010 e setembro de 2024 em seis hospitais públicos de uma grande área metropolitana. A análise primária incluiu 254 pacientes com ICFEr que receberam as doses máximas recomendadas pelas diretrizes dos medicamentos investigados. Uma análise de sensibilidade incluiu 452 pacientes que receberam quaisquer doses submáximas. O desfecho primário foi a combinação de hospitalização ou óbito. As diferenças basais foram ajustadas por meio do pareamento por escore de propensão. Foram considerados significativos valores de p < 0,05. Entre 254 pacientes com ICFEr (idade média de 63,6 ± 12,3 anos, 61,4% do sexo masculino), 115 receberam sacubitril/valsartana 97/103 mg duas vezes ao dia, 33 enalapril 20 mg duas vezes ao dia e 106 losartana 100 mg ao dia. Durante um seguimento mediano de 23,9 meses (intervalo interquartil 11,9–41,1), ocorreram 70 eventos do desfecho primário (56 primeiras hospitalizações e 32 óbitos). Em comparação com doses equivalentes de enalapril ou losartana, sacubitril/valsartana não foi associado a reduções significativas na combinação de hospitalização ou mortalidade (odds ratio 0,650, intervalo de confiança de 95% 0,354–1,195, p = 0,165), mas foi associado à melhora do estado funcional (odds ratio 3,902, intervalo de confiança de 95% 1,745–8,726, p = 0,001). O presente estudo de mundo real não demonstrou reduções significativas de hospitalização ou mortalidade com sacubitril/valsartana em comparação a enalapril ou losartana nas doses máximas recomendadas pelas diretrizes; no entanto, sacubitril/valsartana foi associado à melhora da classe funcional.
Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy. To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice. An analytical-comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch's t-test, and effect size (Hedges' g). Standard-deviation-based cut-off points were proposed for grading abnormality. Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation. International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval. A ressonância magnética cardiovascular (RMC) é o método de referência para avaliação morfofuncional cardíaca. No Brasil, a aplicação de valores de normalidade internacionais enfrenta desafios relacionados à miscigenação populacional, heterogeneidade técnica entre centros e ausência de padronização nacional, o que pode impactar a acurácia diagnóstica. Comparar valores de normalidade de parâmetros morfofuncionais obtidos por RMC entre uma revisão internacional multicêntrica e uma publicação nacional, discutindo concordância, divergências metodológicas e implicações para a prática clínica brasileira. Revisão analítico-comparativa entre dados sumarizados de uma revisão internacional de valores de referência em RMC e um estudo brasileiro. Foram comparadas médias e desvios-padrão das principais variáveis ventriculares, com avaliação de sobreposição de IC95%, teste t de Welch e tamanho de efeito (Hedges’ g). Propuseram-se pontos de corte baseados em desvios-padrão para gradação de anormalidade. Observou-se concordância global entre as médias na maioria das variáveis. Diferenças estatisticamente significativas ocorreram em poucos parâmetros, principalmente diâmetros ventriculares e massa ventricular esquerda, com tamanhos de efeito pequenos a moderados. As discrepâncias foram atribuídas, em grande parte, a diferenças metodológicas de mensuração e indexação. Os valores internacionais de normalidade podem ser utilizados na prática clínica brasileira, desde que ajustados por superfície corporal e interpretados à luz de particularidades locais. A padronização de protocolos e estudos multicêntricos nacionais são necessários para maior robustez e validação regional. Cardiovascular magnetic resonance (CMR) is the reference standard for morphofunctional cardiac assessment. In Brazil, the application of international normal reference values faces challenges related to population admixture, technical heterogeneity among centers, and the absence of national standardization, all of which may affect diagnostic accuracy. To compare normal reference values for morphofunctional parameters obtained by CMR between a multicenter international review and a Brazilian publication, discussing concordance, methodological differences, and implications for Brazilian clinical practice. An analytical–comparative review was performed using summarized data from an international reference-value review and a Brazilian study. Means and standard deviations of key ventricular variables were compared, with assessment of 95% CI overlap, Welch's t-test, and effect size (Hedges’ g). Standard-deviation–based cut-off points were proposed for grading abnormality. Overall concordance between means was observed for most variables. Statistically significant differences occurred in a few parameters, mainly ventricular diameters and left ventricular mass, with small to moderate effect sizes. Discrepancies were largely attributed to methodological differences in measurement and indexation. International normal reference values may be used in Brazilian clinical practice, provided they are adjusted for body surface area and interpreted in light of local particularities. Standardization of protocols and national multicenter studies are needed to strengthen regional validation. Keywords: Normal Values, Cardiac Magnetic Resonance, Reference Interval.
Cardiac arrhythmias are heterogeneous conditions that may limit physical activity (PA) and impair quality of life (QoL). To describe levels of PA and perceived barriers as well as to assess their associations with arrhythmia phenotype and QoL in tertiary care outpatients with preserved left ventricular (LV) function. This pilot cross-sectional study enrolled adults with documented arrhythmias and LV ejection fraction (LVEF) ≥ 50%. PA was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and QoL using the 12- Item Short Form Survey (SF-12). Arrhythmias were classified as supraventricular tachycardia (SVT), atrial fibrillation (AF) and/or atrial tachycardia (AT) (including atrial flutter when applicable), ventricular, inherited, or multiple. Associations were analyzed using chi-square tests, multinomial regression, and linear regression models. Among 202 participants (mean age 50.5 ± 15.3 years; 58.9% men), 20.3% were sedentary and 45.6% were active or very active. The prevalence of sedentary behavior was higher among patients with ventricular arrhythmias (25.9%), inherited arrhythmias (35.1%), and multiple arrhythmias (25.0%) compared with those with SVT (3.8%) and AF/AT (8.0%) (p = 0.043). In adjusted models, active or very active PA showed a trend toward higher SF-12 physical component scores (p = 0.08), whereas mental component scores were primarily influenced by symptom status and sex. In this tertiary outpatient cohort with arrhythmias and preserved LVEF, physical inactivity clustered among higher-risk phenotypes and was frequently associated with potentially modifiable barriers, including medical advice and lack of time. Higher levels of PA tended to be associated with better physical health status, supporting individualized, risk-based counseling and supervised strategies to safely promote PA in patients with arrhythmias. As arritmias cardíacas são condições heterogêneas, que podem limitar a atividade física (AF) e prejudicar a qualidade de vida (QV). Descrever os níveis de AF e as barreiras percebidas, bem como avaliar suas associações com o fenótipo de arritmia e a QV em pacientes ambulatoriais de nível terciário com função do ventrículo esquerdo (VE) preservada, se faz necessário. Este é um estudo piloto, transversal, que incluiu adultos com arritmias documentadas e fração de ejeção do VE (FEVE) ≥ 50%. A AF foi avaliada por meio da versão curta do International Physical Activity Questionnaire (IPAQ), e a QV pelo 12-Item Short Form Survey (SF-12). As arritmias foram classificadas como taquicardia supraventricular (TSV), fibrilação atrial (FA) e/ou taquicardia atrial (TA) (incluindo flutter atrial quando aplicável), ventricular, hereditária ou múltipla. As associações foram analisadas por meio de testes do qui-quadrado, regressão multinomial e modelos de regressão linear. Entre 202 participantes (idade média 50,5 ± 15,3 anos; 58,9% homens), 20,3% eram sedentários e 45,6% eram ativos ou muito ativos. A prevalência de comportamento sedentário foi maior entre pacientes com arritmias ventriculares (25,9%), arritmias hereditárias (35,1%) e arritmias múltiplas (25,0%) em comparação com aqueles com TSV (3,8%) e FA/TA (8,0%) (p = 0,043). Nos modelos ajustados, níveis de AF ativos ou muito ativos mostraram uma tendência a escores mais elevados no componente físico do SF-12 (p = 0,08), enquanto os escores do componente mental foram principalmente influenciados pelo status dos sintomas e pelo sexo. Nesta coorte ambulatorial terciária com arritmias e FEVE preservada, a inatividade física concentrou-se em fenótipos de maior risco e esteve frequentemente associada a barreiras potencialmente modificáveis, incluindo orientação médica e falta de tempo. Níveis mais elevados de AF tenderam a estar associados a melhor estado de saúde física, sustentando a necessidade de aconselhamento individualizado baseado no risco e de estratégias supervisionadas para promover de forma segura a AF em pacientes com arritmias. Cardiac arrhythmias are heterogeneous conditions that may limit physical activity (PA) and impair quality of life (QoL). To describe levels of PA and perceived barriers as well as to assess their associations with arrhythmia phenotype and QoL in tertiary care outpatients with preserved left ventricular (LV) function. This pilot cross-sectional study enrolled adults with documented arrhythmias and LV ejection fraction (LVEF) ≥ 50%. PA was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and QoL using the 12- Item Short Form Survey (SF-12). Arrhythmias were classified as supraventricular tachycardia (SVT), atrial fibrillation (AF) and/or atrial tachycardia (AT) (including atrial flutter when applicable), ventricular, inherited, or multiple. Associations were analyzed using chi-square tests, multinomial regression, and linear regression models. Among 202 participants (mean age 50.5 ± 15.3 years; 58.9% men), 20.3% were sedentary and 45.6% were active or very active. The prevalence of sedentary behavior was higher among patients with ventricular arrhythmias (25.9%), inherited arrhythmias (35.1%), and multiple arrhythmias (25.0%) compared with those with SVT (3.8%) and AF/AT (8.0%) (p = 0.043). In adjusted models, active or very active PA showed a trend toward higher SF-12 physical component scores (p = 0.08), whereas mental component scores were primarily influenced by symptom status and sex. In this tertiary outpatient cohort with arrhythmias and preserved LVEF, physical inactivity clustered among higher-risk phenotypes and was frequently associated with potentially modifiable barriers, including medical advice and lack of time. Higher levels of PA tended to be associated with better physical health status, supporting individualized, risk-based counseling and supervised strategies to safely promote PA in patients with arrhythmias.
Brazil presents regional variations in mortality from cardiomyopathies, influenced by demographic characteristics, socioeconomic inequalities, and differences in access to health services. Between 2001 and 2021, 272,448 deaths from the disease were recorded in the country. To analyze, at the national level, the epidemiological profile and the spatiotemporal distribution of mortality from cardiomyopathies in Brazil, from 2001 to 2021. Epidemiological study based on secondary data from the Mortality Information System (SIM/DATASUS) and population estimates from IBGE. Crude mortality rates were calculated per municipality. Temporal analysis was performed using Joinpoint, estimating the annual percentage change (APC). Spatial analysis used GeoDa, with Bayesian smoothing and evaluation of spatial autocorrelation using the Global Moran's I and LISA indices. Statistical significance was set at p < 0.05. There were 272,448 deaths due to cardiomyopathies, predominantly in men (58.65%), individuals aged 80 or older (25.74%), white individuals (52.18%), married individuals (36.77%), and those with 1 to 3 years of completed schooling (21.91%). The average mortality rate was 6.66 per 100,000 inhabitants, reaching 7.64 per 100,000 in 2004 and falling to 4.15 per 100,000 in 2020. A significant annual reduction of 1.86% was observed (p < 0.05). Spatial analysis revealed clusters of high mortality, mainly in the Midwest, South, and Southeast regions, with Corumbá de Goiás standing out (49.34/100,000). There was a significant reduction in mortality from cardiomyopathies, despite the persistence of critical areas that require targeted strategies for surveillance, early diagnosis, and appropriate management. O Brasil apresenta variações regionais na mortalidade por cardiomiopatias, influenciada por características demográficas, desigualdades socioeconômicas e diferenças no acesso aos serviços de saúde. Entre 2001 e 2021, foram registrados 272.448 óbitos pela doença no país. Analisar, em nível nacional, o perfil epidemiológico e a distribuição têmporo-espacial da mortalidade por cardiomiopatias no Brasil, no período de 2001 a 2021. Estudo epidemiológico baseado em dados secundários do Sistema de Informação sobre Mortalidade (SIM/DATASUS) e estimativas populacionais do IBGE. Calcularam-se taxas brutas de mortalidade por município. A análise temporal foi realizada pelo Joinpoint, estimando-se a variação percentual anual (APC). A análise espacial utilizou o GeoDa, com suavização bayesiana e avaliação da autocorrelação espacial pelos índices de Moran Global e LISA. A significância estatística foi estabelecida em p < 0,05. Ocorreram 272.448 óbitos por cardiomiopatias, predominando em homens (58,65%), indivíduos com 80 anos ou mais (25,74%), brancos (52,18%), casados (36,77%) e com 1 a 3 anos de estudo completos (21,91%). A mortalidade média foi de 6,66 por 100 mil habitantes, atingindo 7,64 por 100 mil em 2004 e caindo para 4,15 por 100 mil em 2020. Observou-se redução anual significativa de 1,86% (p<0,05). A análise espacial revelou aglomerados de alta mortalidade principalmente no Centro-Oeste, Sul e Sudeste, com destaque para Corumbá de Goiás (49,34/100 mil). Houve redução significativa da mortalidade por cardiomiopatias, embora persistam áreas críticas que exigem estratégias direcionadas para vigilância, diagnóstico precoce e manejo adequado. Brazil presents regional variations in mortality from cardiomyopathies, influenced by demographic characteristics, socioeconomic inequalities, and differences in access to health services. Between 2001 and 2021, 272,448 deaths from the disease were recorded in the country. To analyze, at the national level, the epidemiological profile and the spatiotemporal distribution of mortality from cardiomyopathies in Brazil, from 2001 to 2021. Epidemiological study based on secondary data from the Mortality Information System (SIM/DATASUS) and population estimates from IBGE. Crude mortality rates were calculated per municipality. Temporal analysis was performed using Joinpoint, estimating the annual percentage change (APC). Spatial analysis used GeoDa, with Bayesian smoothing and evaluation of spatial autocorrelation using the Global Moran’s I and LISA indices. Statistical significance was set at p < 0.05. There were 272,448 deaths due to cardiomyopathies, predominantly in men (58.65%), individuals aged 80 or older (25.74%), white individuals (52.18%), married individuals (36.77%), and those with 1 to 3 years of completed schooling (21.91%). The average mortality rate was 6.66 per 100,000 inhabitants, reaching 7.64 per 100,000 in 2004 and falling to 4.15 per 100,000 in 2020. A significant annual reduction of 1.86% was observed (p < 0.05). Spatial analysis revealed clusters of high mortality, mainly in the Midwest, South, and Southeast regions, with Corumbá de Goiás standing out (49.34/100,000). There was a significant reduction in mortality from cardiomyopathies, despite the persistence of critical areas that require targeted strategies for surveillance, early diagnosis, and appropriate management.
Contrast-associated acute kidney injury (CA-AKI) results in increased morbidity and mortality, prolonged hospitalization, and worse clinical outcomes. Prior studies have shown that limiting contrast volume (CV) to less than 3 times the estimated glomerular filtration rate (eGFR) implies a lower risk of CA-AKI, and both efficacy and superior outcomes are associated with ultra-low contrast (ULC) volume coronary procedures (total CV ≤ eGFR). This systematic review and meta-analysis aimed to compare clinical outcomes of ULC versus conventional percutaneous coronary intervention (PCI) in patients with chronic kidney disease. The search was conducted in the databases PubMed/MEDLINE, Cochrane, Embase, Scopus, and Web of Science, including all studies reporting clinical outcomes of ULC PCI. The primary efficacy endpoint was the incidence of CA-AKI, and secondary endpoints were need for dialysis, all-cause mortality, and major adverse cardiovascular events (MACE), defined as the composite endpoint of all-cause mortality, non-fatal myocardial infarction, and clinically driven target lesion revascularization. Six studies met the inclusion criteria and were included in the final analysis, encompassing a total of 274,102 patients. ULC PCI was associated with a statistically significant reduction of CA-AKI (risk ratio=0.27; 95% CI=0.13-0.56; p=0.0004). In turn, ULC PCI did not result in statistically significant reduction of need for dialysis (risk ratio=0.33; 95% CI=0.06-1.72; p=0.186), all-cause mortality (risk ratio=0.48; 95% CI=0.17-1.39; p=0.18), and MACE (risk ratio=0.52; 95% CI= 0.21-1.30; p=0.16). ULC, as compared to conventional PCI, in patients with chronic kidney disease, was found to be safe, feasible, and associated with a statistically significant reduction of CA-AKI. Further, larger, well-powered, randomized, and controlled trials are warranted in order to reassure these findings. A lesão renal aguda associada ao contraste (LRA-AC) resulta em aumento da morbidade e mortalidade, hospitalização prolongada e piores desfechos clínicos. Estudos anteriores demonstraram que limitar o volume de contraste (VC) a menos de 3 vezes a taxa de filtração glomerular estimada (TFGe) implica menor risco de LRA-AC, e tanto a eficácia quanto os melhores desfechos estão associados a procedimentos coronários com volume de contraste ultrabaixo (VCU) (VC total ≤ TFGe). Esta revisão sistemática e metanálise teve como objetivo comparar os desfechos clínicos da intervenção coronária percutânea (ICP) com VCU versus ICP convencional em pacientes com doença renal crônica. A busca foi realizada nas bases de dados PubMed/MEDLINE, Cochrane, Embase, Scopus e Web of Science, incluindo todos os estudos que relataram desfechos clínicos de ICP VCU. O desfecho primário de eficácia foi a incidência de lesão renal aguda associada à quimioterapia (LRA-AC), e os desfechos secundários foram a necessidade de diálise, mortalidade por todas as causas e eventos cardiovasculares adversos maiores (MACE), definidos como o desfecho composto de mortalidade por todas as causas, infarto do miocárdio não fatal e revascularização da lesão-alvo clinicamente indicada. Seis estudos atenderam aos critérios de inclusão e foram incluídos na análise final, abrangendo um total de 274.102 pacientes. A ICP VCU foi associada à redução estatisticamente significativa da LRA-AC (razão de risco = 0,27; IC 95% = 0,13–0,56; p = 0,0004) que foi observada. Por outro lado, a ICP VCU não resultou em redução estatisticamente significativa da necessidade de diálise (razão de risco = 0,33; IC 95% = 0,06–1,72; p = 0,186), mortalidade por todas as causas (razão de risco = 0,48; IC 95% = 0,17–1,39; p = 0,18) e eventos cardiovasculares adversos maiores (MACE) (razão de risco = 0,52; IC 95% = 0,21–1,30; p = 0,16). A ICP VCU, em comparação com a ICP convencional, em pacientes com doença renal crônica, se mostrou segura, viável e associada a uma redução estatisticamente significativa da LRA-AC. Ensaios adicionais, de maior porte, randomizados e controlados, são necessários para confirmar essas descobertas. Contrast-associated acute kidney injury (CA-AKI) results in increased morbidity and mortality, prolonged hospitalization, and worse clinical outcomes. Prior studies have shown that limiting contrast volume (CV) to less than 3 times the estimated glomerular filtration rate (eGFR) implies a lower risk of CA-AKI, and both efficacy and superior outcomes are associated with ultra-low contrast (ULC) volume coronary procedures (total CV ≤ eGFR). This systematic review and meta-analysis aimed to compare clinical outcomes of ULC versus conventional percutaneous coronary intervention (PCI) in patients with chronic kidney disease. The search was conducted in the databases PubMed/MEDLINE, Cochrane, Embase, Scopus, and Web of Science, including all studies reporting clinical outcomes of ULC PCI. The primary efficacy endpoint was the incidence of CA-AKI, and secondary endpoints were need for dialysis, all-cause mortality, and major adverse cardiovascular events (MACE), defined as the composite endpoint of all-cause mortality, non-fatal myocardial infarction, and clinically driven target lesion revascularization. Six studies met the inclusion criteria and were included in the final analysis, encompassing a total of 274,102 patients. ULC PCI was associated with a statistically significant reduction of CA-AKI (risk ratio=0.27; 95% CI=0.13–0.56; p=0.0004). In turn, ULC PCI did not result in statistically significant reduction of need for dialysis (risk ratio=0.33; 95% CI=0.06–1.72; p=0.186), all-cause mortality (risk ratio=0.48; 95% CI=0.17–1.39; p=0.18), and MACE (risk ratio=0.52; 95% CI= 0.21–1.30; p=0.16). ULC, as compared to conventional PCI, in patients with chronic kidney disease, was found to be safe, feasible, and associated with a statistically significant reduction of CA-AKI. Further, larger, well-powered, randomized, and controlled trials are warranted in order to reassure these findings.
Bicuspid aortic valve (BAV) is a significant risk factor for aortic stenosis (AS). Yet, the outcomes of transcatheter aortic valve implantation (TAVI) remain unclear, as most randomized trials excluded such patients. Furthermore, most published evidence on TAVI in BAV comes from high-income countries, which may not reflect realities of underserved populations. Evaluate temporal trends, procedural, and in-hospital outcomes between BAV and tricuspid aortic valve (TAV) patients. Retrospective observational study based on a Brazilian multicenter registry of TAVI patients between January 2009 and December 2021. We performed propensity score matching to adjust comparisons. A p-value <0.05 was considered statistically significant for all analyses. Among 2,426 patients from 25 centers, 111 had BAV. TAVI procedures increased over time in both groups. After one-to-three matching, 90 BAV and 243 TAV patients were included. No significant differences were observed in rates of major vascular complications (4% vs. 5%; p=0.99), major or life-threatening bleeding (10% vs. 6%; p=0.34), stroke (2% vs. 0.4%; p=0.37), or in-hospital mortality (7% vs. 3%; p=0.21). Over time, there was a significant reduction in in-hospital mortality (p<0.01) and major procedural complications (p<0.01 for vascular, bleeding, and stroke events), regardless of valve type. During the study period, annual TAVI procedures increased in both BAV and TAV patients, although the prevalence of BAV remained relatively low. No significant differences were observed in procedural or clinical outcomes between the propensity-matched groups. Both valve types showed reductions in procedural complications and in-hospital mortality over time. A valva aórtica bicúspide (VAB) é um fator de risco importante para estenose aórtica. No entanto, os desfechos do implante de bioprótese aórtica transcateter (TAVI) permanecem pouco claros, já que a maioria dos ensaios clínicos randomizados excluiu esses pacientes. Além disso, grande parte das evidências publicadas sobre o TAVI em VAB advém de países de alta renda, o que pode não refletir a realidade de países em desenvolvimento. Avaliar tendências temporais, características do procedimento e desfechos intra-hospitalares entre pacientes com VAB e valva aórtica tricúspide (VAT). Estudo observacional retrospectivo baseado em um registro multicêntrico brasileiro de pacientes submetidos ao TAVI entre janeiro de 2009 e dezembro de 2021. Realizamos pareamento por escore de propensão para ajustar as comparações. Um valor de p<0,05 foi considerado estatisticamente significativo para todas as análises. Entre 2426 pacientes de 25 centros, 111 tinham VAB. Os procedimentos de TAVI aumentaram ao longo do tempo em ambos os grupos. Após o pareamento na proporção de um para três, foram incluídos 90 pacientes com VAB e 243 com VAT. Não foram observadas diferenças significativas nas taxas de complicações vasculares maiores (4% vs. 5%; p=0,99), sangramento maior ou com risco de vida (10% vs. 6%; p=0,34), acidente vascular cerebral (AVC) (2% vs. 0,4%; p=0,37) ou mortalidade intra-hospitalar (7% vs. 3%; p=0,21). Ao longo do tempo, houve redução significativa na mortalidade intra-hospitalar (p<0,01) e nas principais complicações do procedimento (p<0,01 para eventos vasculares, sangramento e AVC), independentemente do tipo de valva. Durante o período do estudo, os procedimentos anuais de TAVI aumentaram tanto em pacientes com VAB quanto com VAT, embora a prevalência de VAB tenha permanecido relativamente baixa. Não houve diferenças significativas nos desfechos do procedimento ou clínicos entre os grupos pareados por escore de propensão, com redução das complicações do procedimento e da mortalidade para ambos os tipos de valva ao longo do tempo.
The coronary sinus (CS) plays a pivotal role in cardiac venous drainage and is anatomically adjacent to the atrioventricular nodal region. Although structural enlargement of the CS has been described in patients with atrioventricular nodal reentrant tachycardia (AVNRT), coronary sinus flow (CSF) assessed by transthoracic echocardiography (TTE) has not previously been investigated in this population. To evaluate the relationship between AVNRT and CSF. This retrospective single-center study included 35 patients with AVNRT who underwent successful slow-pathway ablation and 34 age- and sex-matched healthy controls. All participants underwent comprehensive transthoracic echocardiography. CS ostial diameter, CS diameter, and CSF were measured using pulsed-wave Doppler echocardiography. CSF was calculated using standard geometric and Doppler-derived parameters. A p-value <0.05 was considered statistically significant. Global left and right ventricular systolic and diastolic function parameters were similar between groups. Patients with AVNRT exhibited significantly larger CS ostial and CS diameters compared with controls (both p<0.001). Despite this enlargement, CSF was significantly reduced in the AVNRT group (460.8 ± 83.3 vs. 523.8 ± 90.1 mL/min, p=0.004), accompanied by a lower CS velocity-time integral. Notably, CSF indexed to left ventricular mass also remained significantly lower in AVNRT patients, indicating that reduced flow was independent of myocardial mass. Patients with AVNRT demonstrate a distinct coronary sinus hemodynamic profile characterized by CS enlargement and reduced CSF as assessed by transthoracic echocardiography. These findings suggest altered coronary venous hemodynamics in AVNRT and provide novel pathophysiological insights using a non-invasive imaging modality. O seio coronário (SC) desempenha um papel fundamental na drenagem venosa cardíaca e está anatomicamente adjacente à região nodal atrioventricular. Embora o aumento estrutural do SC já tenha sido descrito em pacientes com taquicardia por reentrada nodal atrioventricular (TRNAV), o fluxo do seio coronário (FSC) avaliado por ecocardiografia transtorácica (ETT) ainda não havia sido investigado nessa população. Avaliar a relação entre TRNAV e FSC. Este estudo retrospectivo, de centro único, incluiu 35 pacientes com TRNAV submetidos à ablação bem-sucedida da via lenta e 34 controles saudáveis pareados por idade e sexo. Todos os participantes realizaram ecocardiografia transtorácica abrangente. O diâmetro do óstio do SC, o diâmetro do SC e o FSC foram medidos por Doppler pulsado. O FSC foi calculado utilizando parâmetros geométricos e derivados do Doppler. Valores de p < 0.05 foram considerados estatisticamente significativos. Os parâmetros globais de função sistólica e diastólica dos ventrículos esquerdo e direito foram semelhantes entre os grupos. Pacientes com TRNAV apresentaram diâmetros significativamente maiores do óstio do SC e do SC em comparação aos controles (ambos p<0.001). Apesar desse aumento, o FSC foi significativamente reduzido no grupo TRNAV (460.8 ± 83.3 vs. 523.8 ± 90.1 mL/min, p=0.004), acompanhado por um menor integral velocidade-tempo do SC. Notavelmente, o FSC indexado à massa ventricular esquerda também permaneceu significativamente menor nos pacientes com TRNAV, indicando que a redução do fluxo foi independente da massa miocárdica. Pacientes com TRNAV apresentam um perfil hemodinâmico distinto do SC, caracterizado por aumento estrutural do SC e redução do FSC avaliado por ecocardiografia transtorácica. Esses achados sugerem alterações na hemodinâmica venosa coronária na TRNAV e fornecem novos insights fisiopatológicos por meio de uma modalidade de imagem não invasiva. The coronary sinus (CS) plays a pivotal role in cardiac venous drainage and is anatomically adjacent to the atrioventricular nodal region. Although structural enlargement of the CS has been described in patients with atrioventricular nodal reentrant tachycardia (AVNRT), coronary sinus flow (CSF) assessed by transthoracic echocardiography (TTE) has not previously been investigated in this population. To evaluate the relationship between AVNRT and CSF. This retrospective single-center study included 35 patients with AVNRT who underwent successful slow-pathway ablation and 34 age- and sex-matched healthy controls. All participants underwent comprehensive transthoracic echocardiography. CS ostial diameter, CS diameter, and CSF were measured using pulsed-wave Doppler echocardiography. CSF was calculated using standard geometric and Doppler-derived parameters. A p-value <0.05 was considered statistically significant. Global left and right ventricular systolic and diastolic function parameters were similar between groups. Patients with AVNRT exhibited significantly larger CS ostial and CS diameters compared with controls (both p<0.001). Despite this enlargement, CSF was significantly reduced in the AVNRT group (460.8 ± 83.3 vs. 523.8 ± 90.1 mL/min, p=0.004), accompanied by a lower CS velocity–time integral. Notably, CSF indexed to left ventricular mass also remained significantly lower in AVNRT patients, indicating that reduced flow was independent of myocardial mass. Patients with AVNRT demonstrate a distinct coronary sinus hemodynamic profile characterized by CS enlargement and reduced CSF as assessed by transthoracic echocardiography. These findings suggest altered coronary venous hemodynamics in AVNRT and provide novel pathophysiological insights using a non-invasive imaging modality.
Atrial fibrillation (AF) is a condition that frequently affects patients with heart failure with reduced ejection fraction (HFrEF) and is associated with worsening left ventricular ejection fraction (LVEF) and unfavorable clinical outcomes. Catheter ablation has been proposed as a strategy to restore sinus rhythm; however, its effects on LVEF remain heterogeneous in the literature. To evaluate the impact of catheter ablation, compared with medical therapy, on LVEF in patients with AF and HFrEF. A systematic review of randomized clinical trials was conducted in accordance with the PRISMA guidelines. The primary outcome was improvement in LVEF, while secondary outcomes included cardiovascular mortality, all-cause mortality, and hospitalizations due to heart failure. Other exploratory outcomes were also considered. The included randomized clinical trials demonstrated improvement in LVEF among patients undergoing catheter ablation compared with those receiving medical therapy. In the CAMERA-MRI study, an absolute increase of 18.3% in LVEF was observed after six months. In the CASTLE-AF trial, catheter ablation was also associated with a lower incidence of cardiovascular mortality and heart failure hospitalizations. In the absence of a meta-analysis, no quantitative synthesis of the effects was performed. The available evidence from individual randomized trials suggests that catheter ablation may be associated with improvement in LVEF and more favorable clinical outcomes in patients with AF and HFrEF. However, given the lack of quantitative synthesis, these findings should be interpreted with caution. A fibrilação atrial (FA) é uma condição que frequentemente acomete pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFEr), estando associada à piora da fração de ejeção do ventrículo esquerdo (FEVE) e a desfechos clínicos desfavoráveis. A ablação por cateter tem sido proposta como estratégia para restaurar o ritmo sinusal; entretanto, seus efeitos sobre a FEVE permanecem heterogêneos na literatura. Avaliar o impacto da ablação por cateter, em comparação à terapia medicamentosa, sobre a FEVE em pacientes com FA e ICFEr. Revisão sistemática de ensaios clínicos randomizados conduzida de acordo com as diretrizes PRISMA. O desfecho primário foi a melhora da FEVE, enquanto os desfechos secundários incluíram mortalidade cardiovascular, mortalidade por todas as causas e hospitalizações por IC. Outros desfechos exploratórios também foram considerados. Os ensaios clínicos incluídos demonstraram melhora da FEVE em pacientes submetidos à ablação por cateter quando comparados à terapia medicamentosa. No estudo CAMERA-MRI, foi observado aumento absoluto de 18,3% na FEVE após seis meses. No estudo CASTLE-AF, a ablação também se associou a menor ocorrência de mortalidade cardiovascular e hospitalizações por IC. Contudo, devido à ausência de metanálise, não foi realizada síntese quantitativa dos efeitos. Os estudos sugerem que a ablação por cateter pode estar associada à melhora da FEVE e a desfechos clínicos mais favoráveis em pacientes com FA e ICFEr. Entretanto, devido à ausência de síntese quantitativa, esses achados devem ser interpretados com cautela. Atrial fibrillation (AF) is a condition that frequently affects patients with heart failure with reduced ejection fraction (HFrEF) and is associated with worsening left ventricular ejection fraction (LVEF) and unfavorable clinical outcomes. Catheter ablation has been proposed as a strategy to restore sinus rhythm; however, its effects on LVEF remain heterogeneous in the literature. To evaluate the impact of catheter ablation, compared with medical therapy, on LVEF in patients with AF and HFrEF. A systematic review of randomized clinical trials was conducted in accordance with the PRISMA guidelines. The primary outcome was improvement in LVEF, while secondary outcomes included cardiovascular mortality, all-cause mortality, and hospitalizations due to heart failure. Other exploratory outcomes were also considered. The included randomized clinical trials demonstrated improvement in LVEF among patients undergoing catheter ablation compared with those receiving medical therapy. In the CAMERA-MRI study, an absolute increase of 18.3% in LVEF was observed after six months. In the CASTLE-AF trial, catheter ablation was also associated with a lower incidence of cardiovascular mortality and heart failure hospitalizations. In the absence of a meta-analysis, no quantitative synthesis of the effects was performed. The available evidence from individual randomized trials suggests that catheter ablation may be associated with improvement in LVEF and more favorable clinical outcomes in patients with AF and HFrEF. However, given the lack of quantitative synthesis, these findings should be interpreted with caution.
Capsinoids (Cap) are bioactive compounds with thermogenic properties capable of promoting physiological changes and aiding digestion, potentially influencing fat loss in obesity. However, their effects on cardiac tissue remain unclear. This study investigated the effects of chronic Cap administration on cardiac contractility and morphology in obese (Ob) rats induced by a saturated high-fat diet (HFD). Male Wistar rats were assigned to standard diet (SD) or HFD groups for 19 weeks. After this period, animals were redistributed into Control (C), Obese (Ob), and Obese supplemented with capsinoids (ObCap). The ObCap group received Cap via orogastric gavage (10 mg/kg). Nutritional assessments, dietary profile, histological analyses, comorbidities, and cardiac evaluations were performed. A significance level of 5% was adopted for all tests. Fat deposits and total adiposity were higher in Ob animals compared with the C group, with no differences between Ob and ObCap. Metabolic, hormonal, and lipid alterations were observed between Ob and ObCap. No differences in cardiac morphometry were detected among groups. The ObCap group exhibited reduced fractional shortening compared with Ob. Regarding shortening time, Ob animals showed a decrease compared with C, whereas ObCap showed an increase compared with Ob. Treatment with Cap did not prevent excessive fat accumulation nor improve metabolic parameters in obesity. Moreover, it impaired cardiomyocyte contractility. Os capsinoides (Cap) são compostos bioativos com propriedades termogênicas capazes de promover alterações fisiológicas e auxiliar na digestão, podendo influenciar a perda de gordura na obesidade. No entanto, seus efeitos sobre o tecido cardíaco permanecem pouco esclarecidos. Este estudo investigou os efeitos da administração crônica de Cap sobre a contratilidade e a morfologia cardíaca em ratos obesos (Ob) induzidos por uma dieta hiperlipídica (DHL) saturada. Ratos Wistar machos foram distribuídos em grupos alimentados com dieta padrão (DP) ou DHL por 19 semanas. Após esse período, os animais foram redistribuídos em Controle (C), Obeso (Ob) e Obeso suplementado com capsinoides (ObCap). O grupo ObCap recebeu Cap por gavagem orogástrica (10 mg/kg). Foram realizadas avaliações nutricionais, perfil dietético, análises histológicas, comorbidades e avaliações cardíacas. O nível de significância adotado foi de 5% para todos os testes. Os depósitos de gordura e a adiposidade total foram maiores nos animais Ob em comparação ao grupo C, sem diferenças entre Ob e ObCap. Alterações metabólicas, hormonais e lipídicas foram observadas entre Ob e ObCap. Não foram detectadas diferenças na morfometria cardíaca entre os grupos. O grupo ObCap apresentou redução na fração de encurtamento em comparação ao Ob. Quanto ao tempo de encurtamento, os animais Ob apresentaram redução em relação ao C, enquanto o grupo ObCap apresentou aumento em relação ao Ob. O tratamento com Cap não preveniu o acúmulo excessivo de gordura nem melhorou os parâmetros metabólicos na obesidade. Além disso, prejudicou a contratilidade dos cardiomiócitos. Capsinoids (Cap) are bioactive compounds with thermogenic properties capable of promoting physiological changes and aiding digestion, potentially influencing fat loss in obesity. However, their effects on cardiac tissue remain unclear. This study investigated the effects of chronic Cap administration on cardiac contractility and morphology in obese (Ob) rats induced by a saturated high-fat diet (HFD). Male Wistar rats were assigned to standard diet (SD) or HFD groups for 19 weeks. After this period, animals were redistributed into Control (C), Obese (Ob), and Obese supplemented with capsinoids (ObCap). The ObCap group received Cap via orogastric gavage (10 mg/kg). Nutritional assessments, dietary profile, histological analyses, comorbidities, and cardiac evaluations were performed. A significance level of 5% was adopted for all tests. Fat deposits and total adiposity were higher in Ob animals compared with the C group, with no differences between Ob and ObCap. Metabolic, hormonal, and lipid alterations were observed between Ob and ObCap. No differences in cardiac morphometry were detected among groups. The ObCap group exhibited reduced fractional shortening compared with Ob. Regarding shortening time, Ob animals showed a decrease compared with C, whereas ObCap showed an increase compared with Ob. Treatment with Cap did not prevent excessive fat accumulation nor improve metabolic parameters in obesity. Moreover, it impaired cardiomyocyte contractility.
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[This corrects the article doi: 10.36660/abc.20250619] [This corrects the article doi: 10.36660/abc.20250619i].