Accepted on 26 Sep 2022
Submitted on 26 Sep 2022
107880
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barreto1
(1) Insituto do Coração – HC FMUSP
Background: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC.
Purpose: To analyze the mortality of congestive heart failure due to CCC in women and men.
Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF (Framingham criteria) due to CCC in a single-center outpatient clinic. Appropriate serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier (K-M) method to analyze time-to-event data and the Cox proportional hazards methods to search for predictors of death.
Results: We studied 733 patients, mean of 61.4 ± 12.3 years, 381 (52%) males. Females were older (63.0 ± 11.9 vs. 60 ± 12.4 years; p = 0.01), had a higher baseline mean left ventricular ejection fraction (LVEF) (44.5 ± 14.6% vs. 37.3 ± 14.8%; p < 0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7 ± 8.9 vs. 62.4 ± 9.4 mm; p < 0.001). Over a 3-years follow-up period, 168 (44%) men and 126 (36%) women died (K-M: log-rank p = 0.002; Figure). Women had more implantable pacemakers (PM) (26.1% vs. 16.5%; p = 0.002) and men more implantable cardioverter-defibrillators (ICDs)(20.7% vs. 12.5%; p = 0.003). Heart transplant occurred in 10.8% of men and 7.4% in women (p = NS). Cox regression for death adjusted for age, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, PM, ICD, heart transplant and LVEF, showed, in descending order, previous stroke (HR = 2.4; 95%CL:1.5–3.6), diabetes (HR = 2.0; 95%CL: 1.3–3.1), and CKD (HR = 1.8; 95%CL:1.3–2.6) as the main predictors of death in men, and in women diabetes (HR = 2.2; 95%CL:1.4–3.4), previous stroke (HR = 1.8; 95%CL:1.1–2.9), and CKD (HR = 1.7; 95%CL:1.1–2.7).
Conclusions: Women had a better prognosis than men but similar predictors of death. Control of diabetes and prevention of stroke and CKD could significantly reduce the death rate in CHF due to CCC.
108498
Modality: WHF Abstracts – Young Researcher
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 14/10/2022 H: 16:50/17:50
L: Auditório 14
JOSÉ LUCAS PERES BICHARA1, José Lucas Peres Bichara1, Luiz Antônio Viegas de Miranda Bastos1, Paolo Blanco Villela1, Glaucia Moraes de Oliveira1
(1) Universidade Federal do Rio de Janeiro – UFRJ
Introduction: Cardiovascular diseases (CVD) are the main causes of death in the world and in Brazil, and ischemic heart diseases (IHD) are one of the main responsible for these statistics. Previous studies have already suggested a relationship between the evolution of IHD mortality rates and socioeconomic indicators.
Objective: To relate the evolution of IHD mortality rates and the sociodemographic index (SDI) from 2000 to 2019 in Brazil and in its federative units (FUs).
Methods: Ecological time series study of deaths from IHD in Brazil. Crude and standardized mortality rate for IHD were analyzed by sex, age group and FU between 2000 and 2019. Data were correlated with the SDI. Deaths and population were taken from DATASUS to estimate crude and standardized mortality rates per 100,000 inhabitants (direct method with Brazilian population in 2000). The SDI for each UF was extracted from the Global Health Data Exchange website.
Results: In the period, there were 1,968,160 deaths from IHD in Brazil, 58.19% of which were male. The national SDI ranged from 0.538 in 2000 to 0.64 in 2019, with constant growth in the period. Concomitantly, the age-standardized mortality rate for IHD decreased from 46.12/100,000 inhabitants to 36.42/100,000 inhabitants. Thus, IHD has become the leading cause of mortality in the country. In the FUs, all states in the North and Northeast regions showed improvements in the SDI, however, the best indicators continued to be concentrated in the other regions. In 2000, the highest mortality rates from IHD were found in the South, Southeast and Midwest regions of the country, but they showed a significant reduction. When evaluating the variation of the standardized mortality rate in the period, it was noted that the FUs with the best SDI were responsible for the greatest drops (graph 1).
Conclusion: During the period, the country showed a significant improvement in socioeconomic indicators accompanied by a reduction in IHD mortality rates. When evaluating the FUs, it was noted that those with better socioeconomic indicators were able to obtain a greater reduction in these mortality rates.
108502
Modality: WHF Abstracts – Researcher
Category: NEGLECTED CARDIOVASCULAR DISEASES
D: 14/10/2022 H: 13:50/14:50
L: Auditório 14
ADRIANA SOARES XAVIER DE BRITO1, Renata Junqueira Moll-Bernardes1, Martha Valeria Tavares Pinheiro1, Paulo Henrique Rosado de Castro1, Gabriel Cordeiro Camargo1, Adriana Pereira Glavam1, Sergio Altino de Almeida1, Fabio Paiva Siqueira1, Marcelo Teixeira de Holanda2, Luiz Henrique Conde Sangenis2, Fernanda de Souza Nogueira Sardinha Mendes2, Andrea Silvestre de Sousa2
(1) D’Or Institute for Research and Education (IDOR), Rio de Janeiro; (2) Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation
Introduction: Chagas disease continues to be an important cause of morbidity and mortality in Latin America. Sudden cardiac death (SCD) represents the most dramatic course of Chagas cardiomyopathy (CC), and it is closely related to the presence of ventricular arrhythmias and myocardial dysfunction. However, there is also a high incidence of SCD when left ventricular ejection fraction (LVEF) is normal or mildly depressed. Unfortunately, despite its significant mortality, there is no clear recommendation for early cardio-defibrillator implantation in patients with CC. Ideally, the risk of SCD should be evaluated in earlier stages of the disease, but important questions remain unresolved regarding its pathophysiological mechanism and the diagnostic tools. New imaging parameters to identify the genesis of arrhythmia such as fibrosis, inflammation and dysautonomia can be a promising strategy.
Purpose: We tested the correlation between the extent of myocardial sympathetic denervation, myocardial perfusion, fibrosis and the severity of the ventricular arrhythmia in patients in the early phase of CC.
Methods: Twenty-nine patients with CC and LVEF >45% prospectively underwent magnetic resonance (MRI), SPECT imaging of myocardial sympathetic innervation using 123Iodine-MIBG (MIBG) and rest myocardial perfusion with 99mTc-sestamibi (MIBI), and were divided into two groups: arrhythmic group (n = 15): >120 ventricular ectopic beats and/or Non-Sustained Ventricular Tachycardia (NSVT) and non-arrhythmic group (n = 14): <120 ventricular ectopic beats without NSVT on 24-h Holter monitoring.
Results: Compared to non-arrhythmic, the arrhythmic group had significantly higher denervation score (mean ± SD 23.2 ± 18.7 versus 5.6 ± 4.9; p < 0.01), higher summed rest perfusion score (mean ± SD 4.7 ± 6.8 versus 0.3 ± 0.6; p < 0.05) as well as the higher mismatch in the innervation/perfusion score between MIBG and MIBI images, which evaluates the extent of denervated but viable myocardium (mean ± SD 18.4 ± 17.5 versus 5.3 ± 4.7; p < 0.01). There was a correlation between myocardium denervation (r 0.555; p < 0.01), hypoperfusion (r 0.562; p < 0.01), and interstitial fibrosis evaluated by extracellular volume at MRI.
Conclusion: The combination of different imaging parameters to assess autonomic innervation, myocardial perfusion and fibrosis may allow better understanding of the pathophysiology and risk stratification for SCD in the early stages of CC.
108593
Modality: WHF Abstracts – Researcher
Category: NEGLECTED CARDIOVASCULAR DISEASES
D: 14/10/2022 H: 13:50/14:50
L: Auditório 14
BRUNO OLIVEIRA DE FIGUEIREDO BRITO1, Bruno Oliveira de Figueiredo Brito1, Emilly Malveira de Lima2, Elsayed Z. Soliman3, Maria Fernanda Lima-Costa4, Antonio Luiz Pinho Ribeiro1
(1) Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; (2) Department of Statistics, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; (3) Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; (4) Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
The electrocardiogram (ECG) plays a key role in the evaluation of Chagas disease (ChD). The ECG shows progressive abnormalities that indicate worsening myocardial damage. There is no information about the evolution of the ECG of elderly individuals with ChD.
Objective: To compare the evolution of electrocardiographic abnormalities in Trypanosoma cruzi chronically infected individuals to that of the non-infected (NChD) elderly in a follow-up of 14 years of the Bambui Cohort Study of Aging in Brazil.
Methods: A digitally recorded 12-lead ECG of each individual was obtained at the baseline examination in 1997, in 2002 and in 2008, and was classified by the Minnesota Code criteria. The influence of ChD on the ECG evolution was assessed by the semi-competing risks methods considering a new ECG abnormality as the primary event and death the terminal event. The group with ChD was compared with the NChD group. A Cox regression model was conducted separately in ChD and NChD groups, in a landmark point at 5.5 years until the end of follow-up. The individuals of both groups were compared according to the following categories: No major: individuals without major abnormalities in the first and second visits; Maintained major: individuals who had the number of major abnormalities in second visit equal to the first visit, More major: individuals who had major abnormalities in the first visit and gained more abnormalities in the second visit and New major: individuals who had no abnormalities in the first visit and gained any major abnormality in the second visit.
Results: Among the 1,462 participants, 557 had ChD. The median age was 68 years for patients with ChD and 67 for patients without ChD. Chagas disease was independently associated to the occurrence of new major ECG abnormalities in the multivariate analysis HR: 2.89 (95% CI 2.28–3.67). Compared with the group of ChD No major, the risk of death was HR: 2.48 (95% CI 1.43–4.28) for the Maintained, HR: 1.95 (95% CI 1.04–3.69) for the New major, and HR: 2.77 (95% CI 1.57–4.88) for the More Major. Compared with the group of ChD Maintained major, the risk of death was HR: 0.79 (95% CI 0.44–1.42) for the group New Major and HR: 1.11 (95% CI 0.66–1.89) for the group More Major.
Conclusion: Even in advanced ages, the patients with ChD have higher risk than NChD of developing new abnormalities in the ECG. It is enough for individuals with ChD to have ECG abnormalities for their risk of death to increase.
108671
Modality: WHF Abstracts – Young Researcher
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 14/10/2022 H: 16:50/17:50
L: Auditório 14
GAUTAM SATHEESH1, Mohammad Abdul Salam2
(1) The George Institute for Global Health, Hyderabad, India; (2) The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
Introduction and/or rationale: Heart failure (HF) is a leading global health burden that disproportionately affects patients in low- and middle-income countries with weaker health systems, such as India. Underutilization of guideline-recommended medical therapy (GRMT)—causing large gaps in evidence and clinical practice—can be mitigated through the adoption of GRMT in the EMLs.
Objectives: To compare the adoption of GRMT across the global (WHO) EML and the national and state EMLs of India.
Methods: We collated a list of medicines recommended by American (American College of Cardiology Foundation, the American Heart Association, and the Heart Failure Society of America; 2017), European (European Society of Cardiology; 2021), and relevant Indian guidelines (Cardiological Society of India; 2018). We assessed the adoption of these medicines in WHO EML (2021), India’s latest national EML (2015), Ministry of Health and Family Welfare’s free medicines list (2020), and 23 Indian state EMLs. We only included ‘evidence-based medicines’, i.e., those supported by relevant randomized controlled trial data for HF. Therefore, we did not include medicines listed as ‘commonly used’ without relevant evidence. We also excluded medicines listed for use in selected patients only (e.g., milrinone, levosimendan, nesiritide etc.).
Results: The adoption of GRMT by WHO EML 2021 was 48% (n = 17), ranging from 75% (beta-blockers) to 0% (SGLT-2 inhibitors). GRMT adoption by Indian EML was 35% (n = 11), ranging from 50% (mineralocorticoid-receptor antagonists) to 0% (SGLT-2 inhibitors). On average, Indian state EMLs contained 36% [18% (Punjab)–53% (Rajasthan)] of GRMT. The lowest adoption (16%; n = 6) was observed in the Ministry of Health’s free medicines list, which omitted several major first-line medicine classes. Newly included GRMT, including angiotensin-receptor neprilysin inhibitors and SGLT-2 inhibitors, are yet to be listed in global and national EMLs. Further, at least one emergency medicine was included in all EMLs.
Conclusion: Inclusion of GRMT for HF remains suboptimal in the global as well as the national and state EMLs of India. EMLs guide medicine selection and procurement in limited-resource settings. Considering India’s increasing cardiovascular disease burden and the potential for EMLs to improve availability and affordability of GRMT, optimizing India’s national and state EMLs and particularly its public sector (free medicines) list, is vital.
109112
Modality: WHF Abstracts – Young Researcher
Category: NEGLECTED CARDIOVASCULAR DISEASES
D: 14/10/2022 H: 16:50/17:50
L: Auditório 14
DENISE MAYUMI TANAKA1, Camila Godoy Fabricio1, José A. Marin-Neto1, Antônio Carlos Leite de Barros Filho1, Luciano Fonseca Lemos de Oliveira3, Jorge Mejia4, Rafael Ribeiro Almeida2, Maria de Lourdes Higuchi2, Edecio Cunha Neto2, Minna Moreira Dias Romano1, Marcus Vinícius Simões1
(1) Medical School of Ribeirao Preto – University of São Paulo, Sao Paulo, Brazil; (2) Heart Institute (InCor), Faculty of Medicine – University of Sao Paulo, Sao Paulo, Brazil.; (3) Physiotherapy Department – Federal University of Minas Gerais, Brazil; (4) Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Background: Microvascular myocardial perfusion defect (MPD) is frequent in chronic Chagas cardiomyopathy (CCC) and may be involved with the progression of left ventricular systolic dysfunction (LVSD). However, the histopathological meaning of MPD in CCC and its correlation with endothelial activation is scarce.
Purpose: To investigate the correlations between MPD detected in vivo with functional and histopathological changes in the model of CCC in hamsters.
Methods: 24 female hamsters were studied 8-months after intraperitoneal infection with 35,000 trypomastigote forms of T. cruzi. All animals were submitted to rest high-resolution 99mTc-Sestamibi-SPECT myocardial perfusion scintigraphy and echocardiography in vivo. The area of MPD was assessed by calculating polar maps using dedicated software (MunichHeart®). After euthanasia, we performed a histopathological study of cardiac inflammation and fibrosis and mRNA expression for TNF-alfa and ICAM to assess inflammation and endothelial activation, respectively.
Results: 17 animals presented MPD (71%) – extension ranging from 1.4 to 30.3% of LV surface. Animals with MPD present lower values of LVEF (38.5 ± 11.2%) when compared with animals without MPD 48.4 ± 9.1%, p = 0.04), and a trend to higher intensity of myocardial inflammation in animals with MPD (540.4 ± 153.6 cell/mm2) vs. without MPD (409.6 ± 130.3 cell/mm2), p = 0.09. In addition, animals with MPD presented a higher ICAM (0.02 ± 0.01) expression when compared with animals without MPD (0.01 ± 0.01, p = 0.02). There was no difference between groups regarding the extent of fibrosis. There was a negative correlation between individual values of MPD with LVEF (R = –0.6, p = 0.001), wall motion score index (WMSi, R = 0.5, p = 0.007), and the number of mononuclear cells (R = 0.5, p = 0.01). Moreover, an analysis based on myocardial segments (n = 312) showed that segments with MPD (n = 54) in comparison to those without MPD (n = 258) presented a higher number of mononuclear cells (608 ± 299.9 cell/mm2 and 478.3 ± 201.1 cell/mm, respectively, p < 0.0001) and higher WMSi (1.8 ± 0.9 and 1.2 ± 0.4, respectively, p < 0.0001.
Conclusions: MPD is a common finding in the experimental model of CCC in hamsters and is correlated with inflammation, endothelial inflammatory activation, and systolic ventricular dysfunction. These results suggest that MPD may be an in vivo surrogate marker for inflammation with potential translational implications for monitoring disease activity.
109166
Modality: WHF Abstracts – Researcher
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 14/10/2022 H: 13:50/14:50
L: Auditório 14
MELANIE B. TURNER, MPH, FAHA1, Laura L. Hayman, PhD, MSN, FAHA2, Dhruv Kazi, MD, MSc, MS, FAHA3, Laxmi S. Mehta, MD, FAHA4
(1) American Heart Association; (2) University of Massachusetts Boston; (3) Beth Israel Deaconess Medical Center; (4) The Ohio State University Medical Center
Introduction: Cardiovascular disease (CVD) is the leading cause of death (LCOD) in women globally, causing ≈9 M deaths annually. Global community awareness data of CVD and its risk factors are limited.
Objective: Determine global awareness of CVD incidence and risk factors among women and examine regional variation in awareness.
Methods: An online native language survey was administered among nationally representative samples of women ≥18 years of age in 50 countries across 6 global regions. The survey was administered June-July 2021 using the YouGov real time omnibus service. The survey included an open-ended question regarding LCOD for women in the country (coded as CVD, cancer, or other/don’t know), and a multiple choice question on CVD risk factors. Results were weighted by country, then combined by region.
Results: Of 24,100 women, 15.5% reported CVD as LCOD (regional range 6.9–35.0%), 49.4% cancer (23.9–62.9%) and 18.0% other/don’t know (9.1–34.4%). Cancer was perceived as LCOD in all regions except South Asia and Middle East and North Africa where other/don’t know was the most common response. Regarding CVD risk, 69.5% identified family history as a risk (regional range 51.0–77.1%). Most recognized hypertension, overweight, high cholesterol, and stress. Awareness of diabetes as a CVD risk was low (32.0%, 26.5–44.1%).
Conclusions: Awareness of CVD as LCOD among women is low in all global regions. Most women recognize hypertension, high cholesterol, and overweight as risk factors, but awareness of diabetes as a risk factor is low. Efforts are needed in all regions to create awareness of lifetime CVD risk in women, focusing on modifiable risk factors. As an increasingly prevalent global chronic condition, diabetes merits raised attention in community heart health education.
109180
Modality: WHF Abstracts – Researcher
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 14/10/2022 H: 13:50/14:50
L: Auditório 14
CHARLE ANDRE VILJOEN1, Karen Sliwa1, Peter van der Meer2, Alice M Jackson3, Mark C Petrie3, Cecile Laroche4, Jolien W Roos-Hesselink5, Petar Seferovic6, Alexandra Frogoudaki7, Bassem Ibrahim8, Hasan Al-Farhan9, Johann Bauersachs10
(1) Cape Heart Institute, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, South Africa; (2) Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands; (3) Institute of Cardiovascular and Medical Sciences, Glasgow University, Glasgow, United Kingdom; (4) EurObservational Research Programme, European Society of Cardiology, Sophie Antipolis, France; (5) Department Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; (6) University of Belgrade Faculty of Medicine, Belgrade, Serbia; (7) Attikon University Hospital, Athens, Greece; (8) North Cumbria University Hospitals, Carlisle, UK; (9) Iraqi Board of Medical Specilazations, Baghdad Heart Center, Iraq; (10) Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
Background: Peripartum cardiomyopathy (PPCM) is a global disease associated with substantial morbidity and mortality. The aim of this study was to analyze to what extent country- and individual-level socioeconomic factors were associated with maternal and neonatal outcomes.
Methods: In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EORP Programme. We investigated the characteristics and outcomes of women with PPCM and their babies according to individual (income and educational attainment) and country-specific (Gini coefficient [GINI], health expenditure [HE] and human developmental index [HDI]) socioeconomic status.
Results: 739 women from 49 countries were enrolled (Europe [33%], Africa [29%], Asia-Pacific [15%], Middle East [22%]). Women from countries with low HDI had lower income and educational attainment (p < 0.001). Low HDI was associated with greater LV dilatation at time of diagnosis (p < 0.001), but LV ejection fraction (LVEF) did not differ according to HDI, HE or GINI. Countries with low HE prescribed guideline-directed heart failure therapy less frequently (p < 0.001). Low HE was associated with more frequent mortality (p < 0.002), whereas HDI and GINI were not. Women from countries with low HDI and low HE had significantly less recovery of LV function (p < 0.001). Analysis of maternal outcome as per highest level of educational attainment showed significant differences in LVEF at 6 months (43.7 ± 12.9% [primary], 46.5 ± 13.0% [secondary], 48.9 ± 11.7 [tertiary education] respectively, p = 0.022). Low maternal income, irrespective of region of origin, was independently associated with poor outcome (OR 1.99 [95% CI 1.1–3.6] for composite of maternal death, re-hospitalization, or LV non-recovery). Neonatal death was more prevalent in countries with low HE (p = 0.009) and low HDI (p = 0.023) but was not influenced by maternal sociodemographic parameters.
Conclusion: Maternal and neonatal outcomes depended on country-specific socioeconomic characteristics, with a greater prevalence of maternal and neonatal deaths in women from countries with low HE. Globally, women with low income and lower levels of educational attainment had poorer outcomes, irrespective of region. Attempts should be made to improve patient education, and allocation of adequate health resources to improve maternal and neonatal outcomes in PPCM.
111430
Modality: WHF Abstracts – Young Researcher
Category: NEGLECTED CARDIOVASCULAR DISEASES
D: 14/10/2022 H: 16:50/17:50
L: Auditório 14
WHESLEY TANOR SILVA1, Matheus Ribeiro Ávila1, Pedro Henrique Scheidt Figueiredo1, Lucas Frois Fernandes de Oliveira1, Vanessa Amaral Mendonça1, Ana Cristina Rodrigues Lacerda1, Vanessa Pereira Lima1, Henrique Silveira Costa1
(1) Universidade Federal dos Vales do Jequitinhonha e Mucuri UFVJM
Introduction: In the functional assessment of patients with Chagas cardiomyopathy, peak oxygen consumption (VO2peak) and ventilatory equivalent of carbon dioxide (VE/VCO2 slope) have already been shown to be parameters of clinical and prognostic relevance. However, other variables assessed by the Cardiopulmonary Stress Test need to be investigated. The peak end-tidal carbon dioxide pressure (PETCO2 peak) has been prominent in the therapy of patients with heart failure. However, its behavior is still unknown in patients with Chagas cardiomyopathy and systolic dysfunction.
Objective: To verify, in patients with Chagas cardiomyopathy and systolic dysfunction, the association between peak PETCO2 and functional and echocardiographic parameters.
Methods: Seventy-six patients with Chagas cardiomyopathy and systolic dysfunction (49.9 ± 10.8 years, 60% male, NYHA I to III) were recruited and underwent clinical evaluation, echocardiography and Cardiopulmonary Stress Test. Systolic dysfunction was defined as a left ventricular ejection fraction (LVEF) of less than 52 or 54% for men and women, respectively. The variables of interest were PETCO2 peak, VO2peak and VE/VCO2 slope (on Cardiopulmonary Stress Test) and LVEF and left ventricular diastolic diameter (LVd) (on echocardiogram).
Results: In the sample, the mean peak PETCO2 was 33.6 ± 4.9 mmHg. In the correlation analysis, PETCO2 peak was associated with VO2peak (r = 0.355; p = 0.008), VE/VCO2 slope (r = –0.626; p < 0.001) and with LVEF (r = 0.299; p = 0.029). There was no correlation between peak PETCO2 and VEd.
Conclusion: These results suggest that peak PETCO2 is associated with important clinical and functional parameters of patients with Chagas cardiomyopathy and should be used in the management of patients with Chagas cardiomyopathy.
112213
Modality: WHF Abstracts – Young Researcher
Category: NEGLECTED CARDIOVASCULAR DISEASES
D: 14/10/2022 H: 16:50/17:50
L: Auditório 14
JULIANA DA ROCHA FERREIRA1, Juliana da Rocha Ferreira1, Julia Passarelli Perreira1, Marcelo Machado Melo1, Helena Cramer Veiga Rey1, Glauber Monteiro Dias2
(1) Instituto Nacional de Cardiologia – INC; (2) Universidade Estadual do Norte Fluminense Darcy Ribeiro – UENF
Aortopathies are a silent disease with a high natural fatality rate. Multiple genes have been linked to hereditary aortic thoracic disease (HATD), and it is believed that 30% of people have a deleterious mutation. This study aimed to uncover genetic variations related to aortopathies using genomic and molecular analysis. Seventy-nine people with aortopathies were studied using clinical data, target-NGS (tNGS), and the Sanger sequencing. The ACMG classification was used to find causal variations. This study defined a severe phenotypic population. Aortic dissection occurred in 49.4% of patients diagnosed at 44.59 years old, mainly after 40, and required surgery at 72.2%. Seven pathogenic variants (PV), 4 likely pathogenic variants (LPV), and 22 variants of uncertain significance (VUS) were discovered. tNGS found 10.37 percent of ATDs in this cohort. Direct sequencing of the fibrillin-1 gene (FBN1) yielded 37.5% diagnostic yield for Marfan syndrome suspect individuals, with two PV and one LPV. PV/LPV variants were identified in 6 genes (ACTA2, FBN1, MYLK, SMAD3, TGFB2, TGFBR2), being FBN1 the most prevalent (6 var). Seven PV/LPV are novel variants. Patients with VP/PPV had a younger mean age (39.3 years vs. 44.4 years) and a larger mean aorta diameter (39.3 years vs. 44.4 years) (6.56 vs 5.66 cm), however no statistic significance was achieved. Both groups required surgery (81.8%), with the VP/PVP group having a worse prognosis and severity. An emphasis is placed on clinical suspicion in selecting the genetic test to use and increasing the yield.
111396
Modality: Best Abstracts Oral – Researcher
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
D: 14/10/2022 H: 10:40/11:40
L: Auditório 14
MARTIN BOBAK1, Steven Hageman2, Hynek Pikhart1, Abdonas Tamosiunas3, Andrzej Pajak4, Ruzena Kubinova5, Wentian Lu1
(1) University College London (UCL), United Kingdom; (2) Utrecht University, Utrecht, The Netherlands; (3) Lithuanian University of Health Sciences, Kaunas, Lithuania; (4) Jagiellonian University Medical College, Krakow, Poland; (5) National Institute of Public Health, Prague, Czech Republic
Introduction: The cardiovascular disease (CVD) risk prediction model SCORE2 uses several biomedical and behavioural factors. It is likely that other factors may also contribute to CVD risk prediction. Cognitive impairment and CVD are associated and share some risk factors. While the causality of this relationship remains unclear, adding cognitive measures to risk prediction may be useful for predicting future CVD events.
Objective: To test the hypothesis that including simple measures of cognitive functions improve the prediction of SCORE2 for future CVD events.
Methods: We used data on 13,391 Polish, Lithuanian and Czech adults without CVD at baseline (45–69 years) from the Health, Alcohol and Psychosocial factors In Eastern Europe cohort. Incident cases of myocardial infarction (MI), stroke, CVD mortality and composite (fatal and non-fatal) CVD events were identified over a 10-year follow-up. Baseline cognitive measures included immediate and delayed word recall (verbal memory and learning), animal naming (verbal fluency) and letter cancellation (attention, mental speed and concentration). Using competing-risks regression, relationships between cognitive functions and CVD outcomes were examined. Improvement in Receiver Operating Characteristic (ROC) was used to compare predictive performance for CVD events of models including SCORE2 variables combined with cognitive tests vs SCORE2 alone.
Results: Incidence rates of MI, stroke, CVD mortality and composite CVD events were 5%, 4%, 4% and 11%, respectively. All four cognitive measures were inversely associated with CVD outcomes; e.g. one standard deviation increase in immediate word recall score was associated with a 28% and 17% reduction in risk of CVD mortality and composite CVD events, respectively. Adding cognitive measures to SCORE2 variables improved the ROCs for prediction of MI, CVD mortality and composite CVD events. E.g. for the composite CVD measure, inclusion of all four cognitive measures increased the ROC area from 0.6948 to 0.7030 (p < 0.001) and similar improvement was seen for word recall.
Conclusion: Including even a single (and simple) cognitive test in assessment of cardiovascular health can improve prediction of future CVD risk and it may be potentially feasible to do so in general practice.
110777
Modality: Best Abstracts Oral – Researcher
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
D: 14/10/2022 H: 10:40/11:40
L: Auditório 14
MARCUS VINICIUS SIMÕES1, Pedro Gabriel Barros e Silva2, Denilson Campos Albuquerque3, Renato Delascio Lopes4, Luis Eduardo Paim Rohde5, Lidia Zytinsky Moura6, Fabiana Goulart Marcondes-Braga3, Evandro Tinoco Mesquita3, José Albuquerque de Figueiredo Neto7, Ricardo Mourille Rocha8, João David de Souza Neto9, Mucio Tavares Oliveira Junior10
(1) Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, SP, Brasil; (2) Brazilian Clinical Research Institute (BCRI), Sao Paulo, Brazil; (3) Sociedade Brasileira de Cardiologia, Departamento de Insuficiência Cardíaca – DEIC, Rio De Janeiro, Brazil; (4) Duke Clinical ResearchInstitute, Durham, United States of America; (5) Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; (6) Santa casa, Curitiba, Brazil; (7) Centro de Pesquisa Clínica doHospital Universitário da Universidade Federal do Maranhão (CEPEC-HUUF, Sao Luis, Brazil; (8) PedroErnesto University Hospital, Rio De Janeiro, Brazil; (9) Messejana Hospital, Fortaleza, Brazil; (10) Heart Institute (InCor), University of São Paulo Medical School, Brazil
Background: Chagas cardiomyopathy (CC) is a prevalent cause of heart failure in Latin America countries. Studies describing clinical manifestations and outcomes of heart failure associated to CC are scarce.
Purpose: Report the results of the I Brazilian Heart Failure Registry (BREATHE) addressing the clinical and laboratorial characteristics, and outcomes of patients with acute heart failures (AHF) due to CC in comparison to other etiologies.
Methods: BREATHE was a multicenter nationwide prospective registry, enrolling 3,013 adult patients hospitalized with AHF, median follow-up of 346 days. We proceeded the comparative analysis between 261 (8.7%) patients with CC and 2,752 (91.3%) patients with other etiologies, concerning clinical, demographic, cardiac structure/function on Echocardiogram, death rate or heart transplantation during hospital stay and death rate at 3, 6 and 12 months after discharge. The categorical variables were compared by using Fisher Exact test and the continuous variables were compared by using Mann-Whitney test. A multivariate logistic model was used to estimate the odds ratio of CC in 12-month mortality adjusted for clinically relevant variables.
Results: CC patients, in comparison to other etiologies, were younger (60.6 ± 13.9 vs 65.7 ± 15.7 y.o., p < 0.001), presented lower systolic blood pressure (108.3 ± 26.1 vs 128.3 ± 30.3 mmHg, p < 0.001), lower heart rate (77.3 ± 22.1 vs 88.5 ± 23.2 bpm, p < 0.001), higher rate of jugular vein distension (54.8% vs 38.9%, p < 0.001) and hepatomegaly (47.9% vs 25.6%, p < 0.001), higher rate of “cold and wet” clinical hemodynamic profile (27.2 vs 10.6%, p < 0.001); larger diastolic left ventricular (LV) diameters (65 [57–72.8] vs 59 [51–66] mm, p < 0.001), and lower LV ejection fraction (25.4 [19–36]% vs 37 [27–54]%, p < 0.001), with higher rates of dobutamine use (23.8% vs 6.8%, p < 0.001); presented higher rate of death or heart transplantation during hospital stay (11.1% vs 17.4%, p = 0.004), and higher cumulative death rate after discharge at 3-months (16.5% vs 10.8%, p = 0.017, at 6-months (25.7% vs 17.5%, p = 0.006, and at 12-months (40.8% vs 27.8%, p < 0.001). In a multivariate analysis, CC was independently associated with 12-month mortality risk with odds ratio = 2.02 [95% IC: 1.47;2.77].
Conclusions: Patients hospitalized with AHF with CC etiology, in comparison to other etiologies, presented higher-risk profile that was associated with a poorer outcome during hospital stay and after discharge.
111321
Modality: Best Abstracts Oral – Researcher
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
D: 14/10/2022 H: 10:40/11:40
L: Auditório 14
PEDRO GABRIEL MELO DE BARROS E SILVA1, Ana Amaral3, Antonielle Figueiredo Macedo4, Celso Musa Correa5, Eduardo Zincone6, Marcelo Paiva Cury7, Gustavo Augusto Lopes Rosa8, Alexandre de Matos Soeiro9, Carlos Alexandre Lemes de Oliveira10, Augusto Celso De Araujo Lopes Junior11, Adriana Bertolami7, Renato Delascio Lopes12
(1) Hospital Samaritano Paulista; (2) Cardiologia Americas; (3) Hospital Pro-cardíaco; (4) Hospital da Luz; (5) Americas Medical City; (6) Hospital Santa Helena; (7) Metropolitano Lapa; (8) Ipiranga Mogi; (9) Incor HC FMUSP; (10) Hospital Paulistano; (11) Hospital Monte Klinikum; (12) Brazilian Clinical Research Institute
Background: Chest pain is a major cause of medical evaluation at emergency department (ED) and demands observation in order to exclude the diagnosis of acute myocardial infarction (AMI). Recent algorithms using high-sensitivity cardiac troponin assays at 0 h and 1 h are accepted as a rule-out/rule-in strategy but there is a lack of validation in specific populations.
Methods: IN-HOPE was a multicentre prospective study that included patients admitted to the ED due to suspected symptoms of AMI at 16 sites in Brazil. All patients followed the standard approach of 0–3h but, in addition, blood samples were also collected at 0 and 1 hour and sent to a core laboratory to measure high sensitivity troponin T (hs-cTn T) Elecsys (Roche). Troponin <12 ng/L with a delta <3 was considered rule out while a value ≥52 and/or a delta ≥5 was considered rule in for AMI. The main objective of the study was to assess the accuracy of 0–1 h rule-out/rule-in algorithm in comparison to the standard of care (0–3h). All patients were followed for 30 days. In addition to the prospective cohort, a retrospective analysis was performed assessing all patients with hs-cTn T measured during 2021 but not included in the prospective cohort.
Results: A total of 5.497 patients were included (583 in the prospective and 4.914 in the retrospective analysis). The prospective cohort had a mean age of 57.3 (±14.8) and 45.6% of females with a mean HEART score of 4.0 ± 2.2. By the core lab analysis, 71.6% would be eligible for a rule-out approach while 7.3% would fit the rule-in criteria. At 30 days, no death or AMI occurred in the rule-out group while 64.9% of the patients in the rule-in group were considered as AMI. In the retrospective analysis, 1.091 patients had a troponin value <5 ng/L without cardiovascular deaths in this group. Among all 4.914 patients, the 30-day risk of AMI or cardiovascular death increased according to the level of troponin: 0% in the group <5 ng/L, 0.6% between 5 and 14 ng/L, 2.2% between 14 and 42 ng/L, 6.3% between 42 and 90 ng/L and 7.7% in the level ≥90 ng/L.
Conclusions: In this large multicentre Brazilian study, a 0–1h algorithm was effective for classifying as rule in or out almost 80% of the patients. The rule-out protocol had high negative predictive value regardless clinical risk scores. Categories of levels of hs-cTn T also showed good accuracy in discriminating risk of the patients with a very favourable prognosis for the group with values <5 ng/L.
112023
Modality: Best Abstracts Oral – Researcher
Category: CARDIOVASCULAR SURGERY
D: 14/10/2022 H: 10:40/11:40
L: Auditório 14
LUIS EDUARDO PAIM ROHDE1, Marcio R. Martins1, Luis E. Rohde1, Flávia K. Borges2, Andre Lamy2, Richard Whitlock2, P. J. Devereaux2, Carisi A. Polanczyk1
(1) Hospital de Clinicas de Porto Alegre, Post Graduate Program in Cardiovascular Sciences and Cardiology, UFRGS; (2) McMaster University, Hamilton Health Sciences
Background: Previous studies addressing the association of chronic kidney disease (CKD) and prognosis after open-heart surgery had limited sample sizes and retrospective designs.
Methods: We investigated the association of preoperative renal function and in-hospital mortality, and major cardiac and cerebrovascular events (MACCE) in patients enrolled in the prospective multicentric VISION Cardiac Surgery Study. Patients were divided in 5 CKD stages according to preoperative estimated glomerular filtration rate (eGFR in mL/min/1.73 m2): Stage I(>90; n = 1914), Stage II(60 to 89; n = 8122), Stage III(30 to 59; n = 3406), Stage IV(<30; n = 352) and Stage V(dialysis; n = 227).
Results: 15,837 were included in the current analysis (71% male, 66% hypertensive and 20% >75 y.o.). Mortality and MACCE during the first 30 days occurred in 480(3%) and 1727(11%) patients, respectively. Logistic regression models adjusted for EuroSCORE demonstrated increased 30-day mortality in CKD Stage III (odd ratio[OR], 1.82; 95% confidence internal[CI], 1.36–2.41), CKD Stage IV (OR, 2.62; 95% CI, 1.66–4.15) and in patients in dialysis (OR, 3.56; 95% CI, 2.17–5.85) In analysis across the whole spectrum of renal function (Figure), mortality was increased particularly when eGFR was <45 mL/min/1.73 m2, while MACCE risk was observed in less severe stages of CKD.
Conclusion: In this contemporary cohort, CKD was significantly associated with morbidity and mortality after open-heart surgery.
112135
Modality: Best Abstracts Oral – Researcher
Category: DIGITAL HEALTH/INNOVATION
D: 14/10/2022 H: 10:40/11:40
L: Auditório 14
LUIZ SÉRGIO FERNANDES DE CARVALHO1, Gustavo Alexim5, Ana Claudia Cavalcante Nogueira3, Marta Duran Fernandez1, Tito Barbosa Rezende4, Sandra Avila4, Ricardo Torres Bispo Reis6, Alexandre Anderson Munhoz Soares3, Andrei Carvalho Sposito4
(1) Clarity: Inteligência em Saúde; (2) Universidade Católica de Brasília; (3) Instituto Aramari Apo; (4) UNICAMP; (5) Hospital de Base do Distrito Federal; (6) Universidade de Brasília
Introduction: Among individuals with premature acute coronary syndromes (prACS, <55 years-old), prevalent risk factors and the magnitude of their impact on recurrent ischemic events critically differ from older subjects. In that sense, it is plausible to develop risk prediction rules specific for young individuals. Our aim was to evaluate potential improvements in risk prediction quality among prACS by (i) developing models specifically in prACS subjects versus in the global cohort; (ii) splitting predictive rules into two models (short- and long-term prediction windows [STWm and LTWm]) versus a global follow-up model (GFm).
Methods: Consecutive individuals with ACS who undergone coronarography up to 48h after hospital admission from January/2011 to February/2020. 6341 subjects (2242 with prACS) admitted into public hospitals in Brasília (Brazil). The observation window in STWm and GFm included the first 48h upon hospital admission, and LTWm included all in-hospital information. prACS cohort was divided into train/validation-set (70%, n = 1569) and test-set (30%, n = 673); global cohort was divided in training/validation-set (70%, n = 4439) and test-set including the 673 prACS subjects. Models were repeated over five cross-validation folds and then assessed in the test-set. C-statistics was the evaluation metric for STWm and time-dependent concordance (Ctd-index) for LTWm. STWm evaluated the occurrence of in-hospital cardiovascular deaths and recurrent ACS (MACE) and LTWm estimated events occurring post-discharge from index ACS hospitalization considering time-to-event with competing risks (MACE versus non-cardiovascular deaths).
Results: Median follow-up of 6.7 years (95%CI 5.6–7.2). Among prACS and older subjects, respectively, in-hospital MACE occurred in 180 and 493 individuals, post-discharge MACE in 454 and 881; and post-discharge non-cardiovascular death in 47 and 285. The best strategy was to design models specifically in prACS individuals combining STWm and LTWm. Among prACS subjects STWm and LTWm, respectively, TabNet and DeepHit yielded the best C-statistics [0.921 (95%CI 0.889–0.953)] and Ctd-index [0.722 (95%CI 0.678–0.760)], while the best Ctd-index in GFm was 0.681 (95%CI 0.654–0.703). There was very low concordance among top predictors of MACE for prACS versus global cohort, as well as for STWm versus LTWm.
Conclusions: Risk prediction in ACS is optimized by using specific rules for prACS and combining short-term and long-term prediction windows.
109042
Modality: Best Abstracts Oral – Young Researcher
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
D: 14/10/2022 H: 09:00/10:00
L: Auditório 14
GUSTAVO AUGUSTO FERREIRA MOTA 1, Sérgio Luiz Borges de Souza1, Danielle Fernandes Vileigas2, Vitor Loureiro da Silva1, Paula Grippa Sant’Ana1, Licia Carla Silva Costa3, Silméia Garcia Zanatti Bazan1, Marília Afonso Rabelo Buzalaf4, Lucilene Delazari dos Santos5, Marina Politi Okoshi1, Mariana Gatto1, Antonio Carlos Cicogna1
(1) São Paulo State University, UNESP, Botucatu Medical School, Brazil; (2) University of São Paulo, USP, Institute of Chemistry, Brazil; (3) University of Campinas, UNICAMP, Institute of Biology, Brazil; (4) University of São Paulo, USP, Bauru Dental School, Brazil; (5) São Paulo State University, UNESP, Biotechnology Institute, Brazil
Introduction: The beneficial effect of aerobic exercise training (ET) on cardiac remodeling induced by aortic stenosis (AS) has been observed in experimental studies. However, the mechanisms involved in cardiac function improvement are not fully understood. In this study we investigated the myocardial proteoma in rats with AS subjected to ET.
Methods: Wistar rats (n = 60, 21 days) were divided into 2 groups: operated control (C) and supravalvar aortic stenosis (AS). AS was induced by the insertion of a stainless-steel clip, 0.60 mm, around the ascending aorta. Two weeks after surgery, rats were assigned into 4 groups: C, exercised C (C-Ex), AS and exercised AS (AS-Ex). Exercised rats underwent treadmill exercise 5 days a week for 4 months, at 60% of the maximal functional capacity. Two and 18 weeks after surgery, rats were subjected to echocardiogram. Functional capacity was analyzed by treadmill maximum exercise testing and blood lactate concentration. Myocardial proteome was assessed by label-free shotgun approach using mass spectrometry. Protein expression was quantified by Western blotting. Statistical analysis was performed by ANOVA or Kruskal-Wallis; significance level of 5%.
Results: Two weeks after AS induction, AS rats had diastolic and systolic dysfunction and concentric hypertrophy. At the end of the protocol, AS maintained the same remodeling pattern; the AS-Ex group presented lower left atrium diameter-to-aortic diameter and lactate concentration; and higher E/E’ ratio, percentage of midwall fractional shortening, and functional capacity than AS. After enrichment analysis by Gene Ontology, myocardial proteome analysis showed higher expression of proteins related to glycolytic pathway, oxidative stress, and inflammation, and lower expression of proteins associated with beta-oxidation in AS than C. The AS-Ex had higher expression of proteins related to mitochondrial biogenesis and lower expression of proteins related to oxidative stress and inflammation than AS. Expression of proteins of physiological and pathological hypertrophic pathways did not differ between groups, except for p-p38, which was higher in the AS than C group.
Conclusion: Aerobic exercise training improves cardiac remodeling and mitochondrial biogenesis, and attenuates oxidative stress and inflammation in rats with ascending aortic stenosis. Financial support: CNPq, FAPESP, and UNESP.
108618
Modality: Best Abstracts Oral – Young Researcher
Category: PHYSICAL EDUCATION
D: 14/10/2022 H: 09:00/10:00
L: Auditório 14
FRANCIS RIBEIRO DE SOUZA1, Carlos Eduardo Rochitte1, Douglas Carli Silva1, André Matheus Rodrigues Gomes1, Marcelo Rodrigues dos Santos1, Guilherme Wesley Peixoto da Fonseca1, Antonio Carlos Battaglia Filho1, Kelly Thayane Souza Correa1, Maurício Yonamine2, Rosa Maria Rodrigues Pereira3, Carlos Eduardo Negrão1, Maria Janieire de Nazaré Nunes Alves1
(1) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (InCor, HCFMUSP); (2) Faculdade de Ciências Farmacêuticas da Universidade de São Paulo (FCF/USP); (3) Laborátorio de Reumatologia e Metabolismo Ósseo da Faculdade de Medicina da Universidade de São Paulo (FMUSP)
Background: The illicit use of anabolic androgenic steroids (AAS) has been associated with diminished cholesterol efflux mediated by HDL, remarkable decrease in high-density lipoprotein (HDL) plasma concentration and subclinical coronary artery disease (CAD). Inflammation is the key to the atherogenic process associated with atherosclerotic plaque vulnerability. The pericoronary mean fat attenuation (pFAM) has emerged as a marker of coronary inflammation and can predict future cardiovascular events, which is measurable from standard coronary computed tomography angiography (CCTA). However, whether AAS abuse has a role in pFAM in young male AAS users is unknown.
Purpose: The aim of this study was to evaluate whether AAS abuse could leads to higher pFAM and premature coronary inflammation in young male AAS users.
Methods: Twenty strength-trained AAS users (AASU) age 29 ± 5 yr, 20 age-matched strength-trained AAS nonusers (AASNU), and 10 sedentary controls (SC) were enrolled in this study. Coronary inflammation was assessed by pFAM-CCTA in the right coronary artery (RCA), left anterior descending artery (LDA) and left circumflex coronary artery (Cx).
Results: pFAM in RCA was significantly higher in AASU compared with AASNU and SC (–64.59 ± 9.45 vs. –79.21 ± 6.67 vs. –80.97 ± 7,91 Hounsfield Units (HU), respectively, p < 0.001]. Also, the pFAM in the LAD was higher in AASU compared with AASNU and SC (–72.83 ± 7.21 vs. –79.41 ± 6.72 vs. –80.97 ± 7.72 HU, p = 0.006). However, no difference to pFAM in the Cx between AASU, AASNU and SC (–74.30 ± 5.85 vs. –79.77 ± 7.13 vs. –78.19 ± 5.82 HU, respectively, p = 0.069) was found.
Conclusion: This study indicates that AAS abuse may be associated with higher pFAM and premature coronary inflammation in the RCA and LAD. In addition, the higher pFAM may be linked to early development of CAD in young AAS users.
109119
Modality: Best Abstracts Oral – Young Researcher
Category: DIGITAL HEALTH/INNOVATION
D: 14/10/2022 H: 09:00/10:00
L: Auditório 14
KELSEY BROWN1, Pooneh Roshanitabrizi, PhD3, Alison Reese, MS1, Andrea Beaton, MD2, Emmy Okello, PhD4, Joselyn Rwebembera, MMed4, Peter Lwabi, MMed4, Emma Ndagire, MMed4, Craig Sable, MD1, Marius George Linguraru, DPhil3
(1) Children’s National Hospital; (2) Cincinnati Children’s Hospital Medical Center; (3) Sheikh Zayed Institute for Pediatric Surgical Innovation; (4) Uganda Heart Institute
Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mortality from heart disease in children and young adults. The mitral regurgitation (MR) jet length on color Doppler echocardiography is an important index for diagnosis, but its measurement and interpretation are variable.
Objective: Develop an automatic machine learning approach to identify and measure the MR jet length on color Doppler for RHD detection. Methods/Design: We used 316 echocardiograms in video format from 95 children (mean age 12 ± 2 years; range 5 to 17 years) with DICOM color Doppler images of the mitral valve taken from parasternal long axis (PLAX) and apical 4 chamber (AP4) views. All echocardiograms were independently reviewed by an adjudication panel which consisted of four expert pediatric cardiologists to determine maximum MR jet length and diagnosis (RHD positive or not). Among 95 cases, 29 were normal and 66 had RHD. Our automated method included. (1) Selection of frames during ventricular systole using a convolutional neural network architecture based on the ResNet-50. (2) Localization of left atrium using convolutional neural networks with LinkNet structure. (3) Measurement of MR jet length using image color analysis. (4) Detection of RHD by applying a generalized regression model based on the maximum MR jet length measured on each view and maximizing the balanced accuracy using cross validation.
Results: Machine learning selected the correct systolic frame with an average accuracy of 0.95 (sensitivity 97%/specificity 93%) and 0.94 (sensitivity 94%/specificity 94%) for the AP4 and PLAX view, respectively. It localized the atrium with an average Dice coefficient of 0.89 and 0.9 for the AP4 and PLAX view, respectively. We estimated the length of the MR jet with an average absolute error of 0.33 ± 0.4 cm (p-value = 0.15 compared to manual measurements). Our deep learning approach performed similar to or better than previously published manual methods for categorization of RHD positive vs negative. The accuracy of RHD detection was 0.84 (sensitivity 86%/specificity 79%).
Conclusion: Our automatic method has the potential to reliably detect RHD as accurately as expert cardiologists. This innovative approach holds promise to scale echocardiography screening for RHD and greatly expand prophylaxis to prevent progression of RHD globally.
109213
Modality: Best Abstracts Oral – Young Researcher
Category: CARDIO-ONCOLOGY
D: 14/10/2022 H: 09:00/10:00
L: Auditório 14
JAVIER ELIECER PEREIRA RODRIGUEZ1, Fernando Rivera-Theurel2, Jorge Antonio Lara-Vargas3, Devi Geesel Peñaranda-Florez1, Pedro Pereira-Rodriguez4, Karla Dominguez-Gomez1, Kelly Perez-Diaz1, Dafne Palacios-Toledo1, Hiady Rivera-Lopez1, Alondra Mijangos-Dolores1, Isaias Sánchez-García1
(1) Centro de Estudios e Investigación FISICOL; Colombia; (2) University of Toronto; Canada; (3) Cardiofit; México; (4) Clínica Medical Duarte; Colombia
Introduction: Cardio-Oncology aims to prevent and treat cardiac dysfunction induced by anti-oncological therapies. One emergent strategy is the physical activity, which has been considered an important strategy to improve quality of life and outcomes in the susceptible population.
Objective: Determine the cardiovascular effects of Moderate Intensity Continuous Training (MICT) and High Intensity Interval Training (HIIT) on oncological patients newly diagnosed with cardiovascular disease (CVD).
Methodology: Randomized controlled trial with sample of 690 with oncological patients with a new diagnose of CVD (heart failure and ischemic heart disease) distributed in 3 groups (MICT, HIIT and control group). We identified the echocardiogram, cardiac biomarkers, stress test, clinical and hemodynamic parameters, hematological samples were identified. In addition, 6-minute walk, anthropometry, quality of life, fatigue, sarcopenia. The tests were performed pre and post 36 sessions of 70-minute training. Then, descriptive statistics were carried out to estimate, the normality of the data was assessed by the Kolmogorov-Smirnov test and the indication of specificity was evident for all analyzes. Also, the ANOVA analysis of variance (one-way analysis of variance) was used, and subsequently, post hoc tests with Tukey test. In all cases, a significance level was 5% (p = <0.05).
Results: After an structured exercise program, there was an increase in left ventricular ejection fraction (LVEF) (EG1: 40 ± 5 vs 44 ± 4%; EG2: 41 ± 4 vs 47 ± 3%; CG: 40 ± 3 vs 40 ± 1%; p < 0.05). In fact, higher values of functional capacity (VO2peak) were noted in the experimental group 2-HIIT (7.0 ± 5.2 vs 9.7 ± 3.7) compared to experimental group 1-MICT (8.0 ± 4 vs 8.5 ± 3) and control group (9.0 ± 5.0 vs 9.2 ± 4.0). Other parameters results incuded systolic blood pressure (135 ± 10 vs 127 ± 2 mmHg), diastolic blood pressure (85 ± 5 vs 80 ± 2 mmHg), maximum heart rate (166 ± 10 vs 179 ± 5bpm) and quality of life (106 ± 8 vs 73.2 ± 11). It was possible to show significant changes in all variables comparing HIIT vs MICT groups (p = <0.05), and also compared to the control group.
Conclusions: HIIT and MICT in oncological patients with newly diagnosed CVD improved the LVEF, functional capacity (VO2peak), hemodynamic parameters (systolic and diastolic blood pressure), exercise tolerance, depression, anxiety, strength, Cancer related fatigue improved as well as other specific cancer variables such as sarcopenia, and quality of life.
109929
Modality: Best Abstracts Oral – Young Researcher
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
D: 14/10/2022 H: 09:00/10:00
L: Auditório 14
LETICIA MARA DOS SANTOS BARBETTA1, Letícia Mara dos Santos Barbetta1, Eduardo Thadeu de Oliveira Correia1, Ronaldo Altenburg Odebrecht Curi Gismondi1, Antônio José Lagoeiro Jorge1, Evandro Tinoco Mesquita1
(1) Universidade Federal Fluminense; (2) Instituto Cardiovascular do Complexo Hospitalar de Niterói; (3) Centro de Educação e Treinamento Edson Bueno – UnitedHealth Group; (4) Hospital Niterói D’Or
Introduction: Previous randomized trials showed conflicting results regarding the effectiveness of influenza vaccination on cardiovascular outcomes in patients with coronary artery disease (CAD). These studies were not adequately powered to show the effectiveness of influenza vaccine on major adverse cardiovascular events (MACE); all-cause mortality or cardiovascular mortality. Therefore, this up-to-date meta-analysis combines data from randomized trials to assess the effectiveness of influenza vaccination on endpoints in patients with CAD.
Methods: We performed a search of the Cochrane Controlled Register of Trials, Embase, MEDLINE, www.ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform from inception to September 2021. Two authors performed the screening, quality analysis and data extraction. A p-value <0.05 was defined as statistically significant. This study protocol is available in PROSPERO under the following registration number CRD42021282917.
Results: We identified 355 records through search of databases. After duplicate analysis, 258 articles remained, of which 239 were excluded based on title and/or abstract analysis. Nineteen full-text articles were assessed for eligibility, and 5 articles were selected for inclusion. Five trials were included in this meta-analysis, comprehending 4238 patients, from which 2116 were controls and 2122 received influenza vaccination. Influenza vaccination reduced all-cause mortality compared with placebo (RR 0.50, CI 0.29–0.88, p = 0.02). However, in a prespecified subgroup analysis, influenza vaccination only reduced all-cause mortality in patients with acute coronary syndrome (ACS) (RR 0.44, CI 0.23–0.82, p = 0.01), but not in stable CAD (RR 1.02, CI 0.32–3.31, p = 0.97). Moreover, influenza vaccination reduced cardiovascular mortality compared with placebo (RR 0.54, CI 0.37–0.80, p = 0.002). Regarding MACE, influenza vaccination was effective compared with placebo (RR 0.65, CI 0.48–0.88, p = 0.005), especially in ACS (RR 0.58, CI 0.39–0.87, p = 0.007), although it was not effective in stable CAD (RR 0.91, CI 0.54–1.54, p = 0.72).
Conclusions: The results of this meta-analysis shows that influenza vaccination is effective to reduce all-cause mortality, cardiovascular mortality and MACE among patients with CAD, especially those with ACS. Healthcare strategies must be outlined to deliver this cheap and effective intervention in order to reduce hard outcomes for CAD patients.
109253
Modality: Best Abstracts Oral – Scientific Initiation
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
D: 13/10/2022 H: 15:40/16:40
L: Auditório 05
NICHOLAS VINCENT LEE1, Nicolas Henrique Borges1, Thiago Mateus Godoy1, Sabriany Nunes Mendes1, Anna Flavia R S Miggiolaro1, Rafaela C Zeni1, Lucas Baena Carstens1, Marcos Roberto Curcio Pereira1, David Batista Wiedmer1, Marina Luise Viola de Azevedo1, Lúcia de Noronha1
(1) PONTIFICIA UNIVERSIDADE CATÓLICA DO PARANÁ – PUC/PR
Introduction: Vascular endothelial cells are involved in the immune response mediated by SARS-CoV-2, which, when activated, has a significant influence on cell stability, culminating in edema, thrombosis, and endothelial dysfunction. The pathways responsible for this endotheliopathy process are still being discussed in the literature. Therefore, the analysis of the vascular events involved in the disease is necessary to concatenate findings that justify the cardiovascular repercussions.
Objective: Evaluate the tissue expression of endothelium dysfunction markers, Intercellular Adhesion Molecule 1 (ICAM-1), angiotensin 2 (ANGIO-2), interleukin-1-β (IL1β), and Von Willebrand Factor (VWF) and correlate with endothelial activation/dysfunction in the vascular endothelium of lung samples from COVID-19 patients and compare with H1N1 and control cases.
Method: The study analyzed post mortem lung samples (COVID-19 group = 20 cases; Group H1N1 = 10 cases and control group = 11 cases) through immunohistochemistry, using the primary monoclonal antibody of anti-ICAM-1, anti-ANGIO 2, anti-IL1β, and anti-VWF. The immunostained slides were scanted and selected by blinding. Then, software was responsible for quantifying the tissue expression of ICAM-1, ANGIO-2, IL-1β, and VWF obtained in each case. The findings were compared using the Kruskal-Wallis nonparametric test.
Results: The histopathological characteristics of pulmonary vascular damage caused by H1N1 differ from those observed in the COVID-19 group. For ICAM-1, an increase in expression was observed with statistically significant (p < 0,0001) when comparing the COVID group with both the control and H1N1 groups. The same pattern was repeated in the expression of IL-1β. Although, for ANGIO-2 and VWF, there was no statistical significance when comparing the COVID group with H1N1 (p > 0,05), when comparing the COVID group with the control group, the expression of these markers was higher (p < 0,05). In addition, there are no significant fibrinous thrombi or neutrophilic endotheliitis present in patients infected with H1N1.
Conclusions: Our results demonstrated endothelium activation and dysfunction secondary to cytokine storm. The endothelial injury and the state of hypercoagulability caused by COVID-19, when added to the blood stasis present in bedridden patients, culminating in the formation of the Virchow triad, capable of elevating the chances of systemic thrombotic events and cardiovascular repercussions.
111707
Modality: Best Abstracts Oral – Scientific Initiation
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
D: 13/10/2022 H: 15:40/16:40
L: Auditório 05
JORGE TADASHI DAIKUBARA NETO1, Jorge Tadashi Daikubara Neto1, Matheus Bissa Duarte1, Gustavo Sarot Pereira da Cunha1, Leonardo Henrique dos Santos de Melo1, Michelle Bozko Collini1, Carolina Ruschel Senger1, Jessica Tamires Reichert1, Raphael Henrique Déa Cirino1, Sabrina Bernardez2, Fábio Papa Taniguchi2, Miguel Morita Fernandes-Silva1
(1) Hospital de Clínicas – UFPR; (2) Hospital do Coração – HCor
Introduction: Acute Heart Failure (AHF) has high mortality and identifying those patients with worse prognosis helps guiding their management. However, current available prognostic assessment scores have sub-optimal performance, so they are rarely used in clinical practice.
Objective: Developing and validating a machine learning-based prognostic score to predict in-hospital death in patients with AHF and compare its performance with the Acute Decompensated Heart Failure National Registry (ADHERE) and the Get With the Guidelines–Heart Failure (GWTG-HF) scores.
Methodology: We included patients admitted with AHF in 17 brazilian hospitals participants of a multicenter study from 2016 to 2019. Clinical, laboratory and echocardiographic data and the WHOQOL-BREF quality of life questionnaire at hospital admission were used as covariates. The outcome was in-hospital death from any cause. Machine learning prediction models – using Random Forest, Gradient Boosting Machines, and Deep Neural Networks – were applied in 70% of the sample (training set) to develop the score (ML-HF score), which was validated on the 30% remaining of the sample (test set).
Results: From 2657 patients hospitalized for AHF, we included 887 [59% men, 61.6 ± 14.5 years, ejection fraction 41.8 ± 17.2%, 84 (9%) died] who had complete data. The five most important variables of the ML-HF score were: Physical Health Domain quality (WHOQOL-BREF), serum sodium, serum urea, serum creatinine and systolic blood pressure at hospital admission. In the test set, the ML-HF score showed good model calibration (Hosmer-Lemeshow test p value = 0.124) and good model discrimination area under the ROC curves [(AUC) = 0.739 (95%CI,0.652–0.825)], which was better than the GWTG-HF [AUC = 0.601 (IC95%, 0.459–0.743)], p = 0.05 and the ADHERE [AUC = 0.594(IC95%, 0.445–0.742)], p = 0.05 scores (figure).
Conclusion: We developed and validated a score using machine learning to predict in-hospital death in patients with AHF, which outperformed the ADHERE and GWTG-HF scores.
111880
Modality: Best Abstracts Oral – Scientific Initiation
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 13/10/2022 H: 15:40/16:40
L: Auditório 05
BEATRIZ SALES DE FREITAS1, Ana Carolina Sampaio Freire1, Caio Resende da Costa Paiva1, Isabel Gomes da Silva1, Gabriel Haiek Fernandes1, Gabriela Gonçalves Almeida1, Maria Luíza Marinho de Sá de Paula Lima1
(1) Universidade de Brasília (UnB)
Introduction: Heart transplant (HT) is one of the main surgeries by which patients with advanced and refractory heart failure can prolong their lives. Nonetheless, its complexity requires a well prepared staff and abundant financial resources, which can be a challenge in developing countries such as Brazil. In this scenario, searching for trends in epidemiology and regional disparities is key to scale the problem and propose interventions.
Objectives: To analyze data of HT in Brazil’s different regions between January 2008 and December 2021.
Methodology: Epidemiological inquiry based on data related to mortality rates and annual HT absolute numbers from 2008 to 2021 in Brazil. The data was obtained through the public domain national platform TABNET from the Informatic Department of the Brazilian Universal Healthcare System. A comparative analysis of data was made, in addition to complementary research in recent literature.
Results: From January 2008 to December 2021, 3.368 HTs were performed in Brazil. The main causes for HT were Ischemic Cardiomyopathy, followed by Congestive Heart Failure and Chagasic Cardiomyopathy. The majority of HTs were in the Southeast (n = 1792). In contrast, in the North, which doesn’t have specialized centers, no surgeries were performed (n = 0). It is possible to recognize an increase in the absolute number of procedures throughout the period analyzed followed by a decrease in the last two years. This decrease may be a consequence of the COVID-19 pandemic. Despite the upward trend described, the number of capacitated teams or centers remained fairly the same from 2014 to 2021. Regarding the mortality rates, 13,62% of the patients who underwent HT died in the procedure or in post-op care at the health service. In general, these mortality rates have been declining, going from 20,99% in 2018 to 9,27% in 2021, a possible effect of the evolution in transplant techniques. HTs represent a challenge for Brazil’s health system. In December 2021, 321 patients were waiting for the surgery. Compared to kidney, cornea and liver transplants, HT boasts one of the higher discrepancies between performed versus demanded transplants.
Conclusion: HT is a highly complex procedure that requires proper logistics, training, resources and specific post-op care, representing a challenge for Brazil’s public health system. Considering the demand of HTs in Brazil, it is necessary to create new centers and to train new teams, especially in the North.
112045
Modality: Best Abstracts Oral – Scientific Initiation
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 13/10/2022 H: 15:40/16:40
L: Auditório 05
LUIZ FELIPE FAÇANHA RAMOS1, Karen Tássia Façanha Ramos1, Hildeman Dias da Costa2, Ayrison Melo Sousa3, Reny Wane Vieira dos Santos1
(1) Universidade Federal do Amapá; (2) Universidade Federal de Rondônia; (3) Centro Universitário UNINORTE
Introduction: The increase in the amount of low-density lipoproteins (LDL cholesterol) or hypercholesterolemia is considered one of the factors in the occurrence and mortality of cardiovascular and cerebrovascular diseases, especially ischemic heart disease (IHD).
Objective: To relate hypercholesterolemia and IHD mortality in men in the countries of America in the year 2018.
Methodology: This is an analytical ecological study of geographic distribution with secondary data from the Health Information Platform for the Americas (PLISA), of the Pan American Health Organization (PAHO), of the year 2018, on the averages of total cholesterol and fractions and the mortality rates due to IHD in men in the countries of the American continent. The rates were standardized per 100,000 inhabitants with a confidence interval (CI) of 95%.
Results: Guyana had the highest IHD male mortality rate (228.9; 95% CI 175.8–312.7) in 2018 in America, followed by Haiti with the 2nd highest rate (190.3; 95% CI 124.6–278.8). In contrast, Peru has the lowest rate (46.6; 30.4–66.6) in the same year. In addition, it was shown that Guyana has men with the highest mean LDL cholesterol (x̄ = 3.81; 95% CI 3.56–4.05). It is noteworthy that Venezuela was the country with the lowest mean LDL cholesterol (x̄ = 3.23; 95% CI 3.03–3.41), despite having the third highest mortality rate in South America (130.9; 95% CI 98.9–169.1).
Conclusions: There is a positive linear correlation between high LDL cholesterol and mortality in men from IHD in America, as Guyana has the highest mortality rate and the highest mean LDL cholesterol in men in 2018. This suggests that public policies should be directed to combat hypercholesterolemia that can significantly increase mortality from ischemic heart disease.
112186
Modality: Best Abstracts Oral – Scientific Initiation
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
D: 13/10/2022 H: 15:40/16:40
L: Auditório 05
DHAYN CASSI DE ALMEIDA FREITAS1, Jefferson Luiz Vieira2, Sabrina Bernardez Pereira3, Fabiana Goulart Marcondes-Braga4, Wilson Nadruz Junior5, Silvia Marinho Martins Alves6, Gabriela Arcoverde Wanderley7, Jessica Tamires Reichert8, José Albuquerque de figueiredo neto9, Alana de Oliveira Castro9, Miguel Fernandes da Silva Morita8, Odilson Marcos Silvestre1
(1) Universidade Federal do Acre; (2) Hospital de Messejana – Dr. Carlos Alberto Studart Gomes; (3) Hospital do Coração; (4) Instituto do Coração – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; (5) Universidade Estadual de Campinas,; (6) Universidade de Pernambuco; (7) Pronto-Socorro Cardiológico Universitário de Pernambuco; (8) Universidade Federal do Paraná; (9) Universidade Federal do Maranhão
Background: There are still no studies that characterize regional differences in HFrEF in Brazil.
Objective: To compare regional characteristics in the socioeconomic, clinical, and treatment aspects of HFrEF in Brazil.
Methods: Rosa dos Ventos is a cohort study in all Brazilian states which will include 3,000 patients with outpatient HFrEF (EF < 50%). We carried out a cross-sectional study to compare the characteristics of patients (n = 853), according to the Brazilian region of origin: North (n = 115), Northeast (n = 351), Center-west (n = 140), Southeast (n = 77) and South (n = 170). We investigated socioeconomic characteristics, clinical presentation of HF, and use of at least four medications of guideline-directed medical therapy (GDMT) in HF (beta-blockers, mineralocorticoid antagonists, SGLT2 inhibitors, and ACE inhibitors or ARBs or ARNIs). We used Student’s T and Chi-square statistical tests.
Results: Comparing the patients, the youngest belonged to the southeast region (55 ± 14, p < 0.001), and were less frequently white (19%, p < 0.001) and with lower monthly familiar income (R$ 2176 ± 3015, p < 0.001) in the Northeast region. There was a higher percentage of chagasic etiology in the Central-West region (42%, p < 0.001) and of ischemic etiology in the North region (39%, p = 0.021), the latter region had the highest mean ejection fraction (37 ± 8, p < 0.001). The use of at least four GDMT drugs was more frequent in the Northeast (23%, p = 0.033) and South regions (22%, p = 0.033), with a higher frequency of ARNI use in the South (45%, p < 0.001).
Conclusions: The Rosa dos Ventos Study aims to determine regional differences in HFrEF, and the results will help in planning its prevention and treatment. These preliminary data suggest regional differences in the etiology and use of therapy.
108365
Modality: Best Poster – Researcher
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
D: 14/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
ANA CLÁUDIA CAVALCANTE NOGUEIRA1, Joaquim Barreto2, Beatriz Luchiari2, Isabella Bonilha2, Luiz Sérgio Fernandes de Carvalho3, Andrei Carvalho Sposito2
(1) Escola Superior de Ciências da Saúde – ESCS; (2) Atherosclerosis and Vascular Biology Laboratory (Aterolab), Cardiology Division, Universidade de Campinas – UniCamp; (3) Clarity Healthcare Intelligence
Background: We sought to compare the effectiveness and cost-effectiveness of cardioprotective glucose-lowering therapies in individuals with T2D in a middle-income country.
Methods: A systematic search was performed for randomized clinical trials published until April 2021 reporting the incidence of MACE for pioglitazone, GLP1A, or SGLT2i. Using date from two national cohorts of T2D, we developed a Markov model to estimate the outcomes for each treatment based on incremental cost-effectiveness ratio (ICER) and the disease-adjusted life years [DALYs] gain per dollar spent projected over a lifetime horizon using a 5% annual discount rate.
Results: 157 RCT including 267,508 patients and 176 active arms were considered. Compared with sulfonylureas, SGLT2i, GLP1A and pioglitazone reduced the relative risk of non-fatal MACE with HR of 0.81 (95% CI 0.69 to 0,96, p = 0.011), 0.79 (95% CI 0.67 to 0,94, p = 0.0039) and 0.73 (95% CI 0.59 to 0.91, p = 0.0057), respectively. Pioglitazone resulted in incremental effectiveness of 0.2339 DALYs per patient, at a mean incremental cost of US$1660 and a US$ 7,082 (95% CI: 4,521; 10,770) incremental cost per DALY gained, when compared to standard care. The addition of SGLT2i or GLP1A led to more evident (0.261 and 0.259, respectively) but with higher ICERs [US$ 12,061 (95% CI: 7,227; 18,121) and US$ 29,119 (95% CI: 23,811; 35,367) per DALY gained, respectively]. Compared to SGLT2i and GLP1A, pioglitazone had the highest probability of being cost-effective based on the estimated maximum willingness-to-pay threshold.
Conclusions: The three therapies bear similar effectiveness in reducing cardiovascular events. In a middle-income country, pioglitazone presents a higher probability of being cost-effective followed by SGLT2i and then GLP1A.
109342
Modality: Best Poster – Researcher
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
D: 14/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
MARCOS DANILLO PEIXOTO OLIVEIRA1, Lélio Lemos Pinto Neto1, Ednelson Navarro2, Adriano Caixeta1
(1) Universidade Federal de São Paulo, UNIFESP; (2) Hospital Regional do Vale do Praíba
Background: Distal transradial access (dTRA) as a refinement of the conventional transradial approach has several potential advantages in terms of patient and operator comfort, faster hemostasis, and lower risk of proximal radial artery occlusion. We aim to describe our prospective real-world experience with dTRA as default for routine coronary angiography and percutaneous coronary interventions (PCI) in a broad sample of all-comers patients.
Material and methods: From February 2019 to April 2022, 3,991 consecutive all-comers patients submitted to coronary angiography and/or PCI via dTRA have been enrolled into the DISTRACTION registry.
Results: Mean patient age was 63.36 ± 13.3-year-old, most male (65.4%) and with acute coronary syndromes (48,8%) at admission. Overall, 843 (20.1%) patients had non-ST-elevation myocardial infarction, 799 (20,0%) had ST-elevation myocardial infarction, and 114 (2.6%) presented in cardiogenic shock. There were only 94 (2.3%) access site crossovers, in only 79 (1.9%) patients dTRA sheath insertion could not be obtained. Right dTRA was the most frequent access (80.1%), followed by redo right dTRA (10.8%), left dTRA (8,1%) and simultaneous bilateral dTRA (0.7%). In 2,210 (60.0%) of all patients, PCI was performed and left anterior descending was the most prevalent target coronary territory (29.1%). No major adverse cardiac and cerebrovascular events and no major complications directly related to dTRA were recorded.
Conclusions: The adoption of dTRA as default for routine coronary angiography and PCI in a real-world fashion of all-comers patients by experienced transradial operators appears to be feasible and safe.
111318
Modality: Best Poster – Researcher
Category: DIGITAL HEALTH/INNOVATION
D: 14/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
ELIZABETH ANNE CALLEJA1, Elizabeth A Calleja1, Dr Amanda K Buttery1, Teresa Gadaleta1, Sheree Hughes1, Jarrod Leggett1, Associate Professor Trevor Shilton1
(1) National Heart Foundation of Australia
Physical activity is an important modifiable risk factor for the prevention and management of cardiovascular disease and can reduce the risk of morbidity by 35% [1]. However, only 15% of Australian adults meet the physical activity guidelines [2]. A national walking program was rolled out across Australia led by a national voluntary group-based community walking program in 2007. In response to the COVID-19 pandemic, we aimed to develop a digital program option for people to walk independently. Personal Walking Plans (PWP) were launched in Australia as a free six-week web-based digital program for adults to address this need.
Methods: We designed personal walking plans on behaviour change principles and theory. This included four graded walking programs with strengthening and flexibility exercises, supported with online instructional videos and motivational messaging via email or text (SMS) messages. A digital self-report survey was conducted on enrollment to the program, and after completion at six weeks. These were completed between 11th of May and 30th June 2021. Survey questions included established items on participant goals, physical activity levels, influence of motivational messaging (text and email) and intention to continue walking following program completion.
Results: Of 2338 (mean 65 years; 87% female) participants completing the survey, 74% completed the program. Of these, 86% achieved their goal and 69% met the Australian physical activity guidelines by the end of the six-weeks. On average, participants increased the number of days they engaged in physical activity from 2.7 days to 4.4 days per week by the end of the six weeks. Strength exercise sessions increased from 0.9 days to 2.4 days per week. Participants reporting they paid attention to motivational messages increased their physical activity (30min physical activity, 4.4 days, strength 2.4 days) more than those who ignored/did not receive texts (30min physical activity, 3.9 days, strength 2.0 days). Nearly all (99%) reported that they would continue walking following the intervention.
Conclusion: A six-week digital personal walking plan was effective in improving participants’ attainment of the Australian adult physical activity guidelines. Motivational text messaging and emails appeared to enhance engagement with the program and physical activity levels. Long-term follow-up surveys at 6 and 12 months will evaluate if benefits are sustained over time.
111421
Modality: Best Poster – Researcher
Category: CARDIOVASCULAR IMAGING
D: 14/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
RONALDO DE SOUZA LEAO LIMA1, Andre Luiz Bezerra2, Claudio Domenico2, Andrea Rocha de Lorenzo2
(1) Fonte Imagem; (2) Universidade Federal do Rio de Janeiro
Introduction: CZT cameras have higher sensitivity for photon detection, as well as higher temporal and spatial resolution. These have enabled que noninvasive quantification of myocardial flow reserve (MFR), which may increase the accuracy of myocardial perfusion SPECT (MPS) for the detection of obstructive coronary artery disease (CAD). This study aimed to compare the accuracy of CZT MPS and of MFR for the detection of obstructive CAD.
Methods: 66 patients with CAD (>50% obstruction) detected at invasive coronary angiography or CT angiography underwent dipyridamole MPS and MFR evaluation within 30 days. A 1-day protocol (rest-stress) was used to quantify MFR. The acquisition of dynamic rest and stress images was initiated simultaneously to 99mTc sestamibi injection (10mCi e 30mCi, respectively), both lasting for 11 minutes, followed by 5-minute imaging. Pharmacologic stress with dipyridamole (0,56 mg/kg for 4 minutes) was performed with the patient positioned in the CZT camera. The images were processed and time-activity curves were generated, calculating global and regional MFR in a semiautomatic software. A global or regional MFR <2.0 was considered abnormal. The MPS perfusion images were classified as normal or abnormal and perfusion scores were calculated. The images were interpreted by experienced physicians blinded to the results of MFR and coronary angiography/CT.
Results: Mean age of the population was 63 ± 3 years, 51.5% male. Hypertension, hypercholesterolemia and diabetes were the most frequente risk factors (80.3%, 45.4%, and 42.4%, respectively). Thirty patients (45.5%) had single-vessel CAD, 28 (42.4%) 2-vessel CAD and 8 (12.1%), triple-vessel CAD. Among the 110 vessels with obstruction, 67 had perfusion abnormalities in MPS and 81 had reduced MFR, while among the normal vessels, 76 had normal MPS and 74 had preserved MFR. The sensitivity of MFR (73,6%) was higher than that of MPS (60.2%), without significant changes in specificity (86,4 vs 84.1%).
Conclusions: MFR in the CZT camera is an absolute, physiologic, quantifiable measure which is more sensitive for the detection of obstructive CAD than perfusion abnormalities in MPS, especially in patients with multivessel CAD.
111997
Modality: Best Poster – Researcher
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
D: 14/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
WARLEY CEZAR DA SILVEIRA1, Manuela Furtado Sacioto2, Luiza Margoto Marques2, Mateus Chaves Ferreira1, Beatriz Figueiredo Lima1, Maria Izabel Alcântara Cunha4, Bruno Barbosa Miranda de Paiva1, Marcos André Gonçalves1, Polianna Delfino Pereira1, Ana Beatriz de Castro Feres2, Magda Carvalho Pires1, Milena Soriano Marcolino1
(1) Universidade Federal de Minas Gerais (UFMG); (2) Faculdade Ciências Médicas de Minas Gerais (FCMMG); (3) Institute for Health Technology Assessment (IATS/CNPq); (4) Centro universitário de Belo Horizonte (UNIBH)
Introduction: COVID-19 patients present a high incidence of venous thromboembolism (VTE), which requires early recognition and treatment. In those patients, the diagnosis of pulmonary embolism is a challenge, as its symptoms and signs overlap with the ones of the severe acute respiratory syndrome (SARS). Several studies have tried to identify risk factors of VTE in hospitalized COVID-19 patients, as a path to promote prevention, early diagnosis and treatment. However, such studies have shown inconsistent results.
Objective: To identify VTE predictors by both logistic regression (LR) and machine learning (ML) approaches and report the incidence of thromboembolic complications in COVID-19 and their prognostic impact.
Methods: This substudy of a large Brazilian COVID-19 Registry included consecutive COVID-19 adult patients from 16 hospitals, admitted between March and September, 2020. Symptomatic VTE was confirmed by objective imaging. LR analysis, tree-based boosting and bagging were used to investigate the association of variables upon hospital presentation with VTE.
Results: Among 4,120 patients (median age was 61 years [IQR, 48–72] years-old, 55.5% men, 39.3% critical patients), VTE was confirmed in 6.7%. In multivariate LR analysis, obesity (OR 1.50, 95%CI 1.11–2.02); being an ex-smoker (OR 1.44, 95%CI 1.03–2.01); surgery ≤90 days (OR 2.20, 95%CI 1.14–4.23); axillary temperature (OR 1.41, 95%CI 1.22–1.63); D-dimer ≥4 times above the upper limit of reference value (OR 2.16, 95%CI 1.26–3.67), lactate (OR 1.10, 95%CI 1.02–1.19), C-reactive protein levels (CRP, OR 1.09, 95% CI 1.01–1.18); and neutrophil count (OR 1.04, 95%CI 1.005–1.075) were independent predictors of VTE. Temperature at admission, SF ratio, neutrophil count, D-dimer, CRP and lactate levels were also identified as predictors by ML methods. Patients with confirmed VTE had higher mortality (28.4% vs 18.5%, p < 0.001) and had a higher frequency of mechanical ventilation support (58.4% vs 26.4%, p < 0.001) and renal replacement therapy (21.5% vs 9.7%, p < 0.001), when compared to the group without confirmed VTE.
Conclusion: By using ML and LR analysis, we showed that D-dimer, axillary temperature, neutrophil count, CPR and lactate levels are risk factors for VTE in COVID-19 patients. Therefore, we suggest that patients presenting these risk factors at admission should be more closely monitored for VTE development, considering the importance of prevention, early diagnosis and treatment of VTE.
108390
Modality: Best Poster – Young Researcher
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
D: 14/10/2022 H: 16:10/16:50
L: Área de exposição de pôsteres
MARINA GAIATO MONTE 1, Carolina Rodrigues Tonon1, Anderson Seiji Soares Fujimori1, Ana Paula Dantas Ribeiro1, Katashi Okoshi1, Paula Schmidt Azevedo1, Marcos Ferreira Minicucci1, Leonardo Antonio Mamede Zornoff1, Sergio Alberto Rupp de Paiva1, Bertha Furlan Polegato1
(1) Faculdade de Medicina de Botucatu
Introduction: Doxorubicin (DOX) is widely used effective chemotherapy drug; however, it can cause cardiotoxicity which is a very serious side effect. There is no effective therapy for cardiotoxicity. Omega-3 fatty acid (O3) supplementation may act in the sphingomyelin-ceramide pathway. We aimed to evaluate the influence of O3 in attenuating DOX-induced cardiotoxicity.
Methods: Male Wistar rats (n = 60) were divided into 4 groups: control (C), administration of O3 only (O3), DOX only (D), and DOX and O3 (DO3). O3 (400 mg/kg/day, gavage) was administered for 6 weeks. DOX (3.5 mg/kg, IP, once a week) was administered for the last 4 weeks of the experiment. At the end of 6 weeks, rats were submitted to echocardiogram and euthanized (thiopental 120 mg/kg, ip). Statistical analysis: 2-way ANOVA (pi: p value for the interaction between DOX and O3; pD: p value for the effect of DOX; pO3: p value for the effect of O3).
Results: Group D exhibited increased left atrium diameter/aorta diameter ratio (C 1.31 ± 0.11; D 1.45 ± 0.11; O3 1.36 ± 0.11; DO3 1.27 ± 0.11; pD = 0.467, pO3 = 0.028, pi < 0.001) and decreased left ventricular fractional shortening (C 0.57 ± 0.07; D 0.46 ± 0.07; O3 0.56 ± 0.08; DO3 0.53 ± 0.08; pD = 0.002; pO3 = 0.164; pi = 0.046) compared to Group C, characterizing diastolic and systolic dysfunction, respectively. DOX increased neutral sphingomyelinase activity (nSMase, C 2283 ± 412; D 2879 ± 680; O3 2461 ± 639; DO3 3319 ± 284 UI fluorescence; pD < 0.001, pO3 = 0.087, pi = 0.461) and decreased myocardial nSMase protein quantification (C 0.05 ± 0.03; D 0.04 ± 0.02; O3 0.05 ± 0.02; DO3 0.03 ± 0.02 arbitrary units; pD = 0.009, pO3 = 0.455, pi = 0.275). There were no differences between groups in myocardial ceramide deposition evaluated by immunohistochemistry.
Conclusion: O3 supplementation attenuates DOX-induced diastolic and systolic dysfunction with no changes in neutral sphingomyelinase activity or expression in the myocardium. Financial support: FAPESP 2018/25677-7 and CNPq 407201/2021-1.
108392
Modality: Best Poster – Young Researcher
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
D: 14/10/2022 H: 16:10/16:50
L: Área de exposição de pôsteres
MARINA GAIATO MONTE 1, Carolina Rodrigues Tonon1, Tatiana Fernanda Bachiega Pinelli1, Anderson Seiji Soares Fujimori1, Ana Paula Dantas Ribeiro1, Nayane Maria Vieira1, Natalia Fernanda Ferreira1, Danilo Malmonge Barbosa Luciano1, Ronny Peterson Cabral1, Katashi Okoshi1, Bertha Furlan Polegato1, Leonardo Antonio Mamede Zornoff1
(1) Faculdade de Medicina de Botucatu
Background: Doxorubicin (dox) is used in the treatment of several types of cancer. However, cardiotoxicity is a common side effect of the drug. The pathophysiology of cardiotoxicity is not clearly understood. Neutrophils produce attractant substances such as NETs (neutrophil extracellular traps), that are involved in immune response and inflammation which could mediate myocardial extracellular matrix remodeling.
Purposes: To analyze the role of NETs in the pathophysiology of acute dox-induced cardiotoxicity.
Methods: 60 male Wistar rats were allocated into 3 groups: Control (C), Dox (D), and Dox + DNAse (DD). D and DD groups received an intraperitoneal injection of dox 10 mg/kg, and 2h later, DD received a subcutaneous injection of DNAse 20 mg/kg (NETs inhibitor). Rats were submitted to cardiac function evaluation and euthanasia 48h after dox injection. Statistical analysis: one-way ANOVA.
Results: D showed increased NETs production compared with C and DD (C = 2997 ± 810; D = 5955 ± 1906; DD = 4108 ± 1674 pg/mL; p < 0.001). Transthoracic echocardiogram showed no differences in systolic parameters, but isovolumetric relaxation time corrected by heart rate was higher in D and DD than C (C = 46 ± 4.6; D = 51 ± 7.9; DD = 51 ± 7.7, p = 0.039). Additionally, in isolated heart study, area under curve for diastolic pressure-volume ratio was reduced in D, indicating lower ventricular compliance, compared with C and DD (C = 827 ± 74; D = 670 ± 109; DD = 966 ± 218; p = 0.007). Dox induced increased malondialdehyde myocardial concentration in D and DD compared to C (C = 48 ± 28; D = 73 ± 32; DD = 82 ± 25 nmol/mg of protein; p < 0.05). Regarding extracellular matrix, dox increased and DNAse attenuated collagen in cardiac tissue (C = 2.88 ± 0.97, D = 3.51 ± 0.7, DD = 2.99 ± 0.66%; p < 0.05). Additionally, dox increased matrix metalloproteinase activity (MMP)-2 (C = 1.01 ± 0.28, D = 2.04 ± 0.47, DD = 2.36 ± 0.6; p < 0.001), but DNAse did not interfere with this parameter. Evaluation of protein expression of |Type 2 and 4 MMP tissue inhibitors (TIMP) showed no differences between groups.
Conclusions: Dox-induced cardiotoxicity is associated with diastolic dysfunction, cardiac fibrosis, increased MMP-2 activity, and oxidative stress. NETs are involved in the pathophysiology of dox-induced cardiotoxicity. Netosis inhibition improved diastolic function, associated with decreased myocardial collagen content. However, this effect was not mediated by oxidative stress, MMP-2 activation, or TIMP-2 and –4 protein expression.
109335
Modality: Best Poster – Young Researcher
Category: CARDIO-ONCOLOGY
D: 14/10/2022 H: 16:10/16:50
L: Área de exposição de pôsteres
RENATA ALVES1, Cláudia de Morais Sequeira1, Jefferson Fernandes Evangelista1, Ana Lucia Rosa Nascimento1, Cristiane Matsuura1
(1) Universidade do Estado do Rio de Janeiro
Introduction/aim: It is well known that doxorubicin (DOX) elicits toxic effects on the heart limiting its use in cancer treatment. Here, we investigated the effects of resistance training on left ventricle (LV) ultrastructure and function in DOX-induced cardiotoxicity in rodents.
Methods: Male adults Sprague Dawley rats were divided into three groups (n = 10): control, DOX that remained sedentary (DoxSed), or DOX submitted to resistance training (DoxTr). Resistance training (5 d/wk for 8 wks) consisted of climbing a ladder with weights placed on the tail, with progressive increase in the training load (number of repetitions and weight). DOX was administered for 10 consecutive days (1 mg/kg/d, i.p.) and it initiated concomitantly with training. At the end, cardiac function was measured by echocardiography, and LV fragments were processed for transmission electron microscopy.
Results: There was a reduction in mortality in DoxTr compared to DoxSed (20 vs. 38%, P < 0.001, log rank test). The decrease in LV ejection fraction observed in DoxSed was attenuated in DoxTr (control: 76 ± 1; DoxSed: 64 ± 1; DoxTr: 71 ± 1%; P < 0.05, one-way ANOVA). The most striking effects were seen in LV ultrastructure (Fig 1). The control group showed a normal structural arrangement, with myofibrils arranged in parallel, preserved sarcomeres with uniform distance between Z lines. Intact mitochondria were seen in parallel arrangement to the myofibrils. The cardiomyocytes of the DoxSed group showed severe cellular disruption, with fragmentation of the myofibrils, disappearance of some sarcomeres, increased electron-lucid cytoplasmic content and the presence of autophagosomes, and degenerated mitochondria. Resistance training resulted in positive effects on the ultrastructural morphology of cardiomyocytes, with intact mitochondria and large areas of preservation of the structural organization of the sarcomere, although it was still possible to observe a non-linear arrangement and reduction in the density of myofibrils.
Conclusion: Resistance training can be a non-pharmacological strategy to prevent the deleterious effects of DOX on the heart.
110132
Modality: Best Poster – Young Researcher
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
D: 14/10/2022 H: 16:10/16:50
L: Área de exposição de pôsteres
FILIPE FERRARI1, Henrique C. da Silva2, Luiz G. M. Emed3, Guilherme D. Dilda4, Haroldo C. Aleixo5, Márcio Dornelles6, Fernando Bassan7, Felipe E. F. Guerra8, Frederico P. L. Coimbra9, Mateus F. Teixeira10, Anderson D. da Silveira11, Ricardo Stein1
(1) Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS – Brazil; (2) Universidade do Estado do Pará (UEPA), Belém, PA – Brazil; (3) Hospital Cardiológico Costantini, Curitiba, PR – Brazil; (4) Hospital das Clínicas da Universidade de São Paulo (USP), São Paulo, SP – Brazil; (5) Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG – Brazil; (6) Grêmio Foot-Ball Porto-Alegrense (GFPA), Porto Alegre, RS – Brazil; (7) Universidade do Estado do Rio de Janeiro (UERJ), RJ – Brazil; (8) Clínica Biocardio, Natal, RN – Brazil; (9) Hospital de Urgências de Goiânia, Goiânia, GO – Brazil; (10) Clube de Regatas Vasco da Gama, RJ – Brazil; (11) Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS – Brazil
Introduction: The 12-lead ECG is a useful tool for screening cardiac abnormalities in athletes. We aimed to describe physiological ECG findings in young Brazilian football players (YBFP) based on the “2017 International Criteria for Electrocardiographic Interpretation in Athletes”.
Methods: Cross-sectional/descriptive study. Intra-group differences were estimated by linear models or binomial and multinomial logistic regressions.
Results: 3.490 YBFP from 41 clubs, aged 15–35 years (median: 19 y) were evaluated. 1.668 were Caucasians, 1.154 Mixed-race (MR) and 668 Afro-Brazilians (AB). Prevalence: sinus bradycardia (50%), incomplete RBBB (12%), first-degree AV block (3%), Mobitz type I AV block (0.1%), and increase QRS voltage for left or right ventricular hypertrophy (34% and 15%, respectively). ST-elevation followed by T-wave inversion confined to V1–V4 leads were identified in 2% of AB. Early repolarization (ER) was present in 35% of athletes (AB versus Caucasians and MR: P = 0.002 and P = 0.004, respectively), which was similar to the PR interval (P < 0,001 for both comparisons). There was no difference between Caucasians and MR for ER or PR intervals. For all remaining variables, there was no difference among races.
Conclusions: This is the first large study to describe the prevalence of physiological electrocardiographic findings in YBFP. Further studies comparing the frequency of these findings with the prevalence observed in other cohorts are welcome.
112183
Modality: Best Poster – Young Researcher
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
D: 14/10/2022 H: 16:10/16:50
L: Área de exposição de pôsteres
PEDRO HENRIQUE DE BORBA ENGSTER1, Pedro Henrique de Borba Engster1, André Zimerman1, Anderson Donelli da Silveira1, Marina S. Borges1, Thomas U. Schaan1, Gabriel C. de Souza1, Giovanni Donelli Costa1, Luís Eduardo Rohde1
(1) Hospital de Clínicas de Porto Alegre; (2) Universidade Federal do Rio Grande do Sul
Background: For patients with heart failure (HF), the validity of the New York Heart Association (NYHA) functional class to assess prognosis may be limited when compared with the objective cardiopulmonary exercise test (CPET).
Purpose: To investigate the prognostic value of NYHA classification and CPET parameters.
Methods: We included the first CPET of every adult patient with HF who in a tertiary care center in Brazil. NYHA class was determined on the day of CPET or during the prior ambulatory visit. NYHA and Weber classes were stratified into “favorable” (NYHA I or II; Weber A or B) or “poor” (NYHA III or IV; Weber C or D), and subjects with discordant classes were compared in a survival analysis. Primary endpoint was all-cause mortality at 5 years. We used a Cox proportional hazards model to estimate the probability of death in 5 years according to relative peak VO2 and NYHA class, adjusted for age and sex.
Results: We included 855 patients, of which 30% (255) were classified as NYHA I, 43% (368) as NYHA II, 24% (202) as NYHA III, and 4% (30) as NYHA IV. Mean age was 56 years (±13), 42% (359) were female, and mean LVEF was 36% (±15). Mean relative peak VO2 ranged from 19.6 (NYHA I) to 14.0 (NYHA IV) ml/kg/min. Patients with poor NYHA and favorable Weber classes displayed similar rates of all-cause mortality as patients with favorable NYHA and poor Weber classes (hazard ratio 1.54 [95% CI 0.88–2.70]. In the multivariable model, both NYHA and relative peak VO2 significantly predicted mortality in 5 years after mutual adjustments (Figure 1). The distinction between NYHA I and II did not, however, improve prognostic assessment.
Conclusions: Physician-assigned NYHA class and objective CPET measures provide complementary prognostic information, and NYHA classification may be particularly limited for mild cases of HF. These findings question the use of NYHA as the main determinant to guide HF therapy.
108597
Modality: Best Poster – Scientific Initiation
Category: DIGITAL HEALTH/INNOVATION
D: 13/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
MARIA EDUARDA QUIDUTE ARRAIS ROCHA1, Bruna Sobreira Kubrusly2, Fernanda Pimentel Arraes Maia2, Rodrigo Carvalho Paiva3, Alessia de Alencar Araripe Gurgel3, Davi Sales Pereira Gondim1, Juvêncio Santos Nobre2, Luis Gustavo Bastos Pinho2, Ana Gabriela Ponte Farias2, Maria Camila Timbó Rocha3, Eduardo Augusto Quidute Arrais Rocha3, Francisca Tatiana Moreira Pereira2
(1) Universidade de Fortaleza (Unifor); (2) Universidade Federal do Ceará (UFC); (3) Centro Universitário Christus (UNICHRISTUS)
Introduction: The remote monitoring (RM) of implantable electronic cardiac devices (IECD) has shown advantages in the reduction of morbidity and mortality. The early detection of alterations and the possibility of treatment before the occurrence of symptoms has been a great attractive of this follow-up method. Meanwhile, not all the groups benefit, there are costs associated to these devices and the large number of events may determine an overload to the professionals. This work aimed to identify the predictive factors of larger benefit during the IECD follow-up through RM.
Methods: This is a cohort prospective study. The statistical analysis used logistic regression models, with p < 5% for statistical significance. The explanatory variables were selected by a stepwise selection method based on the Akaike Information criterion as a measure to choose the best explaining model. The analyzed variables were age, sex, functional class (FC) ≥ II, ejection fraction (EF), type of IECD, sustained ventricular tachycardia and red alert transmission, indicating important events detections. Three different models were created, with the response variable given by, respectively, elective therapy change (model 1), urgent therapy change (model 2) and whether event detections prevented hospitalizations (model 3).
Results: There were 119 patients, with mean age of 72 ± 14 years, 69.8% males. The most common pathologies were ischemic cardiomyopathy 28.6%, dilated cardiomyopathy 22.7% and Chagas disease 6.7%. The groups using a biventricular pacemaker(PM) (75.0%, p = 0.02), reduced EF (76.5%, p = 0.01) FC ≥ Il (75.0%, p < 0.01) had the larger rates of events. The red alert transmission variable was statistically significant in the three models (p-values of, respectively, 0.048;0.007 and 0.048), while the presence of ventricular tachycardia was statistically significant in two models, with p-vales of p = 0.039 (changes in elective therapy) and p = 0.039 (prevented hospitalizations). The FC ≥ II was associated to the urgent therapy change (p = 0.047).
Conclusion: Patients with biventricular PM, reduced EF, and more advanced FC had higher event rates in the RM of IECD. The detection of alerts considered by the system as important (red alerts) was associated with changes in immediate, elective conduct and was able to reduce hospitalizations.
109148
Modality: Best Poster – Scientific Initiation
Category: HYPERTENSION/RENAL DENERVATION
D: 13/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
JOÃO GABRIELL BEZERRA DA SILVA1, João Gabriell Bezerra da Silva1, Gabriela da Silva Nascimento1, Hugo Farah Affonso Alves1, Lucca Hiroshi de Sá Kimura1, João Gabriel Rega do Nascimento Vallaperde1, Vitor de Melo Nolasco1, Bianca Botelho Viegas1, Carlos Filipe dos Santos Pimenta1, Bernardo Chedier1, Arthur Fernandes Cortez1, Elizabeth Silaid Muxfeldt1
(1) Universidade Federal do Rio de Janeiro – Hospital Universitário Clementino Fraga Filho – ProHArt
Background: Resistant hypertension (RHT) defined as an uncontrolled blood pressure (BP) despite the use of 3 or more antihypertensives presents a high cardiovascular (CV) morbidity and mortality and high prevalence of chronic kidney disease (CKD). High BP levels and kidney injury appear to be strongly associated with inflammatory biomarkers.
Objective: To evaluate the relationship between inflammatory markers and subclinical and established CKD in a large cohort of patients with RHT.
Methods: Cross-sectional study that evaluated 423 resistant hypertensives (30.5% male, mean age 64.0 ± 10.8 years) submitted to renal function assessment (albuminuria dosage and evaluation of glomerular filtration rate calculated from the CKD-EPI formula) and dosage of inflammatory markers: TNF-alpha, MCP-1, E-selectin and PAI-1. Socio-demographic characteristics, anthropometric measurements and CV risk factors were recorded. We considered subclinical CKD those patients with moderately high albuminuria (30–300 mg/g) and/or GFR between 30 and 60 ml/min/1.73 m2 and established CKD those who presented albuminuria >300 mg/g and/or TFG < 30 ml/min/1.73 m2. Variance analysis compared serum levels of the 4 inflammatory markers and bivariate analysis compared patients with and without subclinical and established chronic kidney disease.
Results: The prevalence of established CKD was 7.3% (31 patients) and subclinical CKD was 47% (187 patients). Patients with subclinical CKD were older and with higher arterial stiffness (higher pulse wave velocity). TNF-alpha (7.1 [4.4–8.6] vs 51, [3.2–7.5]) and MCP-1(284 [220–379] vs 260 [185–359] were significant higher in this group of patients. When we analyzed patients with established CKD, we observed that they have higher BP levels and that TNF-alpha values (7.8 [5.6–14.0] vs 5.6 [3.5–8.3]) and E-selectin (54.4[41.2–61.3] vs. 47.8 [32.0–65.3]) were significantly higher in this group.
Conclusion: Among the inflammatory markers evaluated, which was most strongly correlated with subclinical CKD were TNF-alpha and MCP-1, while those with established CKD have higher TNF-alpha and E-selectin levels, possibly pointing out that the MCP-1 is an earlier marker of kidney injury.
111855
Modality: Best Poster – Scientific Initiation
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
D: 13/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
LUIZ FELIPE FAÇANHA RAMOS1, Hildeman Dias da Costa2, Reny Wane Vieira dos Santos1
(1) Universidade Federal do Amapá; (2) Universidade Federal de Rondônia
Introduction: Mortality from cardiovascular diseases (CVD) is aggravated by arterial hypertension, as a consequence of high consumption of table salt. Worldwide salt intake is above the 5 grams (2 grams of sodium) per day recommended by the World Health Organization (WHO), and its consumption varies from 8.5 to 15 grams per person.
Objective: To relate CVD mortality with policies to reduce salt/sodium consumption in South American countries in the year 2019.
Methodology: This is an analytical ecological study of geographic distribution with secondary data from the Information Platform in Health for the Americas (PLISA), from the Pan American Health Organization, of the year 2019, with CVD mortality indicators and policies to reduce salt/sodium consumption in South American countries. In addition, mortality rates (MT) were standardized per 100,000 inhabitants, with a confidence interval of 95%, classified by quintile. These data were tabulated in the Microsoft Excel software and the variables were analyzed in the GNU SPPP software version 1.5.3, using the Pearson Correlation Test, with a significance level of 5%.
Results: In 2019, in South America, the highest CVD mortality rates occurred in Guyana (TM = 448.3; 95% CI 363.3–548.5; Q5) and Suriname (TM = 270.8; 95% CI 212.1–337.6; Q5), on the other hand, the lowest mortality occurred in Peru (TM = 77.8; 95% CI 56.9–103.9; Q1) and in Chile (TM = 95. 5; 95% CI 74.4–118.9; Q1). It is noteworthy that the countries that had the highest mortality are the nations that did not have any (n = 0) initiative to reduce salt/sodium consumption in 2019, however, the countries with the lowest mortality were those that developed 3 policies to reduce this excessive consumption. It is evident that Brazil developed 2 reduction policies, but had a high number of deaths from CVD (TM = 217.1; 95% CI 189.9–239.9; Q3). Analyzing the bivariate correlation of the two variables, a negative Pearson coefficient was obtained (r = –0.59; p = 0.043).
Conclusion: Countries that developed more initiatives to reduce excessive salt consumption had significantly lower mortality rates from CVD, showing the importance of reducing this consumption to avoid hypertensive complications that lead to death. Thus, the inversely proportional relationship between the number of these policies and the number of deaths from CVD is confirmed.
111704
Modality: Best Poster – Scientific Initiation
Category: CARDIOVASCULAR PHARMACOLOGY
D: 13/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
PIETRA ARISSA COELHO MATSUNAGA1, Evellyn Cristiny Pereira Marinho Bezerra1, Júlia Fonseca da Silva Saad1, Lara da Silva Soledade1, Ana Cláudia Cavalcante Nogueira3, Alexandre Anderson de Souza Munhoz Soares3, Gustavo Alexim2, Luiz Sérgio Fernandes de Carvalho5, Renato Barros4
(1) Universidade Católica de Brasília UCB; (2) Hospital de Base do Distrito Federal HB-DF; (3) Instituto Aramari Apo; (4) Hospital Regional de Sobradinho do Distrito Federal HRS-DF; (5) Clarity Healthcare Intelligence
Introduction: Prasugrel is an thienopyridine antiplatelet agent, which can be an important alternative to clopidogrel in patients with Acute Coronary Syndrome (ACS) treated through percutaneous coronary intervention. In spite of the role of clopidogrel in these conditions, there are no long-term real-world studies comparing clopidogrel versus prasugrel.
Objective: To evaluate the long-term risk of major adverse cardiovascular events (MACE) in patients with ACS who are making use of prasugrel or clopidogrel.
Methods: This study is a retrospective analysis of all the individuals that were admitted with the principal diagnosis of acute coronary syndrome within the period of 2013 to 2015 and were submitted to cardiac catheterization in public hospitals of Brasilia, FD, Brazil. The total group was divided into two: the first group being of patients who took clopidogrel and the second group formed by patients on prasugrel. The primary clinical outcome was comprised by cardiovascular (CV) deaths and recurrent ACS (MACE). Multivariate analyses on 16 covariates were carried and followed by a Propensity Score Matching analysis (PSM).
Results: A total of 2,491 patients with a principal diagnosis of ACS were included (1,616 with clopidogrel and 875 with prasugrel) and monitored for a median of 6.5 (IQR 1.9) years with 742 primary events. Clopidogrel was associated with high rates of MACE in 12 months (20.1% vs 11.8%, p < 0.001, 428 MACE) and 24 months (23.8% vs 17.7%, p < 0.001, 540 MACE) compared to prasugrel, but the curves equalized at 36 months (25.9% vs 26.6%, p = 0.740) and remained equalized until median follow-up time. In multivariate analysis, prasugrel showed a hazard ratio (HR) 0.61 (95% CI 0.47–0.78 at 12 months), 0.78 (95% CI 0.63–0.96, p < 0.001 at 24 months) and 0.94 (95% CI 0.78–1.1 at 36 months). The results were maintained in the PSM analysis. The mean time on prasugrel in this cohort was 22.1 (IQR 5.9) months.
Conclusion: Stemming from these findings, despite the already known role that prasugrel has in reducing the risk of MACE in ACS, these results do not seem to be sustained in the long term. The data reveal that after the interruption of drug use there was an increase in the amount of major adverse cardiovascular events in the second and third year of monitored patients in the prasugrel group. Therefore, the benefit of using prasugrel is neutralized over time.
111863
Modality: Best Poster – Scientific Initiation
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
D: 13/10/2022 H: 10:00/10:40
L: Área de exposição de pôsteres
RAFAEL DIAS DE BRITO OLIVEIRA1, Denise Mayumi Tanaka2, Thayrine Rosa Damasceno1, Camila Godoy Fabrício2, Alessandra Arantes Resende2, Eduardo Elias Vieira de Carvalho2, Dawit Albieiro Pinheiro Gonçalves1, Enrico de Francisco Magnani1, Mariana Duarte de Souza1, Marcus Vinícius Simões2, Luciano Fonseca Lemos de Oliveira1
(1) Universidade Federal de Minas Gerais – UFMG; (2) Faculdade de Medicina de Ribeirão Preto – FMRP/USP
Introduction: Denervation of atrial parasympathetic and ventricular sympathetic fibers is common in chronic Chagas cardiomyopathy (CC) and may be associated with increased ventricular arrhythmias and sudden death. However, it is unclear if the heart rate variability (HRV) present potential to detect these alterations.
Objective: We aimed to evaluate the applicability of a low-cost, non-invasive, and unrestricted method to identify animals with ventricular sympathetic denervation and severe cardiac dysfunction in an experimental model of CC in hamsters.
Methods: In the study’s first phase, 10 control hamsters were used to validate the non-invasive electrocardiogram (ECG) acquisition system using a vest. Signal quality and heart rate variation were evaluated in anesthetized and dobutamine-infused animals. The vest was also compared to the acquisition of invasive electrodes in conscious animals. In the second phase, HRV was analyzed in an experimental model of CC (CC; n = 6) and its respective controls (CT; n = 6). Myocardial function and morphology were evaluated by two-dimensional echocardiography in dedicated equipment (VEVO2100). The intensity of ventricular fibrosis and/or inflammation was assessed by the extent of perfusion defects at rest using high-resolution myocardial perfusion scintigraphy, acquired by locally constructed equipment and validated system of small animal images.
Results: The ECG acquired by the vest showed excellent signal quality, detecting both the increase in HR during dobutamine infusion and HRV in awake animals. In CC animals, left ventricular ejection fraction (LVEF) correlated with indicators of parasympathetic activity (LF; r = 0.72, p = 0.01) and sympathetic activity (HF; r = –0.72, p = 0.01), as well as with the LF/HF ratio (r = 0.70, p = 0.01). In addition, a significant correlation was observed between left ventricular perfusion defect (LVPD) with LF (r = 0.72, p < 0.00), HF (r = –0.72, p < 0.00), and LF/HF (r = 0.71, p = 0.01). A significant correlation was also observed between left ventricular diastolic diameter (LVDD) and LF (r = 0.59, p = 0.04) and HF (r = –0.59, p = 0.04).
Conclusion: The low-cost, non-invasive and unrestricted vest method effectively detected ECG signals from animals at rest, during dobutamine infusion and in motion. The vest was also able to detect autonomic changes resulting from ventricular dysfunction, and was sensitive in identifying sympathetic denervation resulting from myocardial fibrosis and/or inflammation.
107748
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR INTENSIVE CARE/CARDIOVASCULAR EMERGENCIES
IRENA MITEVSKA1, Elena Grueva1, Irina Kotlar1, Emilija Lazarova1, Marijan Bosevski1
(1) University Cardiology Clinic
Introduction: In patients with pulmonary embolism (PE), assessment of right ventricular (RV) function on transthoracic echocardiography has been shown to be an independent predictor of 30-day mortality.
Objective: We wanted to assess how echocardiographic assessment for RV function compares with other PE prognostic parameters used in ICU during the COVID-19 pandemic.
Methods: This is retrospective cohort study of patients with confirmed PE hospitalized in Intensive Care Unit between January and December 2020. All unstable patients underwent 2-dimensional FOCUS echocardiography before CT pulmonary angiography (CTPA). FOCUS included assessment for right ventricular dilation, McConnell’s sign, septal flattening, tricuspid regurgitation, and tricuspid annular plane systolic excursion (TAPSE). Adverse outcomes were defined as shock, respiratory failure requiring intubation, death, or major bleeding. We have evaluated FOCUS markers of PE diagnosis and prognosis, as well as independent ICU mortality predictors.
Results: We studied 47 patients, with mean age 58.6 ± 19.4 years. Eight patients (17%) had massive PE (3 patients positive for COVID-19) and 39 (83%) had sub massive PE confirmed by CTPA. Twelve patients (25,5%) were tested for COVID 19 with PCR assay, and 3 come positive (12.5%). Eight patients were high risk with shock (17%), 29 were intermediate high risk (61.7%) and 10 patients were intermediate low risk (21.3%). Abnormal RV function with TAPSE <17 was found in 32 patients (68%). Five high risk patients died within 72 hours, resulting in an overall ICU mortality rate of 10,6% and 62.5% for patients with cardiogenic shock. We found FOCUS echocardiography 93% (95% confidence interval [CI] = 72% to 98%) sensitive and 69% specific (95% CI = 55% to 81%) for PE. Mean TAPSE values in patients who died were 13+–/2, comparing to 18+/–2, p < 0.001 in survivals. Multivariate logistic regression analysis showed thrombolytic therapy OR 2.145 (95% CI: 1.105–4,512), TAPSE <14 OR 2.893 (95% CI: 0.932–3.241), and acute renal failure OR 1.821 (95% CI: 1.105–4.762) as an independent mortality predictors.
Conclusions: RV dysfunction is significant predictor of intrahospital adverse PE outcomes. A negative FOCUS examination significantly lowers the likelihood of PE in most unstable patients. Focus echocardiography is very useful tool for fast assessment of RV function, risk stratification and PE management decision in unstable patients during the COVID-19 pandemic.
107749
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
ROQUE DANIEL GONZÁLEZ1, Cayetano Bellomio2, Mercedes Ríos2, Carlos Ramiro Castellanos1, Manuel Parajón Viscido2, Roque Daniel González1
(1) Instituto de Cardiología Tucumán; (2) Sociedad Tucumana de Medicina del Deporte
It has been reported that ultramarathons can elevate plasmatic levels of troponins and natriuretic peptides. The mechanisms and significance of these findings is debated. The objective of this study was to investigate the behavior of these markers before and after a mountain ultramarathon in young and inexperienced runners, unaccustomed to altitude. 20 runners (36.7 ± 6.3 years) were evaluated (6 females). They reported 4.0 ± 3.4 years competing in ultramarathon with a training load of 43.7 ± 16.8 km/week. The plasmatic values of troponin T (Trop-T HS) and N-terminal pro-brain natriuretic peptide (NT Pro-BNP) were determined before, immediately after the race and 24 hours later. The race was completed in 637.9 ± 197.5 minutes, and 55.1 ± 7.3 kilometers were covered. Both markers raised significantly after the competition. There was a statistically significant difference between the values of both determinations before the competition and at the end of the race (p < 0.0001) and between these and those after 24 hours (p < 0, 0001). At the end of the run, 95% of the sample presented NT Pro-BNP values above the diagnostic cut-off point of heart failure. All athletes presented values above the upper reference limit for Trop-T HS and 80% exceeded the diagnostic cut-off value for acute myocardial infarction. Troponin levels showed an inverse relation with weekly training (p = 0.04). There was a significant association between relative intensity of exercise and NT Pro-BNP levels after the competition (p = 0.001), where the group that completed the race with a heart rate higher than 80% of its maximum, significantly raised NT Pro-BNP.
Conclusions: Trop-T HS and NT Pro-BNP significantly raised after the race. The extreme conditions and some characteristics of the athletes (poor habituation to altitude, short experience and relatively low volume of training) could justify these results. The clinical significance and mechanisms of these findings are still unknown, but the uniformity and brevity of the responses, as well the absence of clinical manifestations, suggest that they could represent an adaptive phenomenon.
107765
Modality: E-Poster Researcher – Non-case Report
Category: ANTICOAGULATION
TAMRAT ASSEFA1, Gobezie Temesgen1, Dejuma Yadeta2, Legese Chelkaba1, Teferi Gedif1
(1) School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; (2) School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Background: Oral anticoagulation therapy with warfarin requires frequent monitoring level of anticoagulation by the international normalized ratio (INR).
Aims: This systematic review aimed to systematically summarize anticoagulation control, treatment outcomes, and associated factors in long-term patients receiving warfarin in Africa.
Methods: The literature search was conducted in PubMed, Cochrane Library, African Journal of Online databases, Google Scholar, and Google. An advanced search strategy was computed to retrieve relevant studies related to anticoagulation control and outcomes. Duplication, title and abstract screening, and full-text assessment were conducted in Covidence software. Study quality was assessed using the Joanna Briggs Institute Critical appraisal quality assessment tool. The systematic review is registered in PROSPERO (CRD42021260772) and performed based on the PRISMA guideline.
Results: Out of 298 identified articles, 18 articles were eligible for the final review and analysis. The mean of 39.4 ± 8.4% time in therapeutic range (TTR) (29.4% to 57.3%), 36.7 ± 11.5% TTR (range 25.2–49.7%) and 46% TTR (43.5–48.5%) was computed from studies that determined TTR by Rosendaal, direct and cross-section-of-the-files methods, respectively. The lowest percentage of TTR was 13.7%, while the highest was 57.3% was observed in this review. The highest percentage of patients (32.25%) who had TTR ≥ 65% was reported in Tunisia, but the lowest percentages were in Namibia (10%, TTR ≥ 65%) and Kenya (10.4%, TTR ≥ 70%). Generally, 10.4–32.3% of study participants achieved desired optimal anticoagulation level. Regarding secondary outcomes, 1.6–7.5% and 0.006–59% of patients experienced thromboembolic complications and bleeding events, respectively. The presence of chronic comorbidities, taking more than two drugs, and the presence of medications that potentially interact with warfarin were the frequently reported predictors of poor anticoagulation therapy.
Conclusion: Oral anticoagulation control was suboptimal in patients taking warfarin as evidenced by low TTR in Africa. Therefore, there is an urgent need for further improving oral anticoagulation management service.
107767
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
TAMRAT ASSEFA1, Ashenafi Teklu1, Alfoalem Araba1
(1) School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
Background: Reports indicated association of COVID-19 with coagulation dysfunction and venous thromboembolism (VTE) prevalence was in the range of 20–40%. All patients with COVID-19 who are hospitalized should receive pharmacologic prophylaxis unless they have contraindications.
Aims: To assess VTE risk, incidence, and its management in patients with COVID-19 admitted to Tikur Anbessa Specialized Hospital (TASH).
Methods: A retrospective study was conducted among 146 COVID-19 patients admitted to TASH. A pre-tested data abstraction format was used to collect patients’ clinical information and VTE risk by using the modified Caprini Risk Score in COVID-19. We used Statistical Package for the Social Sciences (SPSS) version 26 for data analysis. Descriptive statistics were used to summarize the findings and binary logistic regression analysis to assess the association between the variables of interest.
Results: Out of 146 patients, 57.53% were males and the mean age was 45.56 ± 18.17 years. All patients were at risk of developing VTE. The most often observed VTE risk factors were being COVID-19 symptomatic (88.40%), serious lung diseases (56.2%), and age >40 years (52.10%). The incidence of VTE was 23 (15.75%) and majorly (91.3%) occurred in highest VTE risk (≥5 scores) patients, >40 years patients, and in patients with severe COVID-19 symptoms (100%). However, parenteral thromboprophylaxis was prescribed only for 98 (67.12%) patients. Out of 23 patients who developed VTE, 15 didn’t receive prophylaxis, and the remaining 8 received thromboprophylaxis. Unfractionated heparin (UFH) was the most widely used prophylaxis. For patients who developed VTE, the majority of them (86.96%) were given a therapeutic dose of UFH.
Conclusion(s): All patients with COVID-19 were at risk of developing VTE. Only one-third received thromboprophylaxis. The incidence of VTE was high and majorly occurred in patients that didn’t receive prophylaxis.
107796
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
JUAN CARLOS ZERPA ACOSTA1, Jose Carlos Pachon Mateos2, Enrique Indalecio Pachon Mateos1, Carlos Thiene Cunha Pachon2, Juan Carlos Pachon Mateos1, Tasso Julio Lobo1, Tomar Guillermo Santillana Pena1, Felipe Augusto Ortencio1, Ricardo Cardneiro Amarante1, Maria Zelia Cunha Pachon2
(1) Hospital do Coração – São Paulo; (2) SEMAP – Serviço de Eletrofisiologia, Marca-passo, Desfibriladores, Ressincronizadores e Arritmias Prof. Dr. José Carlos Pachón M.
Background: Carotid sinus syndrome (CSS) is a rare condition caused by sudden autonomic nervous system imbalance and Vagal overactivity that may lead to sinus arrest, AV block and syncope with severe symptoms commonly treated with pacemaker (PM). Since 2005 the Cardioneuroablation (CNA) procedure has been applied to aim vagal denervation through endocardial radiofrequency removing the cardio inhibition by ablation.
Objective: To study the outcome of CNA controlled by extracardiac vagal stimulation (ECVS) in symptomatic functional CSS.
Methods: Prospective, controlled study of 8 patients with symptomatic CSS, positive carotid sinus massage (CSM) and normal atropine response. Biatrial RF-ablation of the neuro endo-myocardial interface guided by filtered endocardial electrograms, fractionation, and 3D anatomical mapping, identifying type-1 AF-Nests (AFN) related to the 4 main ganglionated plexuses with FlexAbility Abbott irrigated catheter(30W/43°C/30s). ECVS(5s) at the right and left jugular foramen and CSM was performed before, during, and at the end of the ablation, to guide the level of denervation defining the higher CNA effect and end of the procedure, analyzing induced pauses and AVB. The endpoint was to eliminate complete pauses and AVB caused by ECVS and CSM.
Results: Patients mean age was 58,6 (±11,8). Pre-CNA ECVS and CSM response were sinus pauses (5,4 ± 1,3secs) and transient AVB 3/8. Post-CNA, ECVS, CSM and Atropine responses were completely abolished in 8/100%. There was observed immediate sustained HR increase (59.6 ± 12,7/81,7 ± 5,3bpm) as acute result. In a follow up of 28,1 (±11,8) months there were no syncope recurrence. 1 patient had positive CSM at 6 months FU, without spontaneous syncope and had PM implanted.
Conclusion: Bi atrial CNA vagal denervation based on AFN/GP ablation guided by abolishment of the vagal effect by ECVS and CSM response was effective for eliminating syncope recurrence in all the patients with CSS.
107798
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
RITA DE CÁSSIA CASTELLI DA ROCHA1, Sérgio Emanuel Kaiser1, Márcia Regina Simas Torres Klein1, Cyro José Morais Martins3, Ricardo Guimarães Fisher2, Maria de Lourdes Guimarães Rodrigues1, Débora Valença1, Carolina Vicente Teófilo2, Carolina de Castelli da Rocha Carneiro3
(1) CLINEX – UERJ; (2) FACULDADE ODONTOLOGIA- UERJ; (3) HUPE
Epidemiological studies suggest that chronic periodontitis (PD) associates with an increased risk of developing cardiovascular disease, whereas both share a link through inflammatory mediators. Arterial hypertension is a major risk factor for cardiovascular diseases, and it is believed that periodontal disease may favour its development. The relationship between PD and inflammation has been studied through biomarkers and assessment of endothelial function. Several conditions associated with subclinical inflammation seem to promote subtle changes in left ventricular systolic function, that can be detected by speckle tracking technology coupled with echocardiography. This study sought to explore, among hypertensive (HT) and normotensive (NT) individuals, the possible associations between severe chronic PD, inflammatory biomarkers, carotid intimal-medial thickness, and left ventricular systolic and diastolic function. The study consisted of a cross-sectional analysis with control for potential confounding factors, of 88 non-smoking, non-diabetic individuals of both sexes, among which, there were 50 AH under pharmacological treatment, and 38 NT. All underwent dental evaluation with a probe bag protocol aimed at identifying severe periodontitis, as well as laboratory tests (lipid profile, glucose, high-sensitivity C-reactive protei (HsCRP), interleukin-6 and tumor necrosis. They were broken down into 4 groups:AH/no PD; G3(N = 23):NT+PD; G4(N = 15):NT/no PD. Results: Mean age was 49.94 ± 7.32 (Range 35–60) years, 43% women; 39% non-white. Blood pressure (BP) mmHg: G1:136/82; G2:136/79; G3:125/79; G4:131/76 (p < 0.004 for systolic BP G3 vs G1). Mean BP was significantly higher in hypertensives (p < 0.01) regardless of severe PD. HsCRP (mg/dL) was significantly lower in G4 (p < 0.003); Intimal-medial thickness (IMT) was not significantly different among groups. Parameters of diastolic function did not differ significantly among groups regardless of the presence or absence of hypertension or PD. Global longitudinal strain (GLS) was also similar among groups; G1:–21.11 ± 2.24 G2:–21.33 ± 2.67 G3:–20.80 ± 3.17 G4:–21 ± 2.82 (p = 0.94). There were no significant differences in proportion of GLS ≥ –18 among the 4 groups. Since all HT patients were treated, no correlation systolic or diastolic BP and GLS was found. In conclusion, severe chronic PD was not independently associated with IMT, diastolic function nor with subclinical left ventricular dysfunction in the sample studied.
107816
Modality: E-Poster Researcher – Non-case Report
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
MARIA CAROLINA GUIDO1, Priscila Oliveira de Carvalho1, Natalia de Menezes Lopes1, Aline de Oliveira Silva1, Leonardo Jensen1, Roberto Kalil-Filho1, Lygia da Veiga Pereira2, Francisco Rafael Martins Laurindo1, Raul Cavalcante Maranhão1
(1) Instituto do Coração – HCFMUSP; (2) Instituto de Biociências – USP
Introduction: Patients with Marfan syndrome (MFS), a disease caused by mutation of the fibrillin-1 gene, are vulnerable to left ventricular (LV) cardiomyopathy. MicroRNA-1 (miR-1) has involved in cardiomyopathy, but the role of miR-1 in MFS is unknown. Methotrexate (MTX), a chemotherapeutic agent, when associated with lipid nanoparticles (LDE) that mimic LDL composition, markedly increased cell uptake, which enhances the pharmacologic properties and diminishes the toxicity of the drug. LDEMTX showed powerful anti-inflammatory and anti-proliferative effects on rheumatoid arthritis and atherosclerosis rabbit models. In rats submitted to acute myocardial infarction, LDEMTX contributed to the reduction of LV remodeling.
Objective: To investigate the effect of LDEMTX on miR-1 expression in the development of LV cardiomyopathy in MFS mice.
Methods: MFS and wild-type (WT) mice were allocated to the following groups: WT and MFS, both untreated; MFS-MTX, MFS treated with commercial MTX; MFS-LDEMTX, MFS treated with LDE-MTX. The treatment occurred weekly at a dose of 1 mg/kg ip, between the 3rd and 6th month of life. After 12 weeks, the animals were submitted to echocardiography, morphometry and, miR-1 and proteins expressions of LV.
Results: LDEMTX did not improve the LV diastolic dysfunction in MFS mice. LDEMTX reduced LV hypertrophy by decreasing the interventricular septum and posterior wall thickness and the myocytes diameter. Collagen volume fraction in subendocardial, interstitial and papillary muscle areas was also diminished. The protein expression of caspase 3 and hypoxia-inducible factor 2α were lower, whereas VEGF and angiopoietin 1/2 were higher in LDEMTX group. Compared to MFS and MFS-MTX groups, MFS-LDEMTX increased miR-1 expression. The expression of miR-1 had a negative correlation with pro-apoptotic (r2 = 0.48; p < 0.01), cellular hypoxia (r2 = 0.45; p < 0.01), fibrosis (r2 = 0.40; p < 0.01) and myocyte hypertrophy (r2 = 0.24; p < 0.05) markers; while had positive correlation with pro-angiogenic marker (r2 = 0.50; p < 0.01).
Conclusion: Although LDEMTX had no effect on diastolic dysfunction, LDEMTX treatment improved cellular changes in LV cardiomyopathy in MFS mice. LDEMTX had beneficial effects on miR-1 modulation by increasing angiogenesis and decreasing apoptosis, cell hypoxia, fibrosis and hypertrophy of LV. This is the first study that shows therapeutic efficacy in the cardiomyopathy of MFS mice, under the modulation of miR-1.
107826
Modality: E-Poster Researcher – Non-case Report
Category: DYSLIPIDEMIA
FABIANA CORDEIRO JULIANI1, Fátima Rodrigues Freitas1, Viviane Zorzanelli Rocha1, Márcio Hiroshi Miname1, Ana Paula Chacra Marte1, Wilson Salgado1, Raul Dias Santos1, Raul Cavalcante Maranhão1
(1) Heart Institute of the Medical School, University of Sao Paulo – Brazil
Introduction: Familial hypercholesterolemia (FH) is a monogenic disease characterized by elevated LDL-C from birth and increased risk of premature coronary artery disease (CAD). Accumulation of LDL-C in plasma may impair anti-atherosclerotic actions attributed to HDL. In addition to HDL particle size, metabolic aspects related to the antiatherosclerotic protection of HDL should be considered beyond simple determination of HDL-C, such as antioxidant action of HDL-associated paraoxonase 1 (PON1) that protects LDL and other lipoproteins from oxidative stress.
Aim: To assess whether PON1 activity and HDL particle diameter are altered in individuals with FH with or without subclinical CAD.
Methods: Twenty patients with genetic diagnosis of heterozygous FH and subclinical CAD documented by coronary CT angiography and 20 patients with heterozygous FH without subclinical CAD, matched by age, sex and BMI were enrolled. After 30-day interruption of lipid-lowering drugs, plasma lipids and apolipoproteins (apo) B and A-I were determined by commercial kits. LDL-C was calculated using the Friedewald formula. PON1 activity was determined by spectrophotometry. HDL diameter was determined by laser light scattering method.
Results: LDL-C, non-HDL-C and apo B were equally high. There were no differences in triglycerides, HDL-C or apo A-I. PON1 activity and HDL diameter also did not differ between the two groups.
Conclusion: Among patients with FH, the presence of subclinical CAD was not associated with significant differences in plasma lipids and apo’s and in either HDL size or activity of PON1. In the quest for factors not related to high LDL-C that can facilitate or protect against the development of atherosclerosis in FH patients, other defects of HDL functions should be investigated.
107879
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
NIKOLAI NELASOV1, Dmitry Safonov1, Nikolai Nelasov1, Alexander Zubov2, Maria Ovrulova1, Maxim Morgunov1, Roman Sidorov1, Olga Eroshenko1, Anna Nechaeva1, Georgiy Chudinov1, Anna Bazilevich1, Elizaveta Palenaja2
(1) Rostov State Medical University, Russian Federation; (2) Donetsk National Medical University, Ukraine
Introduction: Analysis of left ventricular myocardial strain parameters during stress-Echo showed promising results in detection transient myocardial ischemia. Various echocardiographic modalities of strain analysis can be used: speckle tracking longitudinal (Ls), circumferential (Cs), radial (Rs), area (As) strain and tissue Doppler longitudinal strain (TDI Ls). However, it is still debatable which of these modalities better detects stress-induced ischemia in regions of vascularization of obstructed coronary arteries. Objectives. The objectives of this study were: 1) to explore which of the methods (Ls, Cs, Rs, As or TDI Ls) can more frequently reveal regional transitory deformation disorders and identify coronary arteries responsible for induction of ischemia in patients with stable obstructive coronary artery disease in dynamics of left ventricular 4D stress-Echo with adenosine triphosphate; 2) to compare the efficacy of conventional method of visual evaluation of local contractility and above mentioned strain modalities in detection of ischemia-associated obstructed coronary arteries.
Methods: 32 patients (male 29, mean age 58,2 years (95% CI: 58,2–60,2 years) with stable angiographically documented coronary artery disease (single vessel obstructive disease was detected in 6, multi vessel – in 26 cases) underwent left ventricular 4D stress-Echo with adenosine triphosphate. Criterion of strain impairment during stress-test was an increase in values by 5% in at least 2 adjacent myocardial segments using Ls, Cs and TDI Ls methods, by 7% using As method, and decrease in strain value by 10% using Ra modality.
Results: During stress-test Ls revealed appearance/increase of strain disorders in the regions of vascularization of obstructed coronary arteries in 71.9%, Cs – in 65.6%, Rs – in 59.4%, As – in 75.0% and TDI Ls – in 62.5% of patients, while visual assessment of LV myocardial contractility revealed impairment of contractility in the territories of vascularization of obstructed coronary arteries only in 31.2% of patients (differences with strain methods in all cases were statistically significant).
Conclusion: All methods of regional strain analysis (Ls, Cs, Rs, As, TDI Ls) can identify coronary arteries responsible for induction of ischemia during 4D stress-Echo with adenosine triphosphate in patients with stable coronary artery disease more effectively then visual evaluation of myocardial contractility; the best results can be obtained by applying As.
107881
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barretto1
(1) Insituto do Coração – HC FMUSP
Background: Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, little is known about differences in mortality and predictors of death in women and men with heart failure with preserved (HFpEF), mildly reduced (HFmrEF), and reduced ejection fraction (HFrEF).
Methods: From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men.
Results: We studied 12,015 patients, mean of 63.8 ± 14.3 years, 6637 (55%) males. Females were older (64.9 ± 14.8 vs. 62.8 ± 13.8 years; p < 0.0001), had a higher baseline mean left ventricular ejection fraction (LVEF) (49.8 ± 18.9% vs. 42.6 ± 15.4%; p < 0.001), and a lower left ventricular diastolic diameter (LVDD) (54.1 ± 9.0 vs. 60.1 ± 9.6 mm; p < 0.001). Over a 3-years follow-up period, 1543 (23.2%) men and 1051 (19.5%) women of the cohort died (K-M: log-rank p < 0.0001). Cumulative incidence of death was higher in men (K-M: log-rank p = 0.0002) with HFrEF but similar for HFmrEF and HFpEF (Figure). Cox regression for death adjusted for age, ischemic, idiopathic, hypertension, Chagas, valve, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, and LVEF showed that CKD, previous stroke, and diabetes were the main predictors of death for all phenotypes of LVEF in women and men.
Conclusion: Women had a better prognosis than men in HFrEF but similar mortality for HFmrEF and HFpEF. Control of diabetes and preventing stroke and CKD could significantly reduce the death rate in women and men with all CHF phenotypes.
107882
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barretto1
(1) Insituto do Coração – HC FMUSP
Background: Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, there is evidence of a gender-associated risk of dying of heart failure of different types of cardiomyopathies (CMP).
Purpose: To analyze the mortality of CHF due to different types of CMP in women and men.
Methods: From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria) in five types of CMP (ischemic, idiopathic, hypertensive, Chagas, and valve disease). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses used the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men for each CMP.
Results: We studied 12,015 patients, mean of 63.8 ± 14.3 years, 6637 (55%) males. For all patients, death occurred in 27.5%, 15.3%, 17.5%, 40.1%, and 24.4%, respectively, for ischemic, idiopathic, hypertensive, Chagas, and valve CMPs (p < 0.0001). HFrEF was more prevalent in idiopathic (51.2%) and Chagas (49.9%), and for HFpEF valve disease (80.4%), hypertensive (51.9%), and ischemic (44.4%). Compared to men, women were older, had a higher baseline mean left ventricular ejection fraction (LVEF), and a lower left ventricular diastolic diameter (LVDD) for all five types of CMP (p < 0,001). Over a 3-years follow-up period, the cumulative incidence of death was higher in men with ischemic CMP (38% vs. 31%; p = 0.037) and Chagas CMP (48% vs. 38%; p < 0,001) but similar for idiopathic, hypertensive, and valve disease CMP (Figure). Cox regression analysis for death, for each CMP, adjusted for confounders such as age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), any cardiac surgery, cardiac pacemakers, and LVEF showed that men were an independent predictor of death only for Chagas CMP (HR = 1,28; 95%CL: 1.08–1.43; p = 0.009).
Conclusion: Men were at a higher risk of death in ischemic and Chagas CMP but not for idiopathic, hypertensive, and valve CMP. The other main predictors of death were similar for all types of CMP, namely CKD, stroke, diabetes, and AF.
110849
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
MICHAŁ LEWANDOWSKI1
(1) National Institute of Cardiology, Warsaw, Poland
Introduction: Sudden cardiac death (SCD) constitutes a major clinical and public health problem, whose death burden is comparable to the current worldwide pandemic. The presented abstract and project encompasses the following topics: available rescue systems, wearable electrocardiograms (ECG), detection and transmission technology, and a newly developed fuzzy logic algorithm (FA) for heart rhythm classification which is state-of-the art in the field of SCD prevention. Project “PROTECTOR”, the Polish Rapid Transtelephonic ECG System to Obtain Resuscitation for development of a rapid rescue system is presented.
Methods: From a database containing RR interval series of the recorded arrhythmia events and controls, stored in the defibrillator memory and archived on PC during systematic control visits, RR data was chosen consecutively on the basis of full data availability, i.e., RR interval series with simultaneous intracardiac electrogram (IEGM) prints. Then, the heart rhythm classification of the recorded event was assigned into one of the six diagnostic categories of the developed algorithm. The total number of RR recordings evaluated for statistical analysis came to 298 (obtained from 183 pts). Sensitivity and specificity of the proposed algorithm were calculated on the basis of the widely accepted criteria. If a lethal arrhythmia is detected on the basis of FA, the system produces an alarm signal audible for bystanders and transmits the alarm message along with location to the emergency medical center. Phone guided resuscitation can be started immediately because an automated external defibrillator (AED) localization map is available. An automatic, very fast diagnosis is a unique feature of the PROTECTOR prototype.
Results: The sensitivity and specificity of the tested algorithm were 100% and 97.8%, respectively. Internet data transfer opens potential application of the presented heart rhythm classification in telemedicine. The presented methodology is completely new ECG-based technique in the diagnosis and treatment of cardiac patients.
Conclusions: The rapid detection of SCA is based on a processor characterized by 100% sensitivity (as measured in the pilot studies). An integrated circuit which implements FA has already been designed and a diagnosis is made within few seconds, which is extremely important in ischemic brain damage prophylaxis. This algorithm could be implemented in many mobile devices: smartphones, tablets etc.
107971
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
NATHALIE JEANNE MAGIOLI BRAVO-VALENZUELA1, Alberto Borges Peixoto3, Mattar, Rosiane2, Antonio Fernandes Moron2, David Baptista da Silva Pares2, Gabriele Tonni4, Edward Araujo Júnior2
(1) FEDERAL UNIVERSITY OF RIO DE JANEIRO-RJ, Brazil; (2) FEDERAL UNIVERSITY OF SAO PAULO-SP, Brazil; (3) Federal University of Triangulo Mineiro-MG, Brazil; (4) Prenatal Diagnostic Service, Department of Obstetrics and Gynecology, Istituto di Ricerca a Carattere Clinico Scientifico (IRCCS), AUSL Reggio Emilia, Italy
ABSTRACT Purpose: To establish reference values for the systolic-to-diastolic duration ratio (SDR) of the left ventricle (LV) using spectral Doppler, as well as for the SDR’ of the interventricular septum (SEP), LV, and right ventricles (RV) using tissue Doppler of the fetal heart.
Methods: This prospective and cross-sectional study evaluated 374 low-risk singleton pregnancies from 20 to 36+6 weeks of gestation. The ventricular filling time (FT) was obtained from LV inflow using spectral Doppler. Tissue Doppler was used to assess the FT of each ventricle by placing the cursor at the atrioventricular junction marked by the mitral and tricuspid valves, respectively. SDR was calculated as the sum of the isovolumic contraction time (ICT) and the ejection time (ET) divided by the sum of the isovolumic relaxation time (IRT) and the ventricular FT. We used regression analysis to obtain the best-fit model polynomial equation for the parameters. The concordance correlation coefficient (CCC) was used to assess intra- and inter-observer reproducibility.
Results: SDR and SDR’ LV showed a progressive decrease with gestational age (GA); the SDR’ RV and SDR’ SEP did not show a significant decrease with advancing GA. The SDR LV (r = 0.29, p < 0.0001), SDR’ RV (r = 0.21, p < 0.0001), SDR’ LV (r = 0.20, p = 0.0001), and SDR’ SEP (r = 0.25, p < 0.0001) showed a significant weak positive correlation with fetal heart rate. The inter-observer SDR’ SEP measurements demonstrated poor reproducibility (CCC: 0.50), whereas intra-observer SRD LV measurements demonstrated moderate reproducibility (CCC: 0.78).
Conclusions: Reference values for SDR SEP, LV, and RV using spectral and tissue Doppler of fetal heart were established between 20 and 36+6 weeks of gestation.
108035
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogerio Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Objectives: The novel coronavirus (SARS-CoV-2) may predispose patients to arterial or venous thrombosis due to excessive inflammation, platelet activation, endothelial dysfunction, and blood stasis. Pulmonary embolism as one of the most serious manifestations of this systemic framework worries those who are dealing with COVID-19 daily. The need for isolation and the home office can favor the development of risk factors for PE such as a sedentary lifestyle, immobility, obesity and smoking. The present study aimed to assess the influence of COVID-19 on hospitalizations, mortality rate and length of stay for pulmonary embolism in Brazil.
Method: We used the database from the Department of Informatics of the Brazilian Health System (DATASUS), through the website https://datasus.saude.gov.br/. We evaluated the number of hospitalizations, deaths and length of stay of patients for PE in Brazil and their relationship with the beginning of the COVID-19 pandemic in Brazil (March 2020) based on data from January 2018 to December 2021.
Results: From January 2018 to December 2021, 38902 patients were hospitalized for PE in Brazil, 23706 (60.9%) were female and 15196 (39.1%) were male. There was a slight increase in the average number of hospitalizations, but there was no statistical difference in the average total number of hospitalizations comparing 2018–19 with 2020–21: 9655 ± 624 and 9797 ± 201 (p = 0.804). The number of deaths and mortality rate also did not show important differences for the same period, with 1684 ± 66 deaths and a mortality rate of 17.5 ± 0.43 for 2018–19 and 1805 ± 142 and a mortality rate of 18.4 ± 1.1 for 2020–21 (p = 0.428 and p = 0.415 respectively). The mean hospital stay was similar, with 9.1 ± 0.3 days in 2018–19 and 8.5 ± 0 days in 2020–21 (p = 0.205). Regarding the age group, the number of hospitalizations is higher between 60–69 years old with 7495 cases and an annual average of 1874 ± 59 and the group over 80 years old with the highest mortality rate 34.7 ± 1.5.
Conclusion: In the context of the COVID-19 pandemic, the number of hospitalizations due to PE remained stable in the period studied from 2018 to 2021, with a predominance of female patients (60.9%). The number of deaths and mortality rates also remained stable, as well as the average length of hospital stay. Advanced age was an important factor for both hospitalization and mortality.
108036
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogério Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Objective: Cardiovascular diseases are increasingly becoming a health problem in Brazil and worldwide. They are related to important acute complications such as stroke, which have high morbidity and mortality, especially when identified late. Taking into account the difficulty of the population’s access to health services in brazilian pandemic scenario, the present study aimed to assess the impact of COVID-19 pandemic and vaccination on stroke deaths in the elderly population in Brazil.
Method: Using data from the Civil Registry Information Center in Brazil, through the website https://transparencia.registrocivil.org.br/especial-covid, we evaluated the number of deaths from stroke in Brazil in the elderly (age above 60 years) and its relationship to the COVID-19 pandemic from January 2019 to December 2021.
Results: From January 2019 to December 2021, 239771 patients above 60 years old died of stroke in Brazil, 120107 (50.1%) were male and 119664 (49.9%) female. There was a slight decrease in stroke deaths in the comparison between 2019 and 2020, from 79806 to 79435 with a further increase in 2020 to 80530. The age group with the highest number of deaths was 80–89 with an average of 25807 ± 519, followed by 70–79 with an average of 25180 ± 1012. When we compare the monthly average of deaths and the beginning of the pandemic in Brazil (March 2020), the average was: before 656 ± 44 and after 673 ± 23 (p = 0.27). We also performed an analysis with the start of vaccination in Brazil in January 2021 and found a mean number of monthly deaths of 673 ± 23 before and 671 ± 46 after (p = 0.89).
Conclusion: In the context of the Brazilian COVID-19 pandemic scenario, the number of deaths from stroke in the elderly population fell slightly from 2019 to 2020, with a new increase in 2021. The number of deaths remained similar for the years studied, with the age group of 80–89 years old as the highest number of cases followed by the 70–79 group. Neither the COVID-19 pandemic nor vaccination changed the monthly average deaths from stroke in the Brazilian elderly population.
108037
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogerio Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Objectives: The cardiovascular diseases are an important healthcare problem in Brazil and worldwide. They are related to acute complications such as stroke, which have high morbidity and mortality, especially when identified late. The difficulty of the population’s access to health services in brazilian pandemic scenario associated to isolation and home office can favor the development of traditional risk factors for stroke, most often neglected by young people, as sedentary lifestyle, obesity, smoking and poor nutrition. The present study aimed to assess the impact of COVID-19 on stroke deaths in young people in Brazil.
Method: We used data from the “Portal da Transparência”, a platform managed by the National Association of Registrars of Natural Persons (Arpen-Brazil), through the website https://transparencia.registrocivil.org.br/especial-covid. We evaluated the number of deaths from stroke in Brazil in young people (aged 20 to 59 years) and its relationship with the beginning of the COVID-19 pandemic in Brazil (March 2020) analyzing data from January 2019 to December 2021.
Results: From January 2019 to December 2021, 57,965 patients between 20 and 59 years old died from stroke, 33,764 (58.2%) were male. There was an increase in the number of total deaths over the years studied from 17506 to 19042 and 21417. The average monthly deaths in the period before the pandemic in Brazil was 1451 ± 80, in contrast to 1711 ± 117 after the beginning of the pandemic (p < 0.001). The age group with the highest number of deaths was 50–59 with a mean of 10246 ± 788, followed by 40–49 with a mean of 5215 ± 488.
Conclusion: According to official data on deaths from strokeI in young adults between 20 and 59 years old, there was a progressive increase from 2019 to 2021, with a predominance of male patients. The COVID-19 pandemic contributed to this increase significantly. Age remains an important risk factor and older age groups continue to be the most affected.
108038
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogerio Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Objectives: Cardiovascular diseases are one of the main causes of death in Brazil and worldwide, and AMI is its main exponent. During the pandemic of the new coronavirus, health systems had to adapt to adequate care of these patients. The need for isolation and home office can favor the development of traditional risk factors for AMI, most often neglected by young people, such as a sedentary lifestyle, obesity, smoking, excessive consumption of alcohol, stress and poor nutrition. In addition, and taking into account the difficulty of the population’s access to health services in the Brazilian pandemic scenario, the present study aimed to evaluate the impact of COVID-19 on deaths from AMI in young people in Brazil.
Method: We used data from the “Portal da Transparência”, a platform managed by the National Association of Registrars of Natural Persons (Arpen-Brazil), through the website https://transparencia.registrocivil.org.br/especial-covid. We evaluated the number of deaths from AMI in Brazil in young people (aged 20 to 59 years) and its relationship with the beginning of the COVID-19 pandemic in Brazil (March 2020) with data from January 2019 to December 2021.
Results: From January 2019 to December 2021, 64,512 patients between 20 and 59 years old died from AMI, 44,940 (69.7%) were male. There was an increase in the number of total deaths over the years studied from 20075 to 20706 and 23731. The average monthly deaths in the period before the pandemic in Brazil was 1680 ± 123, in contrast to 1862 ± 181 after the beginning of the pandemic (p = 0.001). The age group with the highest number of deaths was 50–59 with a mean of 13568 ± 766, followed by 40–49 with a mean of 16710 ± 533.
Conclusion: According to official data on deaths from AMI in young adults between 20 and 59 years old, there was a progressive increase from 2019 to 2021, with a predominance of male patients. The COVID-19 pandemic contributed to this increase significantly. Age remains an important risk factor and older age groups continue to be the most affected.
108078
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
WALKIRIA SAMUEL AVILA1, Daniel VInicius Rodrigues Pinto1, Vera Maria Cury Salemi1, Walkiria Samuel Avila1
(1) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo; (2) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo; (3) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo; (4) Instituto do Coração do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
Background: Non-compaction cardiomyopathy (NCC) is a genetic congenital disease, with adverse clinical manifestations. The circulatory overload and hypercoagulability status of pregnancy, both can lead to serious complications.
Purpose: To study the maternal and fetal outcomes of pregnant women with NCC.
Methods: Out of 495 pregnant women with heart disease studied, four of them had a diagnosis of NCC confirmed by echocardiography and/or cardiac magnetic resonance exams. Before pregnancy, the symptoms were angina pectoris, syncope, and three cases with symptomatic arrhythmias, two of them underwent radiofrequency ablation. In the multidisciplinary follow-up, the therapy management was adjusted for pregnancy.
Results: The Table below presents the characteristics of patients and the maternal-fetal evolution. There were no deaths, but three patients required hospitalization for treatment of heart failure and cardiac arrhythmias, right away emergency cesarean section resulting premature babies. In the follow-up-12months, no changes were observed in the clinical or myocardium remodeling of NCC patients. The investigation of newborns did not identify any case of NCC.
Conclusions: The heterogeneity of NCC expression and the proportion of maternal and fetal complications, observed in this series, discourage pregnancy in patients with NCC. However, if pregnancy occurs, it should be followed into a tertiary hospital with a multidisciplinary team on standby.
108095
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
PHILIP MOONS1, Liesbet Van Bulck1, Koen Luyckx1
(1) KU Leuven – University of Leuven, Belgium
Background: Living with congenital heart disease (CHD) and the required invasive treatments are believed to have an impact on the psychological health of afflicted individuals. Therefore, mental health in persons with CHD is an area of concern. The epidemiology of depression and anxiety in CHD, however, is not fully understood and literature seems to report contradictory findings.
Objective: We aimed (i) to estimate the proportion of depression and anxiety in adolescents and adults with CHD around the globe; and (ii) to explore differences in depression and anxiety rates between people with CHD and the general population.
Methods: We conducted a systematic literature review and meta-analysis, registered in PROSPERO (CRD42021228395). Searches were performed in PubMed, Embase, Cinahl and Web of Science from their inception to March 6, 2021. We identified 91 studies, which enrolled 180,176 patients in total. A random effects meta-analysis of single proportions was conducted according to the DerSimonian-Laird method. Hedges’ gu (g) was calculated to compare the level of depression and anxiety with the general population.
Results: The pooled estimated proportion showed that 21.1% of the people with CHD had ≥mild depressive symptoms and 10.3% had ≥moderate depressive symptoms. When looking at the clinical diagnosis of depression, 10.3% had actual depression, and 16.1% had a lifetime episode of depression. For anxiety, 42.7% had ≥mild anxiety symptoms and 21.9% had ≥moderate anxiety symptoms. A clinical anxiety disorder was found in 12.7%, and 23.3% had a lifetime episode of anxiety disorder. The mean scores on questionnaires assessing symptoms of depression (g = 0.215; 95%CI = 0.062–0.368) or anxiety (g = 0.292; 95%CI = 0.165–0.419) were significantly higher in CHD than in the general population. However, this higher symptom score was not reflected in a significantly higher proportion of CHD patients having ≥mild depressive symptoms (p = 0.654), ≥moderate depressive symptoms (p = 0.869), ≥mild anxiety symptoms (p = 0.055) or ≥moderate anxiety symptoms (p = 0.287), when using the predefined cut-off scores.
Conclusions: This meta-analysis showed that there is a high proportion of depression and anxiety in persons with CHD. Although patients with CHD had higher scores of depressive and anxiety symptoms than people from the general population, the prevalence of depressive or anxiety symptomatology was not higher in CHD.
111457
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
MAURO RICARDO NUNES PONTES1, Mario Borba2, Lucélia B. N. C. Magalhães3, Alvaro Avezum4, Emilio Moriguchi5, Roberto Esporcate6, Sérgio Lívio Menezes Couceiro7, Hermilo Borba Griz8, Fernando A. Lucchese9
(1) Nucleo de Pesquisa Clinica do RS; (2) Cardioclinica do Vale, Lajeado; (3) UniFTC-Faculdade de Ciência e Tecnologia; (4) Hospital Alemão Osvaldo Cruz; (5) Hospital de Clínicas de Porto Alegre; (6) Faculdade de Ciências Médicas, UERJ; (7) Universidade Federal Fluminense; (8) Hospital Santa Joana, Recife; (9) Hospital São Francisco, Santa Casa de Porto Alegre
Purpose: Burnout among physicians is frequent and has several consequences for physician and patient. We hypothesized that high spirituality protect against burnout.
Methods: A survey with cardiologists, Aug 2018, asked about Burnout, demographics, spirituality, religiosity, job characteristics. We measured Burnout by 3 validated questions (three MBI -Maslach Burnout Inventory- domains). Subjects were Burnout + (B+) if they were in the top 3 scores (“>once a week”) on emotional exhaustion and/or depersonalization. Demographics, Spirituality score, DUREL religion index, job aspects, were correlated with B+ or B–. We evaluated consequences of burnout (suicidal ideation, stress, anxiety, depression measured by the DASS-21 form). Multivariate models evaluated the adjusted impact of spirituality over burnout and its consequences. Statistical analysis with SPSS version 23.
Results: 1000 survey forms, 40.5% response rate; 39 excluded (4 incomplete, 35 graduated £2y); final sample, 375 cardiologists; age 48.8 ± 12.6y, male 57.3%. Burnout rate was 34.6%. Variables associated with Burnout in bivariate analysis: civil state (divorced/single 28.9% B+, married 6.8%, P = 0.020), years from graduation (B+, 20.3 ± 13.1y; B–, 25.3 ± 12.5y; P < 0.001), age (B+, 45.4 ± 13.1y; B–, 50.0 ± 12.4y; P = 0.001), duty hours/week (Q1 to Q4; 24.0%, 27.8%, 46.5%, and 60.9%; P < 0.001), and night shifts/week (0 to 3; 30.7%, 38.2%, 41.7%, and 71.4%; P = 0.001). Gender (P = 0.295), Spirituality score (P = 0.099), DUREL (P > 0.05 for all 3 domains), postgrad (P = 0.701) and subspecialty (P = 0.668) not associated with B+. Consequences of Burnout: suicidal ideation (B+, Yes 10.9%; B– Yes 1.3%; P < 0.001), DASS Global score (B+, 18.1 ± 11.7; B–, 8.1 ± 6.8, P < 0.001), and DASS subscales of Anxiety, Stress, and Depression (P < 0.001 for all) were all associated with B+. In a multivariate regression model (Table 1), Number of Duty Hours per Week was associated with Burnout (OR = 1.79, 95% CI 1.34–2.41, P < 0.001), while Spirituality Score (but not Religiosity by DUREL index) protected against Burnout (OR = 0.87, 95% CI 0.77–0.98, P = 0.043).
Conclusions: High number of duty hours per week increases Burnout among Brazillian cardiologists, while high Spirituality protects them against Burnout.
108248
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
EDYTA SMOLIS-BAK1, Ilona Kowalik1, Jurand Sloniewicz1, Ewa Rydzewska1, Iwona Korzeniowska-Kubacka1, Jadwiga Wolszakiewicz1, Rafal Dabrowski1, Edyta Smolis-Bak1
(1) National Institute of Cardiology
Background: Regular physical activity is crucial for treatment and prevention of cardiovascular diseases. Adaptive changes in response to regular physical exertion show individual variability, which depends on a number of internal and external factors. The aim of the study was to assess the effectiveness of early post-hospital rehabilitation and to analyze the factors which may influence the exercise tolerance in patients with coronary artery disease (CAD) treated with PCI and CABG.
Material and methods: The study included 334 patients (pts), men 75.1%, with CAD, treated with PCI (87.4%) or CABG (12.6%). Mean age of the study group was 61.1 ± 10.9 years, mean BMI: 27.6 ± 4.1 kg/m2, mean LVEF: 56.1 ± 7.2%. The main risk factors for CAD were: dyslipidemias: 76%, hypertension: 64.7%, smoking: 28.7%, diabetes: 22.5%. The rehabilitation procedures lasted for 6–8 weeks. Pts participated in endurance training and general conditioning exercises with elements of resistance trainings. Before and after rehabilitation, all patients underwent a symptom-limited exercise test (ETT). In order to identify factors influencing the increase in tolerance of training loads, patients were divided into 2 groups: group 1 (198 pts, 59.3%) – pts with the training load which increased ≥50%, group 2 (136 pts, 40.7%) – pts with training loads which increased less, by <50%.
Results: After rehabilitation, a significant improvement in the ETT parameters was observed: 5.7 ± 1.3 vs. 6.8 ± 1.7 METs, p < 0.001; the resulting load predicted for age: 81.5 ± 22.5 vs. 93.7 ± 22.89%, p < 0.001; tests duration: 352 ± 106 vs. 436 ± 136 sec., p < 0.001 and in the training loads obtained: 46.7 ± 10.9 vs. 71.4 ± 22.4 Watts, p < 0.001. On the other hand, after rehabilitation, a significant increase in the number of pts with supraventricular (24.2% vs 34.7%, p < 0.001) and ventricular (34.2% vs 40.5%, p < 0.02) arrhythmias was observed. There was no correlation between the increase in training load tolerance (Watt) and the METs increase in the final ETT. The increase in the tolerance of training loads of ≥50% during rehabilitation was significantly influenced by: younger age, p < 0.001, gender (men), p < 0.001, EF (>50%), p < 0.003, absence of diabetes, p < 0.003, lower initial values of training loads, p < 0.003. The increase in workload (MET > 50%) in the final ETT was significantly influenced by age (younger patients), BMI (thinner subjects) and lower workload (MET) in the baseline test. Other factors: smoking, hypertension.
108254
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
EDYTA SMOLIS-BAK1, Edyta Smolis-Bak1, Zbigniew Lew- Starowicz2, Monika Szymanska2, Ilona Kowalik1, Ryszard Piotrowicz1, Eliza Noszczak1, Rafal Dabrowski1
(1) National Institute of Cardiology, Warsaw, Poland; (2) Postgraduate Medical Education Center, Warsaw, Poland
Background: Data show that cardiological patients (pts), after achieving an improvement in the functioning of the cardiovascular system, begin to expect improvement also in the field of sexual health, which is important in partner relationships, mental health and quality of life. The aim of the study was to analyze the occurrence of sexual disorders and to assess the impact of sexual rehabilitation and physiotherapeutic education on sexuality in pts after left ventricular assist device (LVAD) implantation.
Material and methods: The study included 50 men after LVAD implantation, mean age 51.6 ± 12.8 years. 18 pts did not complete the study (heart transplant –5 pts, resignation –10 pts, death –3 pts). The pts were assessed by a sexologist in terms of the quality of sexual life and erectile dysfunction. All pts received therapeutic interventions: sexological counseling, education (positions during intercourse, safety recommendations) and physical activity. Additionally, pharmacological treatment of erectile dysfunction was started in 15 pts. Upon entry into the study, the quality of sexual life, sexual needs (Mell-Krat scale) and sexual function (International Index of Erectile Function, IIEF-5) were assessed retrospectively (before the onset of the disease) and actually. Additionally, exercise tolerance was assessed using the 6-minute walk test (6-MWT). The tests were repeated after 6 months.
Results: After the implementation of sexual and physical activity education, significant improvement in exercise tolerance assessed by 6-MWT [m] was observed: 350 (310–445) vs. 450 (400–500), p < 0.001. The quality of sex life in the whole group significantly worsened after LVAD implantation compared to the period before the onset of the disease (40 [40–41] vs 33.5 [12–40] vs 34 [26–40]). Mild erectile dysfunction was observed in all the pts, both before onset of the disease, after LVAD implantation and after 6 months. The number of pts with sexual dysfunction increased significantly after LVAD implantation (9.4% vs. 53.1%) and remained at a similar level for 6 months. There was a significant reduction in the frequency of sexual intercourse after LVAD implantation and a significant increase in it after pharmacological treatment, but its level did not reach the level before the disease (3 [2–4] vs 1.5 [0–2.5] vs 2 [1.0–2.5]). The improvement in the quality of sexual life and the reduction of erectile dysfunction were significantly dependent on age and LVEF – bett.
108346
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
LUISA CAMPOS CALDEIRA BRANT1, Pedro Cisalpino Pinheiro1, Luiz Guilherme Passaglia1, Eduardo David Gomes de Sousa2, Carla Valença Daher2, Roberta Maria Leite Costa2, Antonio Luiz Pinho Ribeiro1, Bruno Ramos Nascimento1
(1) Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, UFMG, Brazil; (2) Department of Specialized and Thematic Healthcare, Ministry of Health, Brasilia, Brazil
Introduction: COVID-19 has impacted cardiovascular (CV) mortality worldwide, possibly due to avoidance of healthcare, health system collapse, and the direct CV effects. Data from Brazil are scarce and restricted to some locations or early phases of the pandemic.
Objective: To evaluate the impact of COVID-19 pandemic on mortality for CV diseases (CVD), stratified by age, sex and region of Brazil, comparing underlying (UC) and multiple causes (MC) of death.
Methods: Ecological, time series study analysing the age-standardized death rates for CVD, from epidemiological week (EW) 10/2020 to EW 11/2021, using data from the Mortality Information System (SIM-SUS). CVD was defined as in Chapter IX, ICD-10, and considered if reported as UC or MC of death (UC + other causes reported in any line of death certificate), in separate analyses. Observed was compared to expected data (mean for the same EW of 2017–2019). Risk ratios (RiR) were analysed and 95% confidence intervals were calculated.
Results: Age-standardized mortality rate for CVD as UC of death in the pandemic was 136.8 (95%CI 136.3–137.3)/100,000 inhabitants, 7% (RiR = 0.93; 95%CI 0.93–0.93) lower than expected (147.1; 95%CI 146.6–147.6)/100,000. There was an increase in out-of-hospital mortality (6%) (RiR = 1.06; 95%CI 1.05–1.07) and in deaths with ill-defined CVD causes (49%) (RiR = 1.49; 95%CI 1.47–1.50), particularly in the out-of-hospital setting (58%). The increase in out-of-hospital deaths was more pronounced in the North (RiR = 1.27; 95%CI 1.25–1.28) and Northeast (RiR 1.18; 95% CI 1.17–1.18) regions, both with less structured health systems. Conversely, in MC of death analysis, there was a 4% increase in CV mortality (observed: 225.1 (CI95% 224.5–225.8), expected: 217.2 (95%CI 216.5–217.8)/100,000, RiR: 1.04 (95%CI 1.03–1.04), noticeably in the out-of-hospital setting (11%). In MC of death analysis, the steeper increasing trends also ocurred in the North region (RiR = 1.13; 95%CI 1.12–1.15), and in individuals >60 years (RiR = 1.05; 95%CI 1.05–1.06), and among men (RiR: 1.06; 95%CI 1.05–1.06) vs. women (RiR: 1.02; 95% CI 1.01–1.02).
Conclusions: During the pandemic, mortality rates for CVD as UC of death reduced in Brazil, contrasting with an increase when MC were considered. Higher out-of-hospital mortality – resulting from social distancing and overwhelmed health systems – exaberbation of existing CVD by COVID-19, and competing causes of death may have accounted for this pattern.
108258
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
EDYTA SMOLIS-BAK1, Kamil Szczesniak1, Ilona Kowalik1, Grzegorz Skorupski1, Lukasz Lasecki1, Jerzy Osak1, Magdalena Furmanek1, Hanna Szwed1, Rafal Dabrowski1
(1) National Institute of Cardiology, Warsaw, Poland
Balance and coordination disorders are factors provoking falls in the elderly. Their fast and precise identification is therefore of vital importance. The aim of this work was to assess the risk of falls and the influence of early hospital rehabilitation on the balance and coordination parameters in patients after cardiac surgery.
Material and methodology: The study was conducted on 207 patients: 44 women and 163 men aged 18–87 (mean 60.2 ± 14.0), who participated in comprehensive cardiac rehabilitation following cardiac surgery. The risk of falls and patients’ functional status were tested twice with the use of the FallSkip device: after the initial mobilization and before the discharge from the ward.
Results: After rehabilitation, improvement was noted in the whole group in all analysed functional parameters and in the reduction of the risk of falls (p < 0.0001). A significantly higher risk of falls was observed in women in comparison with men (p < 0.001), and in individuals aged >70 in comparison with patients aged <70 (p < 0.001). There were no differences observed in the risk of falls of patients in the groups with the BMI <30 and >30, both before and after rehabilitation. After rehabilitation the risk of falls decreased significantly in men (p < 0.001) and in individuals aged <70, (p < 0.001), as well as in patients with the BMI <30, p < 0.001, and >30, p < 0.012. There was a tendency for better results in men in all tested parameters.
Conclusions: The proposed comprehensive rehabilitation model after cardiac surgery significantly improved the effectiveness of gait, time of reaction in response to audio stimuli, increased muscular strength of lower limbs and significantly reduced the risk of falls. The FallSkip equipment is useful in the assessment of the risk of fall and of the level of functional parameters in patients after cardiac surgery.
108351
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
LUISA CAMPOS CALDEIRA BRANT1, Luiz Guilherme Passaglia1, Pedro Cisalpino Pinheiro1, Eduardo David Gomes de Sousa2, Carla Valença Daher2, Roberta Maria Leite Costa2, Antonio Luiz Pinho Ribeiro1, Bruno Ramos Nascimento1
(1) Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, UFMG, Brazil; (2) Department of Specialized and Thematic Healthcare, Ministry of Health, Brasilia, Brazil
Introduction: The COVID-19 pandemic impacted hospitalizations for other causes due to change in populations’ behaviour, as a result of fear or adherence to social distancing, or overwhelmed hospitals. Low and middle-income countries may have higher negative impact because of less resilient health systems. Previous studies in Brazil showed a reduction in hospitalizations for cardiovascular diseases (CVD). However, they were restricted to some cities or the first three months of the pandemic.
Purpose: Evaluate the impact of COVID-19 pandemic in the number and severity of hospitalizations for CVD in the Brazilian public and universal health system during 2020 and 2021, considering differentials by age, sex, region of the country.
Methods: Ecological, time series study analysing the number of hospitalizations, number and proportion of intensive care unit (ICU) admissions and in-hospital deaths for CVD, from epidemiological week (EW) 10/2020 (first confirmed COVID-19 case) to EW 21/2021, using data from the Hospitalization Information System (SIH-SUS). CVD was defined as in Chapter IX from ICD-10. Observed data was compared to the mean for the same EW of 2017–2019. Risk ratios (RiR) were analysed and 95% confidence intervals were calculated.
Results: A 16% (RiR 0.84; 95%CI 0.83–0.84) reduction in hospitalizations for CVD was observed in the pandemic period (n = 953,025). However, higher proportion of ICU admissions (RiR 1.09; 95%CI 1.08–1.09), and in-hospital deaths (RiR 1.14; 95%CI 1.14–1.15) revealed greater severity of hospitalized individuals, which may have ocurred due to delayed admissions, or disrupted pathways of care. Two peaks of reductions in hospitalizations were observed, possibly resulting from different drivers: the first, at the beginning of the pandemic, may have resulted from deferred hospitalized treatment, while the second may represent competing demands with COVID-19, resulting in even higher proportion of deaths (Figures 1 and 2). Women, older individuals and those living in the least developed North and Northeast regions were mostly negatively impacted, exacerbating vulnerabilities in CVD care.
Conclusions: The COVID-19 pandemic disrupted CVD care in Brazil. Health policies must address hospitalizations by CVD during future pandemics, including reorganizing pathways of care, public campaigns about symptoms that require hospitalization, and greater availability of ICU beds, besides a plan to face the rebound effect for deferred procedures.
108357
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
MARCOS VINICIUS COELHO DUTRA1, CARLOS ALBERTO KENJI NAKASHIMA1, LILIAN BELINASO1, VIVIANE DE SA PEREIRA1, RICARDO PHILIPE ZAGO1, ANTONIO DEJAIR ACOSTA PAZZINI1, VANESSA DELMIRO DOS SANTOS1, CASSIO PERFETE1, ERASMO SIQUEIRA1, DALTON BERTOLIM PRECOMA1
(1) Hospital Angelina Caron
Background: Early reperfusion of the ischemic myocardium is the most important advance in the last 30 years when it comes to acute myocardial infarction (AMI) with ST-segment elevation (STEMI), which can be in the mechanical form by angioplasty, or pharmacologically with use of thrombolytic, respecting the indication of each one. Antiplatelet therapy, from the studies with acetylsalicylic acid as in the Isis-2 study, demonstrating a 23% reduction in mortality when used alone in acute coronary syndrome (ACS), the addition of low molecular weight heparin, to more recent publications with the new adenosine diphosphate blockers and thrombin receptor blockers, corroborating the reduction of outcomes in the acute scenario of post-angioplasty AMI (thrombosis reduction), and making dual antiplatelet aggregation (DAPT) an essential part of the treatment of ACS. Few trials provide us with information comparing whether such medications, used as indicated in STEMI, were able to maintain the patency of the affected vessel pre-coronary angiography.
Objective: To compare, between the two groups analyzed (pre-treatment with clopidogrel vs. ticagrelor) the patency of the culprit coronary artery assessed by TIMI angiographic flow analysis by coronary angiography.
Methods: A total of 3287 medical records of patients admitted to a chest pain unit of a tertiary hospital in the metropolitan region of Curitiba – Paraná were analyzed from March 1, 2019 to March 1, 2021. Of the 3287 patients initially evaluated, 384 patients were selected with a diagnosis of STEMI, 16 patients were excluded due to lack of data in their medical records and 334 patients were analyzed until hospital discharge.
Results: Of all the cases that used ticagrelor, 65.1% had occluded vessels and of the cases of clopidogrel, 65.8% of the affected vessels remained occluded. Therefore, no significant difference was found between clopidogrel and ticagrelor regarding the probability of being occluded (p = 0.585).
Conclusion: We can conclude that in the analyzed sample, there was no statistical difference between the use of clopidogrel and ticagrelor in the patency of the vessel affected by the occlusion.
108384
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
RAFAEL ALEXANDRE MENEGUZ MORENO1, Nisia Lira Gomes1, Alfredo Nunes Ferreira-Neto1, Auristela IO Ramos1, Zilda Meneghelo1, J. Italo Franca1, Amanda GMR Sousa1, Sérgio Luiz Navarro Braga1, Dimytri Siqueira1, J. Ribamar Costa Jr.1
(1) Instituto Dante Pazzanese de Cardiologia; (2) Universidade Federal de Sergipe; (3) Hospital Primavera
Background: Mitral valve stenosis (MVS) is one of the most common structural heart diseases in developing countries, primarily due to rheumatic disease. Percutaneous mitral balloon valvuloplasty (PMBV) has been, since its introduction in 1984, the preferred option of treatment for such disease. However, restenosis is presented with an approximate incidence of 20%. Echocardiographic scoring of the mitral apparatus has been the main tool used to indicate and foresee the possible result of the procedure. The objective of this study was to enlight risk factors of mitral valvular restenosis in a significant number of patients submitted to percutaneous mitral balloon commissurotomy for the treatment of mitral stenosis (MS), particularly when secondary to rheumatic heart disease.
Methods: This study reports the vast experience of a single center high volume tertiary institution where 1.794 consecutive patients were treated with PMBC between 1987 and 2011. The primary endpoint was to determine the independent predictors of this untoward event, defined as loss of over 50% of the original increase in maximum valve area (MVA) or MVA < 1.5 cm2.
Results: Mitral valve restenosis was observed in 26% of the cases (n = 483). Mean population age was 36 years old, with most patients being female (87%). Mean follow up duration was 4.8 years. At multivariate analysis independent pre-procedural predictors of restenosis were: left atrial diameter (HR: 1.03, 95% ci: 1.01–1.04, p < 0.01), pre procedure maximum gradient (HR: 1.01, 95% ci: 1.00–1.03, p = 0.02) and higher wilkins scores (HR: 1.37, 95% ci: 1.13–1.66, p < 0.01).
Conclusion: In the very long term follow-up, mitral valve restenosis was observed in a quarter of the population undergoing PMBC. Preprocedure echocardiographic findings, including left atrial diameter, maximum valve gradient and high Wilkins scores were found to be the only independent predictors of this deleterious event.
108388
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
LILIAN BELINASO1, Camila Richter1, Carlos Gustavo Marmanillo1, Carlos Alberto Kenji Nakashima1, Erasmo Junior Toledo Siqueira1, Dalton Bertolim Précoma1, Marcos Vinicius Coelho Dutra1, Viviane de Sá Pereira1, Luan Gabriel Paese1, Sérgio Antonio López1, Rômulo de Lima Moreno1, Rodney de Oliveira1
(1) Hospital Angelina Caron – HAC
Background: As the prevalent kidney transplant population grows, there is an increasing need to quantify the risk of medical conditions to minimize complications. Bleeding events are a cause of hospitalization and contribute to the morbimortality of these patients.
Objective: To evaluate perioperative bleeding complications due to the use of dual antiplatelet therapy (DAPT) in kidney transplantation patients.
Methodology: Patients who underwent kidney transplantation between January 2019 and May 2021 were included (n = 372) and divided into 3 groups: control group without antiplatelet therapy (n = 230); patients with perioperative antiplatelet therapy only with acetylsalicylic acid – ASA (n = 123); and patients with perioperative DAPT – ASA and clopidogrel (n = 19). The primary outcome was the rate of bleeding in patients on antiplatelet therapy compared with patients without antiplatelet therapy. Secondary outcomes included location and timing of bleeding, post-bleeding acute myocardial infarction, perioperative transfusion requirement, surgical reintervention, renal explantation, and mortality.
Results: Patients with DAPT were a mean age of 59.63 ± 6.94, were more insulin-dependent diabetes and they were all hypertensive (P > 0,002), significantly higher data compared to the other groups. These patients bled significantly more (P > 0.005), mainly at the surgical site (64,7%); 35.3% of the patients required surgical reintervention (p = 0.0013). In this study, most bleeding events (73.6%) occurred within one week after transplantation and 80% required blood transfusion (p = 0,0001).
Conclusion: Kidney transplantation can be safely performed without interrupting perioperative ASA therapy and prophylactic anticoagulation. There is an increased risk of bleeding requiring blood transfusion and surgical reintervention when the patient is on DAPT, but without an increase in acute myocardial infarction, renal explantation and short-term mortality.
108408
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR PHARMACOLOGY
EDER ANDERSON RODRIGUES1, Camila Moreno Rosa1, Dijon Henrique Salome De Campos1, Felipe César Damatto1, Gilson Masahiro Murata2, Lidiane Moreira de Souza1, Amanda Bergamo Gonçalves de Castro Rêgo1, Leiliane Rodrigues dos Santos Oliveira1, Patrícia Aparecida Borin1, Katashi Okoshi1, Marina Politi Okoshi1
(1) Botucatu Medical School, Sao Paulo State University, UNESP, Botucatu, Brazil; (2) 2 LIM29, Division of Nephrology, University of Sao Paulo Medical School, Sao Paulo Brazil
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on the cardiovascular system in diabetes mellitus (DM) patients. However, as most clinical trials were performed in type 2 DM, the effects of SGLT2 inhibitors in patients with type 1 DM still need further clarification. In this study, we evaluated the effects of long-term treatment with the SGLT2 inhibitor dapagliflozin on cardiac remodeling, myocardial function, and energy metabolism in rats with type 1 DM.
Methods: Male Wistar rats were divided into three groups: control (C, n = 15); DM (n = 15); and DM treated with dapagliflozin (DM+DAPA, n = 15) for 30 weeks. DM was induced by streptozotocin; DAPA was added to the rat chow (5 mg/kg/day). Cardiac performance was evaluated by echocardiogram and myocardial function in isolated left ventricular (LV) papillary muscle preparations. Myocardial energy metabolism enzyme activities were evaluated by spectrophotometry. Statistical analyzes: ANOVA and Tukey or Kruskal-Wallis and Dunn.
Results: DM+DAPA had lower glycemia than DM [C 112 (108–116); DM 531 (522–535)*; DM+DAPA 267 (179–339) mg/dL; p < 0.05 vs C and DM+DAPA]. Echocardiogram showed that DM and DM+DAPA had left atrium and left ventricle dilatation with systolic and diastolic dysfunction; in DM+DAPA, the changes were attenuated in relation to DM. Developed tension and +dT/dt were higher in DM+DAPA than DM in basal condition. After inotropic stimulation with post-pause contraction, extracellular calcium concentration elevation, and isoproterenol addition to the nutrient solution, +dT/dt and –dT/dt were higher in DM+DAPA than DM. Hexokinase, phosphofructokinase, and pyruvate kinase activity was lower in DM than the C. Phosphofructokinase and pyruvate kinase activity was higher in DM+DAPA than DM.
Conclusion: Long-term dapagliflozin treatment attenuates cardiac remodeling and myocardial dysfunction and preserves hexokinase, phosphofructokinase and pyruvate kinase activity in rats with type 1 diabetes mellitus.
108797
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
MARCELA MATTOS SIMÕES1, Angélica Navarro de Oliveira3, Ricardo Simões1, Karina Braga Gomes2, Bruno de Almeida Rezende4, Marcus Vinícius Bolivar Malachias3
(1) Post-Graduate Program in Health Sciences – Faculty of Medical Sciences of Minas Gerais-MG, Belo Horizonte/MG, Brazil; (2) Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte/MG, Brazil; (3) Institute of Hypertension of Minas Gerais, Belo Horizonte/MG, Brazil,; (4) Department of Physiology and Biophysics, Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte/MG, Brazil
Background: Psoriasis is an inflammatory skin disease that can have systemic consequences such as cardiovascular disease (CVD).
Objective: To evaluate commonly recommended clinical risk scores and their associations with pulse wave velocity (PWV) and intima-media thickness (IMT), recognized subclinical cardiovascular (CV) biomarkers, in individuals with psoriasis without apparent CVD.
Methods: This is a cross-sectional observational pilot study involving 44 male subjects, 11 of whom had moderate to severe psoriasis, according to the Psoriasis Area Severity Index (PASI) > 10 and the Dermatological Quality of Life Index (DLQI) > 10, and 33 healthy subjects (control group). Groups were assessed using the Global Risk Score (GRS), Atherosclerosis Cardiovascular Disease (ASCVD) by Pooled Cohort Equations and the SCORE system, in addition to measurements of PWV and IMT. Comparisons between groups and associations between clinical risk scores and biomarkers measurements were performed considering a significance level of 5%.
Results: The psoriasis group (PG) had a higher CV risk estimated by GRS (p = 0.001) and ASCVD (p = 0.025), but not by SCORE (p = 0.289), as well as higher PWV (p = 0.033) compared to the group control (GC). ASCVD (p = 0.014) and SCORE (p = 0.009) were associated with PWV in the psoriasis group. GRS, ASCVD and SCORE showed a positive association with PWV in relation to the total sample. Clinical risk scores showed no significant association with carotid IMT in the psoriasis group.
Conclusion: Patients with psoriasis without apparent CVD have a higher cardiovascular risk when evaluated by clinical scores GRS and ASCVD. ASCD and SCORE were associated with subclinical findings such as higher PWV.
108731
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
LEANDRO BRASIL REGO1, Leandro Brasil Rego1, Rodrigo Villar2, Danilo Salles Bocalini3, Gustavo Allegretti João4, Ruth Caldeira Melo1, Bruna Trindade Souza1, Francisco Luciano Pontes Júnior1
(1) Laboratório de Fisiologia do Exercício e Envelhecimento, Escola de Artes, Ciências e Humanidades da Universidade de São Paulo, São Paulo, Brazil; (2) Cardiorespiratory & Physiology of Exercise Research Laboratory, Faculty of Kinesiology and Recreation and Management, University of Manitoba, Winnipeg, Manitoba, Canada; (3) Laboratório de Fisiologia experimental e Bioquimica, Centro de Educação física e Desporto, Universidade Federal do Espirito Santo, Vitoria, Brazil; (4) Laboratório de Fisiologia do Exercício, Faculdades Metropolitanas Unidas, São Paulo, Brazil. São Paulo, Bra
Introduction: Aging is associated with a decline in cardiorespiratory and musculoskeletal systems that may compromise maximum aerobic power and muscle strength, fundamental aspects for the maintenance of functional capacity in the elderly.
Objective: To verify the correlation between maximal aerobic power, isometric muscle strength, and functional capacity in elderly women.
Methods: The sample consisted of 30 elderly women aged 60 years or more (X = 65.4 SD = 2.8). To determine the maximal aerobic power, we performed ergospirometric test (gas analyzer Metalyzer II, Cortex®, Germany) on a treadmill (centurion® 300) with constant 1% inclination, initial speed of 4 km/h and 1 km/h increases every minute. The maximum strength was evaluated in lower and upper limbs by isometric contraction in a portable dynamometer (Lafayette Instrument Company, USA). The functional capacity was evaluated by the tests: TUG- (Timed Up and Go), TC 10 m (10 m walk) and SLC (Sit and Stand Up Chair). In all tests 3 measurements were taken and the mean was computed. In the statistical analysis, significance was set at 5% and the assumptions of normality, homogeneity, and sphericity were confirmed with the Shapiro-Wilk, Levene, and Mauchly tests, respectively, and parametric techniques were used.
Results: There was a positive and strong correlation between peak VO2 (mL/kg/min) vs. lower limb strength (r = 0.62; p = < 0.001); negative and strong correlation between peak VO2 (mL/kg/min) vs. TUG (r = –0.63; p = < 0.001); moderate and negative correlations between peak VO2 (mL/kg/min) vs. TC10 m (r = –0.49 p = 0.005); peak VO2 (mL/kg/min) vs. SLC (r = –0.52 p = 0.003) and between lower limb strength vs. TUG (r = –0.50; p = 0.005); TC10 m (r = –0.50; p = 0.005); SLC (r = –0.48; p = 0.006). The multiple linear regression showed an R2 49.8% of the result of the dependent variable aerobic power and the following values of the independent variables lower limb strength (B = 0.25; p = 0.012) and “TUG” test (B = –2.161; p = 0.008).
Conclusions: It was demonstrated a positive correlation of aerobic power with isometric muscle strength (lower limb) and a negative correlation of these variables with performance in functional tests. Furthermore, isometric muscle strength (lower limb) and the TUG test were important predictors of maximal aerobic power.
108420
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
GILBERTO ANDRADE TAVARES1, Gilberto Andrade Tavares1, Joathan Borges Ribeiro5, Marcos Antonio Almeida-Santos4, Antônio Carlos Sobral Sousa1, José Augusto Soares Barreto-Filho1
(1) Postgraduate Program in Health Sciences, Federal University of Sergipe; (2) Federal University of Sergipe; (3) Rede D’Or São Luiz, Hospital São Lucas, Division of Cardiology; (4) Tiradentes University; (5) Postgraduate Program in Adult Health Nursing, University of São Paulo; (6) Hospital Sírio-Libanês
Introduction: In Brazil, the Unified Health System (UHS) regulates public health care and has in the Family Health Strategy (FHS) the main strategy of primary care. In 2010, the American Heart Association (AHA) proposed to check seven cardiovascular health (CVH) metrics, with goal of reducing CVD deaths in the U.S. by 20% until 2020. The results of the FHS regarding the CVH of the Brazilian population are not known.
Objective: Evaluate the control of CVH among adult patients assisted by the FHS in the municipality of Aracaju, Sergipe, Brazil. METHODS A cross-sectional study was conducted using the 7 metrics in CVH among patients treated by the FHS. Those metrics being graded at the “ideal”, “intermediate” and “poor” level. The variable “CVH control” was dichotomized into “Controlled” (>five metrics at the ideal level) and “Uncontrolled” (<five metrics at the ideal level).
Results: In our study, 32.5% were at ideal level. The majority of the sample (62.75%) were at intermediate level. At the poor level, 4.5% was found in the sample. In the multivariate analysis, after adjustments, <45 years of age (RRa 1.61 (IC 95% 1.15–2.28)), females (RRa 2.07 (IC 95% 1.20–3.60)) and following health guidance from family members and neighbors (RRa 1.28 (IC 95% 1.15–2.28)) were associated with “Controlled” CVH. Having a higher number of children reduces the chance of having “Controlled” CVH by up to 9% (RRa 0.91 (IC 95% 0.84–0.95)).
Conclusions: We demonstrated that, only 32.5% of the patients had controlled CVH; the adjusted multivariate analysis showed that being under 45 years of age, female and sharing decisions about their health with neighbors and family members are associated with “Controlled” CVH. Having more children reduces this association.
108421
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
CAROLINA DE ARAÚJO MEDEIROS1, Maria Beatriz Araújo Silva3, André Luiz Sá de Oliveira4, Maria das Neves Dantas da Silveira Barros1, Maria Elisa Lucena Sales de Melo Assunção1, Maria da Glória Aureliano de Melo Cavalcanti1, Tayne Fernanda Lemos da Silva1, Gênova Maria de Azevedo Oliveira5, Cristina de Fátima Velloso Carrazzone1, Zulma Maria de Medeiros2, Sílvia Marinho Martins1, Wilson de Oliveira Júnior1
(1) Ambulatório de Doença de Chagas e Insuficiência Cardíaca-PROCAPE-UPE; (2) Programa de Pós-graduação em Ciências da Saúde – FCM-UPE; (3) Faculdade de Enfermagem Nossa Senhora das Graças – FENSG-UPE; (4) Instituto Aggeu Magalhães, Fundação Oswaldo Cruz – Recife –PE; (5) Secretaria Estadual de Saúde de Pernambuco – PROGRAMA SANAR-SES-PE
Introduction: Chronic Chagas disease (CCD), caused by Trypanosoma cruzi. In Brazil, the Northeast Region is one of the endemic areas for CCD. The geoprocessing allows the identification of patterns and trends in spatio-temporal distributions.
Objective: To analyze the spatial distribution of CCD in terms of clinical stages in the reference service in the Northeast region of Brazil.
Methods: Ecological population-based approach, the unit of analysis being the municipalities where the population with CCD from 2016 to 2018. The State of Pernambuco is composed of 184 municipalities and 05 mesoregions: Metropolitan Region, Zona da Mata, Agreste, Sertão and Sertão do São Francisco. The classification used the Clinical stages listed in the “I Latin American Directive for the Diagnosis and Treatment of Chagas Heart Disease” (A, B1,B2,C and D). The analyzed indicator was the average annual rate of occurrence.
Results: The 801 chronic cases, the mean age was 62 ± 12.0 years, with a predominance of females (60%). As for the clinical stages classified as A: 22.5%; B1: 43.5%; B2: 8.5% and C: 25.5%. The mean CCD occurrence rates in terms of clinical stages, the respective standard deviation (SD): A: mean = 0.76; SD = 2.1 in Zona da Mata and Sertão; B1: mean = 1.6; SD = 4.4 in Zona da Mata and Sertão; B2: mean = 0.23; SD = 0.82 in Zona da Mata, Sertão and Sertão do São Francisco;C: mean = 0.67; SD = 1.27 in Zona da Mata, Agreste Sertão and Sertão do São Francisco as shown in the figure.
Conclusions: The spatial distribution of CCD showed spatial heterogeneit, there were clusters in two mesoregions in stages A and B1, while in stages B2 and C in 4 mesoregions indicating the persistence of CCD in these areas, requiring priority health surveillance actions and strengthening of the assistance decentralization.
108422
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
GILBERTO ANDRADE TAVARES1, Matheus Henrique Costa Xavier2, Filipe Euclides Gobatto2, Iara Victoria dos Santos Moura2, Virna Anfrizio Souza2, Wictor Hugo De Souza Silva2, Eleonora Ferraris de Gaspare5, Gledson de Carvalho Santos4, Fabio Batista Santos4, Virgílio Antônio Cardoso Faro4, José Augusto Soares Barreto-Filho1
(1) Postgraduate Program in Health Sciences, Federal University of Sergipe; (2) Federal University of Sergipe; (3) Rede D’Or São Luiz, Hospital São Lucas, Division of Cardiology; (4) Tiradentes University; (5) Parma University
Introduction: The Cardiovascular Diseases have been the main cause of death in the world with a slow decrease in mortality rates in most countries. In 2010, The American Heart Association (AHA) defined 7 metrics for a Cardiovascular Health in order to reduce Cardiovascular mortality by 20%. The Mobile Health Tools are able to support shared clinical decision making, telemonitoring feedback and improve patient’s adherence to medication regimen.
Objective: Demonstrate the development and applicability of the application “Cardiovascular Health” for mobile phones according to the parameters defined by The AHA.
Method: The method chosen is the User Centered Design, Dart programming language, Flutter framework and Firebase database. The application was developed using Scrum, with 2-week sprints in which tasks were divided into small deliverables in order to avoid rework and make the process more agile. The research team monitored the project closely and decided about what was done by the group.
Results: Each parameter considered ideal, evaluated as “Good”, following those requirements, will provide the patient 1 mark. If the participant scores between 5 and 7 marks, will be classified as “Good” Cardiovascular Health; if the score is between 3 and 4 marks, the classification will be “Can be improved”; and if the score is null or under 2 marks, it will be defined as “Needs to be improved”. Hence, he will have his “Cardiovascular Health” classified, generating PDF reports.
Conclusion: The “Cardiovascular Health” application comprises all the components to measure Cardiovascular Health and will be able to provide physicians and other healthcare workers with better decision making about Cardiovascular Health of the treated population.
109090
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ROMERO HENRIQUE DE ALMEIDA BARBOSA1, Emerson Silva de Jesus1, Eldys Myler Santos Marinho1, Johnnatas Mikael Lopes1
(1) Universidade Federal do Vale do São Francisco
Background: Medication adherence is imperative for adequate care of chronic cardiac health conditions due to their disabling and death potential. However, this self-care characteristic does not develop without professional support and may not be homogeneous in the entire population.
Objective: To identify the existence of differences in medication adherence in people with a history of acute cardiac events.
Methods: Cross-sectional population-based study of the National Health Survey (NHS) in Brazil in 2019. The sample with 90846 interviews in people over 15 years old. Diagnosis of heart disease was given by the presence of heart failure, arrhythmia, angina, history of myocardial infarction. The independent variables were coronary artery bypass graft surgery (yes/no) and myocardial infarction (yes/no). Medication adherence due to cardiac condition was treated as an outcome. Data analyzed by stratifying the prevalence of the outcome and estimating the prevalence ratio, taking into account the complex sampling of participants and a confidence interval of 95%.
Results: We identified 4732 (5.1%;4.8–5.3) individuals with some type of heart disease in the NHS, of which 1383 (29.2%;27.0–31.4) reported at least one episode of myocardial infarction. Revascularization was performed in 1483 (28.9%;26.8–31.0) of individuals with heart disease. Approximately one-third of participants with heart disease do not adhere to medication regularly [3284 (31.4%:29.1–33.7)]. However, it is possible to state that individuals who underwent revascularization procedure [1297 (87.9%;85.4–90.0)] have more medication adherence than those who did not undergo. The occurrence of acute myocardial infarction increases the probability of greater adherence to medication by 13.3% in those who underwent revascularization and 27.5% in those who had an infarction and did not undergo revascularization. In relation to individuals with heart disease and without infarction and revascularization events, the probability of adherence is 59.10%.
Conclusion: Acute and harmful cardiac events such as myocardial infarction and revascularization seem to be associated with greater medication adherence in this population. This refers to a scenario of low self-care supported by monitoring of cardiac conditions, requiring greater attention and the proposition of mitigating strategies on the part of health professionals.
109088
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
FARID SAMAAN1, Louis Nakayama Ohe1, Lívia Gâmbaro1, Renata Viana1, Emmanuel Almeida Burdmann2
(1) Instituto Dante Pazzanese de Cardiologia; (2) Universidade de São Paulo
Introduction: Chronic kidney disease and acute kidney injury (AKI) are important complications of heart diseases. In developing countries, epidemiological and cost information on the interaction of these conditions are scarce.
Objectives: To determine the prevalence, costs and outcomes of patients admitted for acute coronary syndrome (ACS) with renal dysfunction and AKI.
Methods: The study was based on a prospective database analysis of patients admitted for ACS to a Brazilian public hospital specialized in cardiology between 7/16/2018 and 12/31/2019. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² at hospital admission. Community-acquired and hospital-acquired AKI were defined as a fall and an increase of ≥0.3 mg/dl in serum creatinine from baseline, respectively.
Results: 1295 of the 1620 patients had a confirmed diagnosis of ACS (median age 64.2 [56.5–70.6] years, 65.4% male, 82.7% had hypertension, 45.5% diabetes and 22.6% renal dysfunction). The imaging diagnosis of ACS was coronary angiography in 84.3% and the treatment was performed by angioplasty, only clinically and by myocardial revascularization in 47.3%, 40.0% and 12.7%, respectively. Hospital- and community-acquired AKI occurred in 43.9% and 2.3% of patients, respectively. Compared with patients admitted with eGFR ≥60 ml/min/1.73 m², those with eGFR <60 were older (70.6 vs. 62.5 years, p < 0.001), had a higher prevalence of hypertension (92.1% vs. 80.0%, p < 0.001) and diabetes mellitus (60.6% vs.54.5%, p = 0.010), had a higher incidence of AKI (65.0% vs. 51.4%, p < 0.001) and higher: median amount reimbursed for hospitalization (1,344 [366–2,103] vs. 1,334 [290–2,018] dollars, p = 0.034), median length of stay (5 [3–10] vs. 4 [2–7] days, p < 0.001), death within 30 days (4.1% vs. 1.4%, p = 0.004) and death within 12 months (9.2% vs. 2.9%, p < 0.001). Patients with AKI, compared to those without this condition, were older (65.6 vs.63.3 years, p = 0.008), had lower eGFR on admission (78.1 ml/min/1.73 m² vs.86.1 ml/min/1.73 m², p < 0.001) and greater: median amount reimbursed for hospitalization (1,334 [301–1,865] vs. 1,724 [973–2,549] dollars, p < 0.001), median length of stay (6 [4–13] vs. 3 [2–5] days, p < 0.001) and death within 12 months (4.8% vs. 2.3%, p = 0.032).
Conclusions: In patients with ACS at a cardiology referral hospital, renal dysfunction on admission and AKI during hospitalization were frequent and associated with worse clinical and economic outcomes.
108437
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
DIANE XAVIER DE ÁVILA1, Gustavo Rodolfo Moreira1, Angelo Michele Di Candia1, Victoria Depes Scaramussa1, Najla Cassibi Cavaliere1, Fernanda Turque Martins1, Maisa Passos Vieira1, Humberto Villacorta1
(1) Universidade Federal Fluminense
Background: Natriuretic peptides (NP) are the gold standard biomarkers in HF. However, new biomarkers have emerged, with additional effects to NP in relation to prognosis. Growth differentiation factor-15 (GDF-15) is a marker of oxidative stress and inflammation that may contribute to the prognosis of patients with HF.
Objectives: We sought to evaluate the distribution of GDF-15 values, the characteristics of patients with high values and the relationship between their values and NT-proBNP in patients with chronic HF.
Methods: This was a cross-sectional study of patients with chronic HF who were on guideline-recommended medical therapies. Patients with signs and symptoms of HF and LVEF <50% were included. The dosage of NT-proBNP was performed using the Elecsys® system (Roche, Basel, Switzerland) and GDF-15 by the sandwich immunoassay method with monoclonal antibodies (Elecsys®, Roche, Basel, Switzerland). Patients were grouped according to GDF-15 values above and below the median. Correlation analysis was performed between GDF-15 and other non-normal continuous variables, using the Spearman method.
Results: A total of 67 patients were included. Etiology was predominantly non-ischemic, 61.2% were male, with mean age of 61 ± 13 years. The median GDF-15 values were 1413 pg/mL (interquartile range 1044–2554) and NT-proBNP was 759 pg/mL (168–2354). Patients with GDF-15 values above the median had higher creatinine values (1.32 mg/dL [0.85–1.71] vs 0.91 [0.78–1.08], p < 0.001), higher NT-proBNP values (2071 pg/mL [508–5350] vs 463 [87–962], p = 0.001) and lower LV ejection fraction (30% [27–43] vs 45% [30–54], p = 0.08. There was a positive correlation between GDF-15 and NT-proBNP (r = 0.46, p < 0.001), creatinine (r = 0.56, p < 0.001) and left atrial volume (r = 0.32, p = 0.037).
Conclusion: Even after adequate treatment, some patients with chronic HF had high levels of GDF-15. GDF-15 identified patients with greater severity. GDF-15 may be a useful tool in the management of HF patients.
108438
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
ANGELO MICHELE DI CANDIA1, Diane Xavier de Ávila1, Gustavo Rodolfo Moreira1, Humberto Villacorta1
(1) Universidade Federal Fluminense
Background: Growth differentiation factor-15 (GDF-15) is a marker of oxidative stress and inflammation and is increased in a number of cardiovascular disorders.
Objectives: We sought to assess the relationship of GDF-15 with severity parameters in patients hospitalized with atrial fibrillation (AF).
Methods: Fifty hospitalized patients with a primary or secondary diagnosis of AF from two hospitals were included. GDF-15 was measured at baseline, as well as cardiac and inflammatory biomarkers. A comparison of baseline characteristics was performed in groups with high (above median) and low (below median) GDF-15 values. Correlations were made between the GDF-15 and other variables, using the Spearman method.
Results: Twenty-nine (58%) patients were male and the mean age was 68.5 ± 17.3 years. Twenty-eight (56%) had permanent AF and 18 (36%) had HF with reduced ejection fraction (LVEF <40%, HFrEF). The median GDF-15 was 2724 pg/mL (interquartile range 1116–5139). Patients with high GDF-15 values were older (77.5 ± 9.7 vs 59 ± 18.5 years, p = 0.0001) and more likely to have hypertension (92.3% vs 70%, p = 0.018) and permanent AF (69.2% vs 37.5%, p = 0.016). They also had higher NT-proBNP values (4006 pg/mL [2156–7023] vs 816 [174–3814], p = 0.0015), creatinine (1.2 [0.95–1.7] vs 1, 0 [0.75–1.15], p = 0.017) and C-reactive protein (3.1 [1.55–7.32] vs 1.25 [0.55–2.45], p = 0.008). GDF-15 was higher in patients with HF (n = 34 [68%]) vs non-HF (3126 [1737–6457] vs 774 [565–4074], p = 0.01). Patients with HFrEF had higher levels of GDF-15 as compared with those with LVEF >40% (3019 [2012–7299] vs 1533 [784–4674], p = 0.05). All risk scores were higher in patients with high GDF-15, namely CHA2DS2-VASC (4.5 ± 1.6 vs 2.9 ± 2.3, p = 0.008), HAS-BLED (2.4 ± 1.3 vs 1.3 ± 1.1, p = 0.0029), ORBIT (3.5 ± 1.5 vs 1.7 ± 1.5, p = 0.0003) and MAGGIC (20.8 ± 12.3 vs 11 ± 11.2, p = 0.006). There was a direct correlation between GDF-15 and NT-proBNP (r = 0.5, p = 0.002), D-dimer (r = 0.52, p = 0.002) and age (r = 0.43, p = 0.002).
Conclusion: GDF-15 values were associated with parameters of greater severity in AF. GDF-15 may be useful as a prognostic factor and may possibly aid in the indication of anticoagulation in AF.
108439
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
GUSTAVO RODOLFO MOREIRA1, Diane Xavier de Ávila1, Angelo Michele Di Candia1, Victoria Depes Scaramussa1, Najla Cassibi Cavaliere1, Maisa Passos Vieira1, Fernanda Turque Martins1, Humberto Villacorta1
(1) Universidade Federal Fluminense
Background: Patients with heart failure (HF) often have altered renal function. Urinary sodium is a marker of diuretic resistance and is associated with a worse prognosis in HF. Growth differentiation factor-15 (GDF-15) is a marker of oxidative stress and inflammation and is a prognostic predictor in HF.
Objectives: We sought to assess the relationship of GDF-15 with renal function parameters and with urinary sodium in patients with chronic HF.
Methods: We undertook a cross-sectional study of patients with HF from specialized outpatient clinic. Patients with signs and symptoms of HF and LVEF <50% were included. An echocardiogram was performed and blood samples were collected, which were frozen for the final study, where the performance of GDF-15 in the prediction of renal outcomes in HF will be evaluated. The dosage of NT-proBNP was performed using the Elecsys® system (Roche, Basel, Switzerland) and GDF-15 by the sandwich immunoassay method with monoclonal antibodies (Elecsys®, Roche, Basel, Switzerland). Analysis of the relationship between GDF-15 and baseline renal parameters was performed. Correlation analysis was performed between GDF-15 and continuous variables, using the Spearman method.
Results: Sixty-seven patients were included. The etiologies of HF were hypertension, diabetes mellitus, alcoholic cardiomyopathy and idiopathic cardiomyopathy. Forty-one (61.2%) individuals were male, with a mean age of 61 ± 13 years. Median GDF-15 values were 1413 pg/mL (interquartile range 1044–2554). Patients with GDF-15 values above the median had lower urinary sodium values (88 mEq/L [53–121] vs 112 [76–171], p = 0.06), lower glomerular filtration rate (GFR) (63.9 ± 29.1 vs 91.2 ± 25 mL/min/1.73 m2, p = 0.001) and higher creatinine levels (1.32 mg/dL [0.85–1.71] vs 0 .91 [0.78–1.08], p < 0.001). There was no significant difference in relation to urinary albumin (21 mg/L [7–126] vs 15.1 [5.8–41], p = 0.30). The urinary albumin/creatinine ratio was higher in the group above the median, but did not reach statistical significance (38 mg/g [11–110] vs 12.5 [4.9–29], p = 0.13). There was a direct correlation between GDF-15 and creatinine (r = 0.56, p < 0.001) and an inverse correlation with urinary sodium (r = –0.39, p = 0.005) and with GFR (r = –0.55, p < 0.001).
Conclusion: GDF-15 correlated with lower urinary sodium levels and worse kidney function in patients with chronic HF. Future studies should address whether GDF-15 is a predictor of worsening renal function overtime.
108440
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
DIANE XAVIER DE ÁVILA1, Ana Luiza Carraro de Souza2, Gabriel Alverca Meyas2, Mayara Cristina Villela Santos2, Jonatas da Costa Mendonça2, Luciene Maria Mendes da Costa2, Beatriz de Paula Sousa2, Maria Victoria Borges de Oliveira2, Julia Correia Cardoso Guimarães2, Julie Xavier de Ávila Guedes3, Ulisses Oliveira de Melo1, Humberto Villacorta2
(1) Hospital Municipal Che Guevara; (2) Universidade Federal Fluminense; (3) Universidade Estácio de Sá
Background: Cardiovascular risk factors are prognostic factors in COVID-19 and have been scarcely studied in Brazil.
Objectives: To assess the impact of cardiovascular risk factors on the outcomes in patients admitted for COVID-19.
Methods: From July 2020 to February 2021, 200 patients from two public hospitals were enrolled. Patients were included if they had: typical symptoms or signs of COVID-19, a positive real-time polymerase chain reaction test (RT-PCR) for COVID-19, and age above 18 years old. This was a prospective, observational, longitudinal study. Data was collected within 24 hours from admission. The primary endpoint was a combination of hospital mortality, mechanical ventilation, hemodialysis or hospital length of stay >28 days.
Results: There were 98 (49%) events during the hospital course and 72 (36%) died in the hospital. Patients with a primary endpoint were older and more likely to have a history of hypertension, diabetes, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Vital signs at admission associated with events were diastolic blood pressure, respiratory rate and oxygen saturation in ambient air (O2Sat). Serum creatinine >1.37 mg/dL at admission had sensitivity of 51.6 and specificity of 82% to predict the primary endpoint, with an area under the curve (AUC) of 0.68. In multivariate analysis, age, diabetes, CKD, and COPD were independent predictors of the primary endpoint. Age and CKD were independent predictors of in-hospital mortality.
Conclusion: Cardiovascular risk factors, such as diabetes and CKD are related to a worse prognosis in patients hospitalized with COVID-19 in Brazil.
108452
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
EDUARDO ARRAIS ROCHA1, Luís Gustavo Bastos Pinho1, Juvêncio Santos Nobre1, Maria Eduarda Quidute Arrais Rocha3, Marcela Sobreira Kubrusly2, FernandaPimentel Arrais Maia4, Eduardo Augusto Quidute Arrais Rocha2, Maria Camila Timbó Rocha3, Pedro Barbosa Duarte Vidal1, Vitor Olímpio Coimbra2, Bruna Sobreira Kubrusly1, Ana Rosa Pinto Quidute1
(1) Universidade Federal do Ceará; (2) Universidade Unichristus; (3) Universidade de Fortaleza – UNIFOR; (4) Universidade Federal do Ceará – Campos Sobral
Introduction: The remote monitoring (RM) of Implantable electronic cardiac devices (IECD) has become a common follow-up modality in many countries given its effectiveness, safety, facilities for the patient and possibilities of early interventions. In Brazil, however, this form of follow-up is an exception. This work aims to demonstrate the findings, evolution and peculiarities of IECD follow-up in a tertiary center in Brazil.
Methods: This is a cohort, prospective study, involving 119 patients, followed in room office visit at 6 months interval with daily RM, with mean age 72 ± 14.2, ejection fraction 55% (34.5/57%), 57.1% in functional class ≥II, 30.2% with pacemakers (PM), 42.8% with defibrillators (D), 3.3% with biventricular pacemaker (CRT) and 22.7% with CRT-D. The logistic regression was used to obtain evidences that the RM is associated with the following outcomes: immediate changes in therapy, elective changes in therapy and avoidance of hospitalizations.
Results: Events were detected in 63.9% of the cases in 29.5 ± 23 months of follow-up; 16% presented more than 6 events; 36.1% no events and 27.7% had more than one event detected. The most common events were: 18.5% with alterations in the electrode/battery or in the thoracic impedance parameters; 33.6% with ventricular arrhythmia and 44.5% with supra-ventricular arrhythmias. It was observed that 86.5% of patients and 91.6% of physicians reported feeling secure with this method of follow-up. The outcomes found were: 23.5% needed immediate changes in therapy, while 44.5% needed elective changes. The RM was important to the beginning or maintaining of the anticoagulation in 16.9% and avoided hospitalization in 19.3%. Through the use of logistic regression, there are evidences that the RM had an statistically significant impact in the elective changes of conduct (p = 0.03), immediate changes of conduct (p = 0.007) and reduced hospitalization (p = 0.04).
Conclusion: The RM was considered effective and safe in the following-up of patients with IECD in some regions of Brazil. This method of follow-up allowed for many early interventions or electives ones which made therapeutic handling and increased safety of the patients.
108459
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
JAIME AFONSO SOUSA NETTO1, Arise Garcia de Siqueira Galil1, Andre Pereira Duque Estrada2, Marcus Gomes Bastos1
(1) Universidade Federal de Juiz de Fora-UFJF; (2) Universidade Federal Fluminense-UFF
Background: Half of the patients with heart failure (HF) have diastolic dysfunction (DD) and a preserved left ventricular ejection fraction (LVEF). The indexed left atrial volume (ILAV) is one of the main components in the assessment of DD. However, there are controversies regarding the use of the left atrial strain (LAE) to assess DD.
Objectives: To evaluate the use of LAE in the identification of indeterminate diastolic dysfunction (IDD) not detected by ILAV, in patients with chronic kidney disease (CKD) stages 3B to 5 in conservative treatment and LVEF.
Methods: Prospective cross-sectional study that evaluated 114 patients with CKD stages 3B to 5 under conservative treatment and who presented LVEF through transthoracic echocardiography (TTE). The patients were divided into two groups, with and without left ventricular hypertrophy (LVH). The analysis of the strain of the left atrium was evaluated by the speckle tracking method from the apical section of 2 and 4 chambers, evaluating the deformation curves of the left atrium (LA).
Results: LAE increased the detection of DD in the group with LVH (p < 0.01). The mean glomerular filtration rate (GFR) (in mL/min/1.73 m2) in patients with and without LVH was 32.6 ± 11.9 and 40.4 ± 13.9, respectively (p < 0.05). The LAE found was lower in the LVH group 20.3 ± 5.11 vs 26.1 ± 9.1, (p < 0.05).
Conclusion: In patients with non-dialysis CKD stages 3B to 5 with LVH and LVEF, in the studied sample, the use of LAE potentially increases the identification of indeterminate cases of DD.
108717
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barretto1
(1) Insituto do Coração – HC FMUSP
Background: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Brazil and carries high morbidity and mortality. Type 2 diabetes mellitus (T2DM) is associated with a higher cardiovascular risk in women than men. This study aimed to analyze the influence of T2DM on CHF mortality from CCC in women and men.
Methods: From February 2017 to September 2020, we followed CCC’s cohort of outpatients with CHF (Framingham criteria). Specific serological tests diagnosed Chagas disease. Baseline data included clinical features and echocardiographic findings. Statistical analyzes used the Kaplan-Meier method for time-to-event data and Cox proportional hazards methods to look for predictors of death.
Results: We studied 733 patients mean age of 61.4 ± 12.3 years, 381 (52%) were male. T2DM was present in 46 (15%) women and 40 (12%) men. Women with T2DM, compared to men with T2DM, had a higher mean age (62.7 ± 12 vs. 59.7 ± 12.5 years; p < 0.001), had a higher mean left ventricular ejection fraction (LVEF) (42.8 ± 14.3% vs. 37.3 ± 14.3%; p < 0.001) and a smaller left ventricular diastolic diameter (58.2 ± 8.5 vs. 61.9 ± 8 .6 mm; p < 0.001). Over a 3-year follow-up period, 26 (65%) men and 30 (65.2%) women with T2DM died, and mortality were higher in T2DM patients compared to nondiabetics (Women: log-rank p < 0.001; Men: log-rank p < 0.001; Figure). Cox regression adjusted for age, previous myocardial infarction, T2DM, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), and LVEF showed, in descending order, T2DM (HR = 2). .19), stroke (HR = 1.81), AF (HR = 1.80), CKD (HR = 1.72), and reduced LVEF (HR = 1.29) as the most important predictors of death in women and, in men, stroke (HR =), DM2 (HR = 2.01), CKD (HR = 1.83), AF (HR = 1.58) and reduced LVEF (HR = 1.24).
Conclusions: CHF mortality from CCC was similar in women and men with T2DM. T2DM neutralized the protection of women compared to men concerning mortality from CHF.
108719
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
LEANDRO LOUREIRO BUZATTO1, Tarsila Perez Mota1, Leticia de Lana Pereira1, Mayumi Alves Hayafugi1, Daisa de Mesquita Escobosa1, Marina Barros de Melo1, Carolina Ivo de Araujo1, Carla Manuela Pereira de Araujo1, Marcelo Franken1
(1) Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein
Introduction: The adaptations and changes in the lifestyle of patients with heart failure (HF) is the main reason why the quality of life of these individuals becomes fragile. Studies show the high prevalence of depression and associate this condition directly with HF. The relationship between changes in quality of life, the occurrence of depression and the presence of HF result in unfavorable outcomes for the patient, justifying the performance of the present study.
Objective: Identify factors associated with quality of life and depression in patients with heart failure.
Method: This is a descriptive exploratory cross-sectional study, in patients aged over 18 years, hospitalized with a diagnosis of systolic HF and who had a recent hospitalization between the period March 2017 to December 2020. Patient Health Questionnaire (PHQ2) and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) were administered 30 days after discharge by telephone contact. The analysis considered the relationship between the scores of both questionnaires and the following variables: gender, diagnosis, functional class, previous atrial fibrillation, previous diabetes, previous acute myocardial infarction and previous arterial hypertension.
Conclusions: Female patients with heart failure showed a greater association with the depression outcome (p = 0.001) and the reduction in quality of life showed a decline once associated with diagnosis, functional class and age.
108484
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
EWA-LENA BRATT1, Mariela Acuna Mora1, Carina Sparud-Lundin1, Sandra Skogby1, Åsa Burström2, Markus Saarijärvi1, Katrina Hanseus3, Annika Rydberg4, Shalan Fadl5, Eva Fernlund6, Kalliopi Kazamia7, Philip Moons8
(1) Institute of health and care science, University of Gothenburg, Sweden; (2) Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden; (3) Department of Pediatric Cardiology, Children’s Heart Center, Skane University Hospital, Lund, Sweden; (4) Department of Clinical Sciences, Umeå University, Umeå, Sweden; (5) Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; (6) Department of Clinical and Experimental Medicine, Linköping University, Division of Pediatrics, Crown Princess Victoria Children’s Hospital, Linköping University Hospital, Linköping, Sweden; (7) Children’s Heart Center Stockholm-Uppsala, Karolinska University Hospital and Akademiska University Hospital, Sweden; (8) KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
Introduction: Adolescents with congenital heart disease (CHD) need to acquire knowledge about their heart disease and treatment. This is fundamental for them to implement health promoting behaviors and know how to manage their CHD. Amongst other things, transition programs aim to equip adolescents with this knowledge. However, evidence on the effectiveness of such interventions is limited.
Objective: To investigate if a transition program is effective in improving disease-related knowledge of adolescents with CHD.
Methods: The STEPSTONES (Swedish Transition Effects Project Supporting Teenagers with chrONic mEdical conditionS) transition program is an 8 components intervention. The central component was a transition coordinator (specialized nurse) who had three consultations with the participants during a 2y period. A randomized controlled trial (RCT) was conducted in two CHD centers in Sweden. Participants were randomly assigned to the intervention (IG; n = 70) or control group (CG; n = 69). Knowledge was measured at the age of 16 y (T0; baseline), 17y (T1) and 18.5y (T2) using the Knowledge Scale for Adults with Congenitally Malformed Hearts questionnaire, psychometric evidence supported its validity and reliability. The total score ranges from 0–7, with higher scores denoting a higher CHD-related knowledge. Change in score between T0 and T2 was analyzed using Fisher’s non-parametric permutation test unadjusted between the two groups. Analyses were performed on the Full Analysis Set (FAS).
Results: In total, 114 participants were included in the FAS, of which 54 were in the IG and 60 in the CG. At baseline, the mean knowledge score in the IG was significantly lower (3.7 ± 1.6) than in the CG (4.4 ± 1.5) (p = 0.03). At T2, the knowledge score was significantly higher in the IG (5.0 ± 1.3) than in the CG (4.5 ± 1.5) (p = 0.045). In line with this, the change over time (T0–T2; 2.5y) was significantly different between the two groups (Mean difference = 1.22; 95%CI = 0.60–1.82; p = 0.0002). The effect size was 0.74, indicating a moderately large effect.
Conclusion: This RCT showed that the STEPSTONES transition program was effective in increasing disease-related knowledge in adolescents with CHD, which is an important aspect in preparing them for the transition to adulthood and the transfer to adult care.
108485
Modality: E-Poster Researcher – Non-case Report
Category: CARDIO-ONCOLOGY
DIEGO RAFAEL FREITAS BERENGUER1, Gustavo Freitas Alves de Arruda1, Mayara Laís Coêlho Dourado1, Felipe Alves Mourato2, Monica de Moraes Chaves Becker1, Roberto de Oliveira Buril1, Brivaldo Markman Filho1, Simone Cristina Soares Brandão1
(1) Universidade Federal de Pernambuco (UFPE); (2) Real Hospital Português de Beneficiência em Pernambuco
Objective: To evaluate the behavior of the standardized uptake value (SUV) of the radiopharmaceutical 18F-FDG before, during and after chemotherapy (QT) at different cardiac sites, as well as to measure the degree of reproducibility for the method in the context of cancer treatment follow-up.
Materials and Methods: Retrospective cohort including lymphoma patients who underwent 18F-FDG PET/CT before, during and/or after chemotherapy. The uptake behavior through the mean and maximum SUVs was evaluated in four cardiac sites and in control sites in the aorta and liver. Twenty exams were randomized for reproducibility analysis by two examiners who were blinded to each other’s results. Each one of them did the evaluation in a second moment to elucidate the intra-observer reproducibility.
Results: A significant increase in SUVs was observed in all cardiac sites in the interim and final moments (post-terminus of QT) when compared with pre-QT SUVs. The left ventricular (LV) free wall was the cardiac region with the greatest increase in 18F-FDG uptake (Figure). As for the reproducibility, it was possible to verify substantial results for the reliability of the measurement of SUVs, both intra and inter-observer (Figure).
Conclusions: 18F-FDG Cardiac uptake increased along QT, with the LV free wall being the site with the greatest increase. The reproducibility analysis showed high intra- and inter-observer correlation values.
108487
Modality: E-Poster Researcher – Non-case Report
Category: NUTRITION
RAMPHUL YOGESHWAREE1, Chan Sun Marie France1, Cheeneebash Jayrani1
(1) University of Mauritius, Faculty of Medicine and Health Sciences
Introduction: In Mauritius, a rapidly developing island in the Indian Ocean, 89% of the deaths are due to non-communicable diseases, out of which 33% are caused by Cardiovascular Diseases. With the prevalence of obesity which has increased from 10.3% in 2004 to 19.1% in 2015, cardiovascular complications linked to obesity are expected to increase, based on the well-established relationship between obesity and cardiovascular diseases.
Objective: This study investigated the perception on obesity of Mauritian police officers for tailor-made health interventions. No such study had previously been conducted in Mauritius.
Methods: This cross-sectional study was carried out using a pre-tested survey instrument, based on the Health Belief Model with obesity-related questions pertaining to participants’ perceived susceptibility, severity, barriers, benefits, cues to action and self-efficacy. The study population consisted of random sample police officers, with the calculated sample size being 384. Ethical clearance was obtained from the relevant research ethics committee.
Results: There were 384 respondents, consisting of 240 men (62.5%), and 144 women (37.5%) with age span from 18 to 59, 77.3% of the study population being in the age group 26 to 50. The participants’ mean score on the perceived severity scale was 3.8 out of five points (±1.2), while their mean score on the perceived susceptibility scale was 3.0 out of five points (±1.2). A stepwise multiple regression analysis showed that the susceptibility score (dependent variable) and sex, age, ethnicity, socioeconomic position and alcohol (independent variables) were significant at 95% confidence interval.
Discussion: The lower mean susceptibility score among women as compared to men and among those who are overweight/obese as compared to those with normal Body Mass Index is of great concern. The findings of this study need to be the basis for the development of customized health interventions for the primary prevention of cardiovascular diseases. The vulnerability of women to cardiovascular diseases needs to be emphasized to make women more cautious on their health.
Conclusions: In light of the findings of this study, we recommend primary prevention with integrated approach for promotion of healthy eating and physical activities, with a particular focus on women who need to be sensitized on their vulnerability to cardiovascular diseases.
108490
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
BRUNO REZNIK WAJSBROT1, Ana Luiza Ferreira Sales1, Andre Luis Sales Feitosa1, Carolina Pereira de Barros1, Felipe Neves de Albuquerque1, Marcelo Imbroinise Bittencourt1, Pedro Pimenta de Mello Spineti1, Roberto Esporcatte1, Denilson Campos de Albuquerque1, Ricardo Mourilhe-Rocha1
(1) State University of Rio de Janeiro – Pedro Ernesto University Hospital
Introduction: Right Ventricle (RV) failure is found in as many as fifty percent of heart failure (HF) patients. Echocardiographic parameters are studied with the aim of refining prognosis of HF, but isolated prognostic impact of the “forgotten ventricle” is not often studied.
Purpose: The objective of this study is to define echocardiographic parameters associated with post-discharge mortality after admission for ADHF.
Methods: This is a study in a single center, transversal, cohort of hospitalized patients with ADHF, aged >18 years, conducted at a University Hospital in Brazil. Data was collected from September 2019 to September 2021. Patients in renal replacement therapy before admission or with cancer in palliative care were excluded. Continuous variables were analyzed with Mann-Whitney U test, categorical variables with log-Rank test. Analysis was made using SPSS software.
Results: A total of 200 patients were enrolled. The mean age was 62 years (SD ± 14.5), 65.9% male, 63% with hypertension, 29.1% with diabetes and 32.8% with ischemic heart disease (IHD). Three month and a year mortality was respectively 8.4% and 39.5%. HFrEF was observed in 67.2%, 14.4% HFmrEF and 18.4% HFpEF. Severe mitral regurgitation (MR) was observed in 22.5% RV dysfunction in 47%. Median ejection fraction, end-systolic (ESD), end-diastolic diameter (EDD) and systolic pulmonary arterial pressure (sPAP) was respectively 33% (24–45.5), 49 mm (38.25–56), 59 mm (52–65) and 44.5 mmHg (32.75–57.25). Only RV dysfunction was associated with reduced long-term mortality (p = 0.038). Average follow-up time was 459 days.
Conclusion: RV disfunction has an isolated prognostic impact on long term survival after admission for ADHF. Trials that focus on therapies for RV function might reduce mortality for HF patients.
108496
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
ANTONIO ALCEU DOS SANTOS1, Gilmara Silveira da Silva2, Flávia Cortez Colósimo Bastos2, José Francisco Baumgratz2, José Pedro da Silva2, Luciana da Fonseca da Silva2, Rodrigo Moreira Castro2, Rodrigo Freire Bezerra2, Carlos Eduardo Panfilio1, Isabel Cristina Céspedes1
(1) Escola Paulista de Medicina – Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; (2) A Beneficência Portuguesa de São Paulo Hospital, São Paulo, Brazil (BP-SP)
Introduction: Allogeneic blood is an increasingly scarce resource in blood banks around the world due to its increasing demand [1]. Cardiac surgeries represent an excessive consumption of hemocomponents [2]. Plasma transfusions are associated with more risks than benefits [3,4]. The rational use of allogeneic blood has become a worldwide necessity, aiming to reduce morbidity and mortality and hospital costs [5–7]. Hence the importance of scientific educational measures, encouraging procedures, techniques, and drugs to reduce allogeneic blood transfusions in coronary artery bypass graft surgery (CABG).
Objective: To verify whether clinical and surgical strategies for conserving the patient’s own blood are effective in reducing plasma transfusions and their complications in CABG.
Methods: Retrospective cohort study of patients undergoing CABG. A total of 4923 patients were studied from a database, 3010 patients from the year 2010 (group 1) and another 1913 patients from the year 2012 (group 2). For one year and six months, biweekly multidisciplinary meetings were held for scientific updates on transfusion practices, focusing on learning and implementing patient blood conservation strategies, based on two main pillars: 1. Reduction of blood loss (meticulous hemostasis and optimal use of antifibrinolytics); 2. Optimization of physiological tolerance to anemia (supplementary oxygen therapy, more restrictive transfusion management, treating anemia). After these educational measures to conserve the patient’s blood, a new data collection was carried out for a comparative analysis of the variables of group 1 and 2.
Results: A total of 377 patients received plasma transfusions, with a significant reduction from 13.1% (282 patients) in group 1 to 6.7% (95 patients) in group 2, p < 0.001. There was also a significant reduction in infection (mediastinitis) from 3.0% (group 1) to 1.4% (group 2), p < 0.05. There was no difference in the total length of hospital stay and intensive care unit stay in the two groups. The mortality expected by the Euroscore (2.35 vs 2.44, p = 0.215, groups 1 and 2, respectively) in the preoperative period of the patients showed no significant difference in both groups.
Conclusion: Patient blood conservation strategies focused on reducing blood loss and optimizing physiological tolerance to anemia resulted in reduced plasma transfusions and postoperative mediastinitis-like complications in patients undergoing coronary artery bypass graft surgery.
108503
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogerio Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Introduction: Coronary artery disease represents one of the main causes of death in Brazil and worldwide. Rapid diagnosis is important for effective treatment. The difficulty of accessing referral medical centers during the COVID 19 pandemic influenced the management of these diseases. Coronary angioplasty (CA) as an option for the management of patients with coronary disease was also impacted during this period. The present study aimed to evaluate the influence of COVID-19 on coronary angioplasties in Brazil.
Method: We used the database from the Department of Informatics of the Brazilian Health System (DATASUS) through the website https://datasus.saude.gov.br/. We evaluated the number of hospitalizations, deaths, costs and length of stay of patients undergoing CA in Brazil and their relationship with the beginning of the COVID-19 pandemic in Brazil (in 2020) based on data from 2018 to 2021.
Results: From January 2018 to December 2021, 302572 patients were hospitalized for CA with stent in Brazil with an annual mean of 75643 ± 4742. Meanwhile, 43870 were hospitalized for primary angioplasty with an annual mean of 10968 ± 278. There was an 8.5% decrease in CA averages for the years before the beginning of the pandemic compared to after the beginning of the pandemic, from 79022 ± 4214 to 72264 ± 2008 (p = 0.177). The mean number of primary angioplasty also decreased (1.8%) from 11067 ± 287 to 10868 ± 332 (p = 0.587). Despite the decrease in the number of angioplasties, there was a 13% increase in the mortality rate in this period in CA from 4.3 ± 0 to 4.9 ± 0 (p = 0.013). In cases of primary angioplasty, there was a 4.5% decrease from 6.8 ± 0.1 to 6.5 ± 0.2 (p = 0.200). The mean hospital stay was 8.5% shorter in CA (p = 0.069) and 8% (p = 0.057) in primary angioplasty. Regarding the costs (in brazilian reais) per hospitalization, there was a slight increase both in CA with 1.6% (p = 0.137) and primary angioplasty with 1.3% (p = 0.133).
Conclusion: In the context of the COVID-19 pandemic, hospitalizations for CA and primary angioplasty decreased by 8.5% and 1.8%, respectively, comparing the period before the beginning of the COVID-19 pandemic and after. However, we observed a 13% increase in CA mortality rates over the same period while a 4.5% decrease in primary angioplasty rates. The average hospital stay decreased by about 8% for both PTCA and primary angioplasty while costs increased slightly in both cases.
108501
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
AUREO DO CARMO FILHO1, Rogério Gomes Fleury1
(1) Hospital Universitário Gaffrée e Guinle – UNIRIO/EBSERH
Introduction: Coronary artery disease represents one of the main causes of death in Brazil and in the world, whose diagnosis and treatment often require speed and appropriate technologies. The difficulty of accessing health systems during the COVID19 pandemic influenced this entire process. Myocardial revascularization surgery (CABG), one of the options for the management of patients with coronary artery disease, was also impacted during this period. The present study aimed to assess the influence of COVID-19 on (CABG) in Brazil.
Method: We used the database from the Department of Informatics of the Brazilian Health System (DATASUS) through the website https://datasus.saude.gov.br/. We evaluated the number of hospitalizations, deaths, costs and length of stay of patients undergoing CABG using cardiopulmonary bypass (CPB) in Brazil and their relationship with the beginning of the COVID-19 pandemic in Brazil (2020) based on data from 2018 to 2021.
Results: From January 2018 to December 2021, 65827 patients were hospitalized for CABG with CPB in Brazil. There was a decrease in these surgeries from 18987 in 2018 and 19272 in 2019 to 14641 and 12927 in 2020 and 2021 respectively. Surgery averages for the years before the beginning of the pandemic dropped 27.9% compared to after the beginning of the pandemic, from 19130 ± 201 to 13784 ± 1211 (p = 0.025). Despite the drop in the number of surgeries, there was an 8.8% increase in the mortality rate in this period, from 11.9 ± 1.3 to 12.9 ± 0.6 (p = 0.405). The mean hospital stay was slightly shorter (6.5%), with 25.9 ± 0.6 days in 2018–19 and 24.2 ± 0 days in 2020–21 (p = 0.064). Regarding costs (in brazilian reais) per hospitalization, there was a slight increase (1.2%) from 26332 ± 353 to 26655 ± 131. (p = 0.350).
Conclusion: In the context of the COVID-19 pandemic, hospitalizations for CABG with CPB decreased by almost 30% when compared to the period before the beginning of the COVID19 pandemic and after. However, we observed an 8% increase in mortality rates in the same period associated with a slight increase in hospitalization costs. The length of hospital stay remained similar.
108521
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
MARCOS DANILLO PEIXOTO OLIVEIRA1, Lélio Lemos Pinto Neto1, Ednelson Navarro2, Adriano Caixeta1
(1) Universidade Federal de São Paulo, UNIFESP; (2) Hospital Regional do Vale do Praíba
The ANGIE (Anatomical sNuffbox for Coronary anGiography and IntervEntions) randomized study compared efficacy and safety between distal transradial (dTRA) and right conventional transradial (cTRA) approaches, observing an association of dTRA with a 2-fold lower risk of occlusion of the proximal radial artery on Doppler ultrasound at 60 days. The dTRA, however, resulted in a 4-fold higher access crossover rate (21.8% vs 5.5%), mainly due to failure to insert the guidewire, as well as longer times to obtain access and perform the procedure. (dTRA vs cTRA: 120 vs 75s and 14 vs 11min, respectively), in addition to a higher radiation area-dose product (~10%). It is therefore questioned whether such limitations associated with the dTRA could impact its incorporation into the primary PCI, which must be performed in a timely manner and by experienced operators. default approach for Coronary Angiography and IntervenTIONs, eventosclinicos.gov.br Identifier: RBR-7nzxkm), among 3,991 patients consecutively submitted to coronary angiography (89%) and/or PCI (60.3%) via dTRA (80.1% by dTRA right), 917 (23%) were due to STEMI. In this subgroup, there were only 17 (2%) access crossovers (failure to insert the sheath wire), 4 of them made possible by contralateral dTRA. Thus, despite the retrospective nature and potential selection biases not documented in this series, it seems to us to be feasible and safe to incorporate dTRA as the route of choice for primary PCI in patients with STEMI. Large randomized trials are still needed and expected to assess the limitations and advantages of this potentially disruptive technique in such a challenging scenario.
108540
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
ISABEL CRISTINA SILVA SOUSA1, Brunnella Alcantara Chagas de Freitas1, Kelvin Oliveira Rocha1, Luciana Moreira Lima1
(1) Universidade Federal de Viçosa – UFV
Introduction: Mental stress, represented by disorders such as anxiety and depression, has figured in the current scenario, along with modifiable and non-modifiable risk factors, as a risk factor for cardiovascular diseases (CVD).
Objective: To describe the global cardiovascular risk and mental status of students and employees at a public university.
Methods: This is an observational, descriptive study, whose sample consisted of students, teachers, and staff, aged 18 or over, of both sexes. Data collection was conducted during the months of August and September 2021, using an online questionnaire contemplating the data necessary to calculate the global cardiovascular risk by the Framingham Score and by three instruments of screening of the metal status: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Self-Reporting Questionnaire (SQR-20).
Results: A total of 247 individuals participated in the study, 171 (69.2%) were female and 76 (30.8%) were male. Regarding age, 120 (48.6%) were under 30 years old, 118 (47.8%) were between 30 and 60 and 9 (3.6%) were over 60 years old. There were 157 (63.3%) students, 49 (19.8) professors and 41 (16.6%) staffs. Female participants had a lower 10-year risk of developing CVD (p < 0.001), higher scores for anxiety (p < 0.001), depression (p < 0.001), and mental distress (p < 0.001) when compared to male participants. In the stratification by age group, dichotomizing by gender, individuals younger than 30 also had a lower risk of developing CVD in 10 years (p < 0.001), higher anxiety scores (p = 0.003), depression (p = 0.007), and mental distress (p = 0.004) when compared with participants aged 30 years or older, regardless of gender. The parameters age, body mass index, total cholesterol, LDL, and triglycerides were significantly higher in professors and staff when compared to students (p < 0.01). However, significantly higher scores of depression, anxiety, and mental distress were observed in students when compared to staff and professors (p < 0.001). In addition, the group of professors had a higher risk of CVD in 10 years than staff and students (p < 0.001).
Conclusions: Women have higher scores for mental health disorders compared to men. The younger the age, the higher the scores for mood disorders, anxiety, and mental distress, regardless of sex. The 10-year CVD risk was not correlated with mental health markers in the sample studied.
108584
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
MIGUEL MEIRA E CRUZ1, Cristina Salles2, David Gozal4, José Fausto Pinto5, Isabel Rocha3
(1) Centro Europeu do Sono; Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal; (2) International Center on Clinical Sleep Medicine and Research, Bahiana School of Medicine and Public Health, Salvador, Brazil; (3) Cardiovascular Autonomic Function Lab, Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal; (4) University of Missouri, Columbia, United States; (5) Dpt Coração e Vasos, Centro Hospitalar Universitário de Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Introduction: While the associations between Sleep Apnea and cardiovascular and metabolic dysfunction are now well established, the interactions between insomnia and cardiometabolic disturbances are less well understood. Notwithstanding, when both sleep disorders occur as in COMISA patients, it is possible that the morbid consequences will be exacerbated, albeit while displaying age and sex dependencies. We therefore examined 3 groups of COMISA patients of markedly different ages to assess whether the presence of COMISA interacts differentially with cardiovascular risk during the lifespan.
Methodology: A total of 850 patients were enrolled in this study: Pediatric (n = 50; ages ranging from 9 to 19 years), Adult (n = 685; 31–60 years) and Elderly (n = 115; ≥65 years). Obstructive Sleep Apnea and Insomnia were assessed with validated age-adjusted questionnaires for each group and high-risk COMISA was established when high risk for OSA as well as high risk for Insomnia were present.
Results: Among the Pediatric cohort (58% males), 9 (18%) subjects were high-risk for COMISA (age was 13.6 ± 3.3 years; BMI of 23.0 ± 6.9 Kg/m2). Neither hypertension nor CVD were present in this age group; 28% were obese (BMI >95% for age), 11.1% consumed alcohol regularly and 54.4% were sedentary (no physical activity). In the Adult cohort, 25.3% were high-risk for COMISA (49.8 ± 13.8 years; BMI of 31 ± 6.3 Kg/m2). 76.5% were hypertensive or reporting cardiovascular disease, 13.3% were diabetic and 60.3% were sedentary, 8.4% were cigarette smokers, and 46.9% consumed alcohol regularly. Of the Elderly cohort, 22.6% of patients (11 males, 42.3%) were with high risk for COMISA. Their mean age was 70.6 ± 6.6 years and BMI of 28.7 ± 5.1 Kg/m2, with 61.5% being hypertensive or reporting the presence of cardiovascular disease, 21% were diabetic, 65,4% were sedentary and 7.7% were cigarrete smokers.
Conclusions: The presence of high risk COMISA is frequent across all ages and may confer increased risk for cardiovascular and metabolic disorders, particularly after reaching adulthood and beyond. It is likely that both the sedentary lifestyle, and alcohol consumption may contribute to this risk, but the presence of COMISA may add an additional risk factor for cardiometabolic complications. Further research is needed to explore how the concurrent presence of Sleep Apnea and Insomnia exacerbates cardiovascular and metabolic risk in larger clinical populations subjected to more precise diagnostic methods.
108589
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
SÉRGIO LUIZ ZIMMERMANN1, Sérgio Luiz Zimmermann1, Leonardo Campanelli Steinhausen2, Bruno Luiz Mueller2
(1) Hospital Santa Isabel, Blumenau; (2) Universidade Regional de Blumenau
Background: Coronary angiography is the most accurate method for diagnosing coronary heart disease, but it envolves exposure to radiocontrast agents and radiation, which can increase morbidity and mortality. Thus, it is necessary to study additional markers to identify of coronary artery disease (CAD), such as the diagonal ear lobe crease (DELC).
Objectives: To determine DELC’s diagnostic properties in the identification of coronary disease and its association with comorbidities.
Methods: A cross-sectional study with 278 patients over 18 years old, who underwent coronary angiography performed by at least 1 of 2 interventional cardiologists. The presence and absence of PLL and associated comorbidities was determined by two trained examiners.
Results: PLL was only associated with older age (p < 0.05). PLL had a sensitivity of 76.2%, a specificity of 17.6% in the identification of CAD and an overall accuracy of 58.3%.
Conclusion: We concluded that the diagnostic accuracy of PLL was lower when compared to the scientific literature, acting as a low quality marker for the identification of patients with CAD. In our study, there was no association between PLL and CAD.
108592
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
DR OSUNKWO DAMARIS AMARACHUKWU1, Dan-Nwafor Chioma3, Chukwuma David Umeokonkwo3, Patrick Nguku2, Emmanuel Nna4
(1) Department of Internal Medicine, National Hospital Abuja; (2) African Field Epidemiology Network Nigeria Country Office; (3) Nigeria Field Epidemiology and Laboratory Training Program, Abuja, Nigeria; (4) Safety Molecular Pathology Lab, The Molecular Pathology Institute, Enugu
Background: Hypertension is on the increase in sub-Saharan Africa and it is one of the risk factors for cardiovascular morbidity and mortality. Prisoners are at a greater risk for hypertension because of prevalent tobacco use, unhealthy diet, and incarceration-induced stress. We investigated the prevalence and the risk factors associated with hypertension among Kuje Prison inmates in the Federal Capital Territory (FCT), Nigeria.
Materials & Methods: A cross-sectional study was conducted among 180 male prisoners. WHO’s Stepwise approach to surveillance of chronic disease risk factors was used to conduct the study. Data collected at the various steps included: demographic and behavioral risk factors (Step 1); Blood pressure and anthropometric measurements (step 2) and Random blood sugar (Step 3). Body mass index (BMI) was determined. Data were analyzed using Epi-Info version 7. Odds of hypertension among participants with risk factors were calculated, p-value less than 0.05 was considered significant.
Results: The mean systolic blood pressure was 131 ± 15 mmHg, diastolic 81 ± 12 mmHg, BMI 24.8 ± 3.6 and RBS 97.1 ± 21.8 mg/dl. Overall, 60 (33.3%) were overweight, 13 (7.2%) obese, 65 (36.1%) were prehypertensive, 57 (31.6%) were hypertensive and 1(0.6%) diabetic. The risk for elevated systolic BP was significantly higher among respondents that has first degree relative with hypertension (OR = 5.6; CI = 1.6–19.9), ≥45years (OR = 7.5: CI = 1.6–35.9), insufficient physical activity (OR = 4.3; CI = 1.5–12.5; P = 0.007) and increased BMI (OR = 9.1; CI = 2.7–31.1).
Conclusion: There is a high prevalence of hypertension among prison inmates in FCT, age >45 years, insufficient physical activity, family history of hypertension, and obesity were found to be independent risk factors for hypertension.
108634
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
JULIANO AFONSINO JORGE1, Murilo Foppa1, Fábio Tremea Cichelero1, Deniz Martinez1, Marcelo Balbinot Lucca1, Geórgia Pante3, Flávio Danni Fuchs1, Sandra Costa Fuchs1
(1) Graduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; (2) Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil; (3) School of Medicine, UFRGS, Porto Alegre, RS, Brazil
Obstructive sleep apnea (OSA) has been associated with left ventricular (LV) diastolic dysfunction. Treating HTN with diuretics could reduce fluid retention and rostral fluid shift in patients with OSA, leading to changes in LV diastolic parameters. We compared the effects of diuretics or amlodipine on echocardiographic LV diastolic parameters.
Methods: Patients with HTN and an apnea-hypopnea index between 10 and 40 events/hour were randomized to receive chlorthalidone plus amiloride (25 mg/5 mg) daily or amlodipine (10 mg/daily) for eight weeks. The changes on echocardiographic LV diastolic function parameters were the primary outcome.
Results: 62 participants completed the study. Systolic and diastolic BP (24h) decreased without between-treatment differences at the end of study. Nighttime SBP dipping was higher in the diuretic group than the amlodipine group (P = 0.01). The following deltas were found between diuretic and amlodipine groups, respectively: septal E/e‘ ratio, –0.20 ± 0.36 vs. 0.08 ± 0.36 (P = 0.6); lateral E/e‘ ratio –0.14 ± 0.22 vs. 0.66 ± 0.38 (P = 0.07); and average E/e‘ ratio –0.19 ± 0.21 vs. 0.43 ± 0.32 (P = 0.1).
Conclusion: Patients with OSA and HTN treated with diuretics or amlodipine showed similar reductions in BP and LV structural measurements. The trend for the association of diuretics to have a greater effect on diastolic parameters and nocturnal SBP dipping suggest it can have beneficial cardiac effects in the long-term management of BP.
108659
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
SANDRO GONÇALVES DE LIMA1, José Arthur Viana de Oliveira Pimentel2, Manuella de Amorim Silva2, Maria Eduarda Cavalcanti Tompson2, Andréa Bezerra de Melo da Silveira Lordsleem1
(1) Hospital das Clínicas – Universidade Federal de Pernambuco – UFPE; (2) Centro Universitário Maurício de Nassau – UNINASSAU
Introduction: Cardiovascular diseases are a major cause of death in patients with advanced chronic kidney disease (CKD). Valve calcification (VC), mitral and aortic, associated with significant valve disease is a predictor of cardiovascular mortality, coronary artery disease and arrhythmias in these patients.
Objectives: To assess the frequency of heart valve disease, its progression, and associated factors in patients with CKD.
Methods: A total of 568 medical records of patients treated between 2007 and 2021 at the cardiology-renal outpatient clinic at a university hospital were analyzed, of which 347 were included due to the presence of CKD and heart valve disease. The explanatory variables analyzed were: age, gender, VC, glomerular filtration rate (GFR), dyslipidemia, coronary artery disease, systemic arterial hypertension, diabetes mellitus, C-reactive protein, secondary hyperparathyroidism and laboratory data on mineral and bone metabolism. To assess the association between categorical variables, the Pearson’s chi-square test or Fisher’s exact test was used.
Results: 50.7% were female. The most frequent risk factor was systemic arterial hypertension (83.9%) and 25.1% of patients were diabetic. Mitral valve disease was observed in 81.6%, followed by aortic valve disease (66%). Regurgitant lesions were the most frequent: mitral (75%) and aortic (40.2%). Around half (48.1%) of those with heart valve disease were in the 30–39 age group, confirming the precocity of heart valve disease in CKD. A progression of heart valve disease was observed in 122 patients (35.2%). Valve calcification was significantly associated only with the progression of aortic valve disease (p = 0.01). The variables significantly associated with mitral valve disease were secondary hyperparathyroidism (p = 0.03), GFR (p = 0.02) and total cholesterol (p = 0.02). None of the variables analyzed were significantly associated with aortic and pulmonary valve disease. Secondary hyperparathyroidism (p = 0.019) was also significantly associated with tricuspid valve disease, as well as altered levels of triglycerides (p = 0.017).
Conclusion: The frequency of heart valve disease, particularly mitral and aortic, is high in patients with CKD. The factors significantly associated with heart valve disease were: secondary hyperparathyroidism, GFR, total cholesterol and altered triglyceride levels. The progression of valve disease was observed in 35% of patients and was significantly influenced by VC.
108733
Modality: E-Poster Researcher – Non-case Report
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
MIGUEL MEIRA E CRUZ1, Joana Belo2, Mariana Picado3, Nuno Canha5, Carla Viegas2, Susana Marta Almeida4
(1) Centro Europeu do Sono; Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal; (2) H&TRC- Health & Technology Research Center, ESTeSL- Escola Superior de Tecnologia da Saúde, Instituto Politecnico de, Lisboa, Portugal; (3) Instituto Português de Oncologia de Lisboa, Lisbon, Portugal; (4) Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal; (5) Centre for Environmental and Marine Studies, Department of Environment and Planning, University of Aveiro, Aveiro, Portugal; (6) NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de, Lisboa, Portugal; (7) Comprehensive Health Research Center (CHRC), Portugal
Introduction: Inadequate sleep and poor air quality are both associated to an increased cardiovascular risk. Sleep quality and structure are also vulnerable to environmental influences. Typically, sleeping environments have low ventilation rates, leading to pollutants accumulation. Though during nighttime and early morning there is a circadian propensity to cardiorespiratory events, environmental factors which may aggravate this risk should be taken into account. The aim of this study is to test the associations between ais pollutants, specifically CO and CO2 and heart rate dynamics as an indicator of cardiovascular autonomic function.
Methodology: Ten men followed specific inclusion criteria: age between 25 and 40 years old, healthy individuals, non-smoking, without children below five years and without sleeping, cardiac and respiratory problems and whose households are within Lisbon area, were recruited. An unattended polysomnography (PSG) was performed during 2 weeknights in a row. The second night PSG’s results were used in order to minimize the first night effect. For the propose of this study the data related to heart rate (HR) were collected, namely HR acceleration index (HR Acc index), mean of HR (HRmean) and minimum of HR (HRmin). IAQ monitoring was based on a comprehensive multi-pollutant assessment where chemical, in particular carbon dioxide (CO) and carbon monoxide (CO), were assessed through real time instruments. Non-parametric statistics were applied, namely Spearman correlations, to analyze potential associations between sleep and environmental parameters. The level of significance considered was α = 0.05.
Results: The mean age was 33.9 ± 5.20 years. HR and IAQ parameters showed a moderately positive correlation between CO exposure and HR Acc index (rs = .635) and HRmin (rs = .0,667) and a highly positive correlated between CO exposure and HRmean (rs = .0,71); also a moderately and positive correlation between CO2 exposure and HR Acc index (rs = .668) awas observed as well as a highly positive correlation between CO2 exposure and HRmin (rs = 713) HRmean (rs = .0,794).
Conclusions: Results from this preliminar study suggest that high levels of CO and CO2 may increase the HR Acc index, HRmin and HRmean, raising awareness on the possible impact of indoor air quality on cardiovascular autonomic modulation. Further studies are needed to confirm such findings and to establish their clinical relevance within cardiorespiratory health.
108720
Modality: E-Poster Researcher – Non-case Report
Category: ANTICOAGULATION
CHRISTIAN HENGSTENBERG1, Martin Unverdorben2, Helge Möllmann3, Nicolas M Van Mieghem4, Holger Thiele5, Peter Nordbeck6, Tienush Rassaf7, Raul Moreno8, Roxana Mehran9, Irene Lang1, Roland Veltkamp10, George D Dangas9
(1) Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University, Vienna, Austria; (2) Daiichi Sankyo, Inc., Basking Ridge, NJ, USA; (3) Department of Internal Medicine, St. Johannes Hospital, Dortmund, Germany; (4) Department of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands; (5) Department of Internal Medicine–Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig; (6) Department of Internal Medicine I, University Hospital Würzburg, Würzburg & Klinikum Links der Weser gGmbH, Bremen, Germany; (7) Clinic for Cardiology and Vascular Medicine, Essen University Hospital, Essen, Germany; (8) Department of Cardiology, Tübingen University Hospital, Tübingen, Germany; (9) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA; (10) Division of Brain Sciences, Imperial College London, London, UK; Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany
Introduction: In ENVISAGE-TAVI AF (NCT02943785) edoxaban was noninferior to vitamin K antagonists (VKAs) for the composite endpoint of net adverse clinical events in patients with atrial fibrillation after transcatheter aortic valve replacement (TAVR).
Objective: To evaluate the association between baseline patient characteristics and ischemic stroke (IS) incidence.
Methods: This on-treatment analysis of ENVISAGE-TAVI AF included patients that received ≥1 dose of the study drug over the period treatment and ≤3 days after interruption or discontinuation. Baseline demographic and clinical characteristics were stratified by IS incidence. Numerical variables were compared using one-way analysis of variance; categorical variables were compared using Fisher’s exact test. Stepwise logistic regression with 30 independent predictors determined patient characteristics associated with first IS event.
Results: Of 1377 patients included in the on-treatment analysis, 41 (3.0%) experienced IS during the on-treatment period (edoxaban, n = 19; VKA, n = 22). Most IS events occurred within 6 months of TAVR for both the edoxaban (57.9%) and VKA (68.2%) arms. Differences in baseline demographic and clinical characteristics are shown for patients who did or did not experience IS while receiving treatment (Table). Significantly more patients who experienced IS had a history of systemic embolic events (SEE; P = 0.015). Only a history of SEE was independently associated with IS (P = 0.006). Body mass index (P = 0.052) and history of myocardial infarction (P = 0.074) were numerically, but not statistically, associated with IS.
Conclusions: In this on-treatment analysis of the ENVISAGE-TAVI AF trial, few patients experienced IS. Patients with history of SEE may be at increased risk of IS following TAVR.
109072
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
CRISTIANE DA CRUZ LAMAS1, Mariah Rodrigues Paulino1, Léo Rodrigo Abrahão dos Santos2, Ingrid Paiva Duarte2, Marcelo Goulart Correia1, José Alfredo de Sousa Moreira1, Letícia Roberto Sabioni1, Fabiana Bergamin Mucillo1, Rafael Quaresma Garrido1, Bruno Zappa1, Stephan Lachtermacher Pacheco1, Andrea Rocha de Lorenzo1
(1) Instituto Nacional de Cardiologia; (2) Universidade do Grande Rio
Introduction: Reported nosocomial acquisition of COVID-19 has varied between 5 to 41%. Our aim was to describe the demographic, clinical and laboratory features and outcomes of patients with cardiac disease hospitalized with COVID-19 in a reference cardiology institution in Brazil, comparing the patients with hospital-acquired COVID-19 (HACOVID19) with those who had non-hospital acquired (NHA) COVID-19.
Methods: This is an observational retrospective study of consecutive adult patients admitted, between March and September of 2020 with a diagnosis of SARS-CoV-2 infection confirmed by RT-PCR. Data was collected as per the International Severe Acute Respiratory and Emerging Infection Consortium and complemented with a cardiovascular questionnaire. HA COVID-19 was considered when the patient had a negative nasopharyngeal swab on admission and a positive one 14 or more days later. Statistical analysis was performed using the Jamovi 1.6 and R 4.0.1.
Results: One hundred twenty-one patients with a confirmed diagnosis of COVID-19 were included. There were 20 patients (16.5%) with HA-COVID19 and 101 (83.5%) with NHA-COVID-19. Patients who developed COVID-19 in hospital had as reasons for admission: decompensated heart failure (35%), acute coronary syndrome (20%), cardiac surgery (CABG, valve replacement or aortic surgery) in 25%, complete AV block, pacemaker dysfunction, stroke and hematologic disease (5% each). The median(IQR) length of stay of HACOVID19 was 29 days (18.5–60.2) vs 16 (7–31)days. Median age was 64 years (61.8–69.3) for HA-COVID-19, and 63 (52–72) for NHACOVID19. There was no difference between patients with HACOVID-19 and those with NHACOVID-19 regarding the presence of heart disease, COPD, obesity, complicated diabetes mellitus, heart valve disease, coronary artery disease, and systemic arterial hypertension. However the 2 groups were significantly different regarding laboratory features (serum creatinine, D-dimer, ferritin, AST). HACOVID patients had more dyslipidemia (15/20 (75%) vs 49/101 (48.5%), P = 0.030] and chronic renal failure [7/20 (35%) vs 15/101 (15%), p = 0.033]. Most importantly, mortality was significantly higher in HACOVID-19[10/20 (50%) vs 19/101 (18.8%), p = 0.003].
Conclusions: Cardiac patients who acquired COVID-19 in hospital had longer hospital stay and higher mortality, which highlights the impact of the pandemic on the outcomes of cardiac patients admitted to hospital for cardiac, non-COVID related reasons.
108800
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
CHARLE ANDRE VILJOEN1, Mahmoud Al-Naili2, Jean Jacques Noubiap3, Alice Jackson4, Karice Hyun5, Andrea Neves6, Clovis Nkoke7, Charles Mondo8, Juliet Nabbaale9, Julian Hoevelmann10
(1) Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; (2) Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; (3) Centre for Heart Rhythm Disorders, The University of Adelaide, Adelaide, Australia; (4) British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, Scotland; (5) School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead 2145, Australia; (6) Gynecology and Obstetrics, Hospital Geral José Macamo, Av. OUA, 1100, Maputo, Mozambique; (7) Department of Internal Medicine, Buea Regional Hospital, Buea, Cameroon; (8) St. Francis Hospital Nsambya, P. O. Box 1799, Nsambya Road, Kampala, Uganda; (9) Uganda Heart Institute, Plot No. 1, Upper Mulago Hill, P. O. Box 37392, Kampala, Uganda; (10) Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg (Saar), Deutschland
Introduction: Cardiac disease is an important cause of maternal mortality worldwide. However, diagnosing heart failure (HF) during pregnancy remains challenging. Patients with HF present with symptoms that are often attributed to the physiological changes of pregnancy. Although the measurement of natriuretic peptides has been recommended as a cost-effective screening test for HF, its value in predicting underlying structural heart disease on echocardiography during pregnancy is unclear. We aimed to evaluate the accuracy of point-of-care (POC) NT-proBNP to predict echocardiographic evidence of structural heart disease in pregnant women. Methods All consecutive consenting pregnant women with symptoms of HF, who underwent echocardiography at a tertiary hospital in Cape Town, South Africa, between March 2021 and March 2022 were compared with asymptomatic pregnant women. Demographic and obstetric data were collected, as well as clinical and echocardiographic parameters. POC NT-proBNP was measured; a receiver operating characteristic (ROC) curve was used to determine the level of NT-proBNP that would have the best predictive value for detecting structural heart disease on echocardiography.
Results: We included 121 women with a median age of 31.3 years (IQR 24.9–36.4), gravidity of 3 (2–4), mostly in their third trimester of pregnancy (76.9%). Symptomatic women (66.9%) presented mainly with dyspnoea (90.8%) and peripheral oedema (50%). Overall, the median POC NT-proBNP was 108 pg/ml (60–470) but was not statistically different between symptomatic and asymptomatic participants. However, NT-proBNP levels were significantly elevated in those with left ventricular (LV) dilatation (395 [86–1668] vs 80.5 [60–303], p = 0.001), left atrial enlargement (417 [98–1211] vs 78 [59–167], p < 0.001), LV systolic dysfunction (539 [94–2582] vs 80 [60–323], p < 0.001), diastolic dysfunction (300 [77–1450] vs 80 [60–322], p = 0.038), mitral regurgitation (247 [60–794] vs 84 [60–323], p = 0.027) and pericardial effusion (448 [84–1487] vs 80 [60–303], p < 0.001). An NT-proBNP of <250 pg/ml had the highest negative predictive value (79.3%) to rule out structural heart disease (ROC area 0.66).
Conclusion: In this cohort of pregnant women with symptoms HF, POC NT-proBNP identified those with structural heart disease with acceptable discrimination. POC NT-proBNP testing might be particularly useful as a screening test in settings where pregnant women do not readily have access to echocardiography.
108804
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
DANIELE BARRIONUEVO KALLAS1, Lia Kanae Okita Buschinelli1, Eneas Antonio Rocco1, Amanda Barbuio Teixeira1, Luana Talita Diniz Ferreira1, Raquel Yuri Mori1, Bianca Sprovieri Moraes1, Gabriela Macoppi Carreiro1, Gabriela Zanussi Barreto1, Camila dos Santos Arcas1, Felipe Lopes Malafaia1, Patricia Canteruccio Pontes Vianna1
(1) Hospital Samaritano Paulista
Introduction: Health Coaching (HC) is an approach for changes in health behaviors and self-care. The British Association for Cardiovascular Prevention lists health behavior change, education, and management of risk factors related to physical activity, diet, weight control, alcohol and tobacco among the 6 central components of cardiac rehabilitation (CR) programs. Thus, interventions based on changes in health behaviors are justified as part of medical care.
Objective: To evaluate the impact of a HC Program in lifestyle of patients under CR immediately after and 6 months after the intervention.
Methods: Patients in CR of a specialized institution were invited to voluntarily enroll in a HC Program in the dimensions of diet, physical activity, stress management and sleep. The intervention was composed of 6 weekly coaching sessions, with trained health professionals, lasting 1h30, made 100% remote by the telemedicine of the institution, where patients were gathered in groups of up to 4 people, plus the Health Coach. Fantastic Lifestyle Questionnaire (Fantastic) was applied before, immediately after and 6 months after the intervention. Sessions addressed wellness, ambivalence, behavioral change process, thoughts and beliefs, relapse prevention and habit support plan, and patients were invited to create health goals with the Smart framework to a day-to-day practice. Between sessions they received educational materials about the four dimensions.
Results: The intervention took place between August 2020 and March 2022. 31 patients completed the program. Results of the Fantastic are at Table 1.
Conclusions: Interventions for health behavior changes seem to be promising for patients in CR and seem to last after 6 months.
108810
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
RENATA JUNQUEIRA MOLL BERNARDES1, Sérgio Costa Fortier3, Andréa Silvestre de Sousa4, Renato D. Lopes6, André Feldman8, Guilherme D.A.S. Arruda9, Denílson C. de Albuquerque1, Ariane V. S. Macedo7, Olga Ferreira de Souza1, Fernando A. Bozza1, Ronir Raggio Luiz5, Emiliano Medei2
(1) D’Or Institute for Research and Education, Rio de Janeiro, Brazil; (2) National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro, Brazil; (3) Patological Anatomy Laboratory, Rede D’Or São Luiz, São Paulo, Brazil; (4) Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil; (5) Public Health Studies Institute – IESC, Federal University of Rio de Janeiro, Brazil; (6) Brazilian Clinical Research Institute, São Paulo, Brazil; (7) Hospital São Luiz Jabaquara, São Paulo, Brazil; (8) Hospital São Luiz Anália Franco, São Paulo, Brazil; (9) Hospital São Luiz São Caetano, São Caetano do Sul, Brazil; (10) Hospital Sino Brasileiro, Osasco, Brazil; (11) Hospital Villa Lobos, São Paulo, Brazil; (12) Hospital São Luiz Morumbi, São Paulo, Brazil
Background: Cardiovascular comorbidities and immune response dysregulation are associated with 2019 coronavirus disease (COVID-19) severity. Reduced populations of lymphocytes, including T, B, and natural killer cells, and increased neutrophil counts have been detected in patients with COVID-19. We aimed to explore the key immune cell profile and understand its association with disease progression in patients with hypertension hospitalized due to COVID-19.
Methods: Immune cell populations in cryopreserved peripheral blood mononuclear cell samples were obtained from 156 hypertensive patients who were included in the BRACE CORONA randomized trial. The primary outcome was progression to severe disease, according to a modified World Health Organization Ordinal Scale for Clinical Improvement, during hospitalization. The probability of progression to severe disease was estimated using a logistic regression model that included clinical variables and immune cell subsets associated with the primary outcome.
Results: During hospitalization, 11 (7.1%) patients showed progression to more severe COVID-19; 3 of these patients died. Obesity, diabetes, oxygen saturation, lung involvement on computed tomography (CT) examination, the C-reactive protein concentration, total lymphocyte count, proportions of CD4+ and CD8+ T cells, CD4/CD8 ratio, CD8+ human leukocyte antigen DR isotope (HLA-DR) median fluorescent intensity (MFI), and CD8+ natural killer group 2 member A (NKG2A) MFI on admission were associated with progression to severe COVID-19. According to our predictive model, the risk of progression to severe disease reached 86.2% in the presence of three clinical variables (obesity, diabetes, reduced oxygen saturation, or >50% CT lung involvement) combined with increased CD8+ NKG2A MFI.
Conclusions: This study demonstrated that increased CD8+ NKG2A MFI at hospital admission, in combination with some clinical variables, is associated with a high risk of COVID-19 progression in hypertensive patients. These findings reinforce the hypothesis of functional exhaustion of T cells with the increased expression of NKG2A in patients with severe COVID-19, elucidating how severe acute respiratory syndrome coronavirus 2 infection may break down the innate antiviral immune response at an early stage of the disease, with future potential therapeutic implications.
109063
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
MIGUEL MEIRA E CRUZ1, Luis Vicente Franco de Oliveira3, Monica Gomes2, Lilian Giannasi2
(1) Centro Europeu do Sono; Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisboa, Portugal; (2) Universidade Estadual de São Paulo – UNESP, São José dos Campos, São Paulo, Brazil; (3) Centro Universitário de Anapolis-UniEvangélica, São Paulo, Brazil
Introduction: COMISA refers to the frequent co-occurrence of Insomnia and Sleep Apnea and has been linked to increased cardiovascular risk where autonomic dysfunction play an important role. Therefore, improving cardiovascular autonomic function (CAF) is a clinically relevant target to be achieved in these patients. While mandibular advancement devices (MAD) are recommended as an effective alternative for obstructive sleep apnea control, the benefits of such therapeutic tool in COMISA remains elusive. In this pilot study we aimed to test the null hypothesis that MAD will have no effect on heart rate variability (HRV) as a surrogate of CAF in COMISA adult patients.
Methodology: Patients with COMISA, as defined by OSA + Sleep Latency >30min, were treated with PMPositioner oral appliance (OAm) for their sleep disordered breathing and were evaluated after 3 months of OAm therapy, been retrospectively compared regarding major clinical and polysomnographic outcomes. Sleep variables were evaluated by PSG and Heart rate variability (HRV) was accessed and analized by rythmography.
Results: 12 COMISA patients (6 males), mean age = 49.7, mean BMI = 25.9, mean neck circumference = 38.9 were enrolled. Insomnia and OSA were confirmed by both clinical criteria (validated questionnaires) and PSG parameters. All patients were treated with a PMPositioner oral appliance for sleep disorder breathing. The AHI was reduced from 22.7 ± 12.7 to 4.0 ± 3.5(p < 0.0002), IDO was reduced from 18.8 ± 14.0 to 3,5 ± 2.0 (p < 0.02), sleep latency reduced from 63.1 ± 49.4 to 21.8 ± 21.4 (p < 0.2), reaching a normal level. The time-domain and frequency–domain parameters were significant for RR interval and both Fast Fourrier Transform and Wavelet spectral method, respectively.
Conclusions: The rejection of the null hypothesis allow us to confirm the impact of MAD in HRV of these patients. This is the first study showing a positive and clinically relevant effect of MAD therapy on both respiratory and insomnia related therapeutic outcomes in COMISA together with an improvement of CAF and therefore on cardiovascular risk as a major concern among these patients.
109361
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ANNE GERYMAIA OLIVEIRA DE MELO SILVA1, ANNE GERYMAIA OLIVEIRA DE MELO SILVA1, NEILA ANDERS AIDAR2
(1) SECRETARIA DE SAÚDE DO DISTRITO FEDERAL; (2) MEDCOR
Introduction: The interest in understanding what accelerates the degradation of cardiovascular function in some individuals, is matched by the need to understand what protects other subjects. Pulse-wave velocity (PWV) is a measurement of arterial stiffness that is an independent predictor of cardiovascular risk. It can be measured simply and noninvasively by modern oscillometric methods.
Objectives: To evaluate vascular aging variables and arterial stiffness in adult patients with trisomy 21, treated at the Distrito Federal Down Syndrome Reference Center – Crisdown.
Methods: Transversal study of PWV in 28 adults with Down syndrome. The central hemodynamic parameters of blood pressure, pulse wave velocity (PWV), and heart rate-adjusted increase index (Alx@75) were estimated using the oscillometric device Arteris-AOP (Cardio Sistemas Comercial e Industrial Ltda, São Paulo, Brazil), ANVISA 10361059013. The device performs the analysis through a cuff installed on the patients‘ left arm. The software was used for data analysis comparing with a database with the Brazilian population matched by sex, age, weight, and height.
Results: Twenty-eight patients with Down Syndrome ranging from 18 to 64 years old, being 18 female and 10 male, were evaluated. For data analysis, they were divided into groups of 18 to 24 years (N = 13), 25 to 34 years (N = 6), and over 35 years (N = 9). There was no statistical difference between the groups regarding mean BMI (30.7 + 4.3 Kg/m2), mean central systolic pressure – CSP (85.6 + 10.5 mmHg), mean central diastolic pressure – CDP (62.3 + 10.1 mmHg), mean cardiac output (3.4 + 0.5 l/min) and mean total cholesterol serum level (171.7 + 35.3 mg/dl). The mean PWV was 5.2 m/s (SD 1.4) and the mean augmentation index was 17.5% (SD 8.5). There was a statistical difference between the groups in relation to pulse wave velocity and augmentation index, which were significantly higher in the group aged over 35 years. Compared with a database of the typical Brazilian population, the level of PWV in adults with Down Syndrome was within the average, even in the group aged over 35 years.
Conclusion: The findings suggest that adults with Down syndrome have a pattern of central arterial hypotension. The lack of relationship of PWV, an independent predictor of adult cardiovascular events, with its traditional determinants, including arterial pressure suggests Down syndrome–specific phenomena may alter such relationships in this population.
109071
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
MIRIAN FIORESI1, Juliana Mitre da Silva1, Cândida Caniçali Primo1, Maria Edla de Oliveira Bringuente1, Bruno Henrique Fiorin1, Karolini Zuqui Nunes1, Lorena Barros Furieri1, Walckiria Garcia Romero Sipolatti1
(1) Programa de Pós-Graduação em Enfermagem, Universidade Federal do Espírito Santo
Introduction: The concept of decreased cardiac output is found mainly in the nursing and medical fields. As a nursing phenomenon, it is present in the NANDA-I and ICNP classification systems. Nurses are the professionals who stay the longest in direct care of people, so they commonly identify clinical changes and signs of deterioration of patients‘ health at all levels of health care. Therefore, a data collection instrument can optimize risk prediction in adults and facilitate clinical thinking and nursing care for patients with this condition.
Objective: To develop an instrument to assist nursing in the physical examinations of a suspected low cardiac output patients.
Methods: This is a methodological study developed in three stages: literature scope review, pilot instrument construction and validation by judges. The instrument was constructed following the principles of Pasquali’s elaboration of instrument. Content and face validation was based on content validity index (CVI) and was considered as inclusion criteria CVI greater than or equal to 0.8. The judging population consisted of nurses with a minimum degree of specialist and minimum experience of two years in the field of nursing cardiology. The items that made up the instrument were evaluated as: 1- Adequate, 2- Needs adequacy and 3- Inadequate, within the criteria of clarity, relevance or representativeness and comprehensiveness.
Results: After the validation process, the instrument was composed of the following nine items, called clinical indicators: consciousness status, respiratory status, activity tolerance, fluid volume, gastric status, sensory alteration of cardiac origin, heart rate and rhythm, blood pressure and tissue perfusion. Each item can be scored from 1 to 3 in ascending order of severity and by summing the total points the patient risk can be stratified into: minimum risk (9 to 12 points), intermediate risk (13 to 18 points) and high risk (19 to 27 points). If the patient is tired with minor exertion (eating) and/or presents with chest pain that does not cease at rest and therapy, he/she should be classified as high risk even if the patient has a score below 19 points.
Conclusion: An instrument to assist nursing in the assessment was developed and validated to classify the risk of decreased cardiac output in adults that can support nursing care and favor the clinical reasoning of nurses in the nursing process to patients who present signs and symptoms of this phenomenon.
108869
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
POLYANA EVANGELISTA LIMA1, André Maurício Souza Fernandes2, Marta Silva Menezes1, Edmundo José NassriCamara2, Rafael de Castro da Silva2, Heverton Garcia de Oliveira3, Sarah Rodrigues de Assunção Vaz3, Alane Mota dos Santos3, Matheus Pereira Barreira3
(1) Escola Bahiana de Medicina e Saúde Pública; (2) Universidade Federal da Bahia; (3) Universidade Federal do Vale do São Francisco
Introduction: Early identification of myocardial damage appears to be important in the approach to patients with Chagas disease (CD). Echocardiography with strain obtained by speckle tracking (STE) and the evaluation of myocardial fibrosis (MF) through cardiac magnetic resonance imaging (CMRI) may be promising diagnostic methods in this regard.
Objective: Evaluate myocardial involvement, specifically in the chronic mild cardiac form of CD using strain by STE and MF by CMRI, as well as their correlations.
Methods: A cross-sectional study analyzed patients with the chronic mild cardiac form of CD (preserved ejection fraction) who underwent STE strain echocardiography and CMRI.
Results: Twenty-one participants were included (female: 62%, age: 54 +/– 5 years). The prevalence of MF by late myocardial enhancement (LME) was 50%. Global longitudinal strain (GLS) was decreased in 17 patients (81%) with a median of 14.1% (interquartile range 12.1–16.3). The average T1 mapping values were high in patients with CD (993 +/– 163 ms). T1 mapping was significantly correlated with GLS (r = 0.634; p = 0.015). Furthermore, the mechanical dispersion index obtained by strain was increased (>55 ms) by 84%, with the largest area under the receiver operating characteristic curve (AUC 0.696; 95% confidence interval 0.412–0.981) for fibrosis discrimination by LME.
Conclusion: The present study suggests that myocardial strain and T1 mapping behave as early markers of myocardial damage in mild chronic CD. The mechanical dispersion index was elevated, and it was the parameter that most correlated with myocardial fibrosis by LME.
108876
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ANNE GERYMAIA OLIVEIRA DE MELO SILVA1, NEILA ANDERS AIDAR2, MARIA CAROLINA VIANA VALE1
(1) SECRETARIA DE SAÚDE DO DISTRITO FEDERAL; (2) MEDCOR
Introduction: Down syndrome continues to be the most common chromosomal condition, with rising prevalence and increased survival. With increased longevity, such individuals are susceptible to differing cardiovascular disorders.
Objectives: Describe cardiovascular disorders in adults with Down Syndrome.
Methods: Descritive and observational study of 129 adults with cytogenetically and/or clinically proven Down syndrome. For each individual, carers were interviewed to elicit a past history of any medical condition and to elicit any symptoms suggestive of an ongoing medical illness. A standard physical examination was undertaken.
Results: 129 adults with Down syndrome participated in this study, sex distribution being 65 (50.3%) males and 64 females. The mean age of the sample population was 29 years; range 18–64 years. The individuals were living in their family homes. The commonest cardiac disorders were cardiac congenital malformation in 43 (33.3%), dyslipidemia in 37 (28.7%) subjects, cardiac arrhythmia in 12 (9.3%) and dysautonomic disorders in 10 (7.7%). The commonest cardiac malformations were valvular diseases in 21 (16.3%) atrioventricular septal defect in 13 (10.0%), interatrial septal defect in 11 (8.5%), interventricular septal defect in 9 (7.0%), patent ductus arteriosus in 9 (7.0%). The mean rate was 74 beats per minute (SD 14), the mean systolic arterial pressure was 118.7 mmHg (SD 21.6), the mean diastolic arterial pressure was 77.2 mmHg (SD 16.2) and the mean oxygen saturation level was 95% (SD 4). The mean body mass index was 30.8 kg/m2 (SD 15.4), overweight and obesity was observed in 67.6% of individuals. The mean cholesterol was 175.1 mg/dl (SD 46.6). Other important clinical disorders was hypothyroidism in 52 (40.3%) individuals, epilepsy in 17 (13.1%) and diabetes mellitus in 6 (4.6%). Screening of obstructive sleep apnea (OSA) was positive in 20 cases (15.5%), being 13 (10.0%) considered severe OSA and 7 (5.4%) moderate OSA. Carotid ultrasound was performed on 26 individuals and measurement of intima-media thickness was normal in all cases.
Conclusion: Overweight/obesity, dyslipidemia and cardiac defects were frequently. Considering that Down syndrome presents with chronic hypotension, it is reasonable to propose that the prolonged reduction of arterial distending pressure may contribute to functional preservation of the arteries in patients with Down syndrome.
108881
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
POLYANA EVANGELISTA LIMA1, Rafael de Castro da Silva -Silva1, André Maurício Souza Fernandes2, Marta Silva Menezes1, Edmundo José NassriCamara2, Matheus Pereira Barreira3, Alane Mota dos Santos3, Sarah Rodrigues de Assunção Vaz3, Heverton Garcia de Oliveira3
(1) Escola Bahiana de Medicina e Saúde Pública; (2) Universidade Federal da Bahia; (3) Universidade Federal do Vale do São Francisco
Introduction: Chronic Chagas cardiomyopathy presents as chronic myocardial inflammation that causes progressive tissue destruction and extensive fibrosis. Cardiac magnetic resonance (CMR) is the gold standard noninvasive test to assess myocardial fibrosis (MF) using the technique of late myocardial enhancement (LME). CMR has recently been used to perform new evaluations with parametric mapping (T1 and T2). It is possible that the use of the T1 mapping technique generates complementary and even prognostic information in the evolution of patients with CD.
Objective: Describe the T1 mapping values obtained with CMR in the evaluation of patients with CD and their correlation with the LME technique.
Methods: This cross-sectional study analyzed patients with the chronic mild cardiac form of CD who underwent CMR. Eligible patients underwent CMR to analyze MF by 2 techniques: the LME technique, which was categorized as present/absent for MF, and T1 mapping time, expressed as average +/– standard deviation.
Discussion: Sixteen patients composed the study population; 81% female, and the mean age was 54.3 +/– 5.3 years. Mean left ventricular ejection fraction was 65.3% +/– 5.4%. The prevalence of MF in the sample using the LME technique by CMR was 50%. The T1 mapping values were high in patients with CD without ventricular dysfunction, with mean of 993 +/– 163 ms. The medians and interquartile range (IQR) of T1 mapping were: 1033 (IQR 998–1081) in group I and 1010 (IQR 1002–1047) in group II. In the MF group, the times were even higher, as found in other dilated cardiomyopathies.
Conclusion: These data reinforce the ability of T1 mapping to identify MF more completely and earlier when compared with LME and suggest that this technique is a marker of early cardiac involvement by CD.
108908
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
EDUARDO PITTHAN1, Vânia Hirakata2, Natanael Alves de Lima1, Thiago Emanuel Rodrigues Novaes1, Pamela Sandri1
(1) Universidade Federal da Fronteira Sul Passo Fundo; (2) Instituto de Cardiologia do Rio Grande do Sul
Introduction: In Brazil, the clinical-epidemiological scenario of Heart Failure (HF) has shown significant changes in recent decades. The main factors that have affected the change in profile were the exponential increase in the elderly population and the impact of new therapies.
Objective: To evaluate the trend of variation in gross mortality rates in HF in Brazil from 1996 to 2019, comparing with the variation in the growth of the elderly population stratified by age groups.
Methods: Refers to an ecological, descriptive and quantitative study that used data available on DATASUS on March 8th 2022 regarding to mortality in the elderly due to HF, in Brazil, from 1996 to 2019, divided into three age groups: 60 to 69 years, 70 to 79 years and 80 years or more. The gross mortality rates in these variables were calculated per 100,000 inhabitants, based on the population variation in Brazil in the years chosen for the study, made available by IBGE in a consultation that happened on March 8th 2022.
Results: The analysis of mortality from HF over 80 years, in 1996, shows a rate of 770.2/105 inhabitants and showed a significant drop in 2019, being 324.4/105 inhabitants. Making a drop of 57.9% per 105 inhabitants. On the other hand, in the same period, the population of this age group has increased 172.5%. The analysis of mortality from HF from 60 to 69 years, in 1996, showed a rate of 87.6/105 inhabitants and showed a significant drop in 2019, being 26.6/105 inhabitants. Making a drop of 69.6% per 105 inhabitants. On the other hand, in the same period, the population of this age group has increased 120.7%. In the 70–79 age group, in 1996, it had a mortality rate of 248.1/105 inhabitants and showed a significant drop in 2019, being 79.6/105 inhabitants. Making a drop of 67.9% per 105 inhabitants. On the other hand, in the same period, the population of this age group has increased 121.3%.
Conclusion: The results of this study demonstrate downward trends in the mortality rate from HF in the elderly in Brazil in recent decades. In contrast, there has been an exponential increase in the elderly population in all ages studied.
108942
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
LUIZ FERNANDO KUBRUSLY1, Douglas Mesadri Gewehr2, Alexandre Gelás Haddad1, Victor Daniel Falkenbach Tenius1, Fernanda Prehs Izar1, Allan Fernando Giovanini1, Fernando Bermudez Kubrusly3
(1) Mackenzie Evangelical School of Paraná, Curitiba, Paraná, Brazil; (2) Denton Cooley Institute of Research, Science and Technology, Curitiba, Paraná, Brazil; (3) Curitiba Heart Institute, Curitiba, Paraná, Brazil
Introduction: The bovine pericardium is a biological tissue widely used as a biomaterial for tissue engineering applications. Glutaraldehyde and formaldehyde are frequently used in these reticulation processes to improve the material’s resistance and preservation.
Objective: The objective was to evaluate the impact of long-term storage in 4% formaldehyde on the quantitative expression of immunophenotypic markers of glutaraldehyde-treated bovine pericardium.
Methods: Bovine pericardium (BP) patches used were produced and supplied by Braile Biomédica®. We performed a histological and immunohistochemical analysis comparing two patches of BP, one manufactured in 2009, thickening 0.35 mm/measuring 35 cm2, and another manufactured in 2020, thickening 0.36 mm/measuring 99 cm2. BP were fixed in a 10% formalin solution for 24h, embedded in paraffin blocks, trimmed and mounted on histological glasses. Sections were stained with H&E, Weigert and picrosirius red and immunolabeled with vimentin, laminin 5, collagen I and collagen IV using a standardized protocol. Images were captured using light and polarized microscopy and the area of antibody signal was quantified using Image J Software.
Results: Histological analysis of the patches showed no autolysis or significant changes. In immunohistochemical analysis, collagen I and IV was diffused throughout the connective tissue of the patches. In 2020 specimen, collagen I occupied an area of 21.36% and collagen IV an area of 24.67%, while in the 2009 specimen, only 15.87% (collagen I) and 12.02% (collagen IV). Laminin was not reacted between the specimens. Immunopositivity for vimentin differed markedly between patches occupying a 54% area in the 2020 patch and a 13% area in the 2009 patch.
Conclusion: We observed no expressive differences in immunophenotypic expression between 2009 and 2020 bovine pericardia, except for the higher expression of the vimentin in the 2020 bovine pericardium patch.
108955
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
EDUARDO PITTHAN1, Vânia Hirakata2, Pamela Sandri1, Guilherme Sommavilla1
(1) Universidade Federal da Fronteira Sul Passo Fundo; (2) Instituto de Cardiologia do Rio Grande do Sul
Introduction: Heart failure (HF) presents epidemic characteristics with considerable impact on morbidity and mortality, especially among the elderly. In Brazil, HF is responsible for high mortality rates.
Objectives: To evaluate the variation trend of HF gross mortality rates by gender in the elderly in Brazil, comparing with the variability of population growth by age group and gross mortality rate from all causes in recent decades.
Methods: An ecological study that used data available on DATASUS on March 2022, regarding mortality by gender in elderly people with HF in Brazil, from 1996 to 2019, stratified into three age groups: 60 to 69 years, 70 to 79 years and >80 years. The gross mortality rates were calculated in these variables per 105 inhabitants, comparing with the variation of the population in Brazil in the years that were studied, made available by the IBGE in a consultation on March 2022.
Results: In the analysis of HF mortality in Brazil in men aged 60 to 69 years, there has been a decrease of 67%, falling from 98/105 inhabitants to 32/105 inhabitants. In the same age group, among women, the gross death rate has decreased 72%, falling from 77/105 to 21/105 inhabitants. In contrast, the male and female population aged 60 to 69 has grown 119% and 121%, respectively. In men aged 70 to 79 years, the mortality rate has dropped from 269/105 to 94/105 inhabitants, with a drop of 65%. Moreover, among women in this age group, there has been a drop of 70%, from 229/105 to 68/105 inhabitants. In contrast, the male population grew 112% and the female population 129%. In the age group of more than 80 years, in the same period, male mortality has decreased 54%, falling from 741/105 inhabitants to 339/105 inhabitants. In women, there was a drop of 60%, falling from 785/105 inhabitants to 315/105 inhabitants. In contrast, the male population has grown 151% and the female population, 187%.
Conclusion: This study demonstrates trends of a significant decrease in the mortality rate from HF in elderly people of both genders in Brazil in the recent decades. This trend is more pronounced in women aged 60 to 79 years.
108973
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ROMERO HENRIQUE DE ALMEIDA BARBOSA1, Luana Resende Cangussú1, Eduardo Antonio Sartori Alho1, Matheus Rodrigues Lopes1
(1) Universidade Federal do Vale do São Francisco
Introduction: Health literacy comprises the cognitive and social skills that determine an individual’s ability to obtain, process, understand and use health and medical information to make decisions that are relevant to their own health. Cardiovascular diseases are the leading causes of death in Brazil and Systemic Arterial Hypertension (SAH) contributes directly or indirectly to 50% of these deaths. Poor health literacy can impact in the management and control of these comorbidities leading to significant losses in quality of life.
Objectives: To evaluate the level of health literacy and the quality of life of patients with systemic arterial hypertension users of the Public Health System in a municipality in the Northeast region of Brazil.
Methods: Cross-sectional analytical observational study carried out with 105 patients with SAH through the application of the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), Short Test of Functional Health Literacy in Adults (S-TOFHLA) and the Mini- Quality of Life Questionnaire in Arterial Hypertension (MINICHAL).
Results: It was found that about 60% of the interviewed patients did not have adequate health literacy in both tests to measure the level of health literacy. It was found that some factors such as age, economic class and education were associated with inadequate health literacy (p < 0.01). In the assessment of quality of life, using the MINICHAL, 46.7% of patients reported that hypertension interferes with quality of life. It was also possible to show that the time of diagnosis and economic class influenced the quality of life of patients (p < 0.05).
Conclusion: A relevant portion of patients with SAH did not have an adequate level of health literacy, which reflects the difficulty in understanding and processing health information and can impact the therapeutic management of the disease.
108986
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
EDGARD FREITAS QUINTELLA1, Leonardo Hadid1, Márcio José da Costa Montenegro1, Luiz Kohn2, Dinaldo Cavalcanti Oliveira5, Gustavo Lycurgo4, Paulo Antonio Marra da Motta4, Maximiliano Otero Lacoste3
(1) Instituto Estadual de Cardiologia Aloysio de Castro (IECAC); (2) Universidade Estadual do Rio de Janeiro, Hospital Pedro Ernesto (HUPE); (3) Hospital Copa Star (Copa Star); (4) Hospital HOME; (5) Universidade Federal de Pernambuco (UFPE)
Introduction: The left atrial appendage(LAA)percutaneous closure presents itself as a promising non-pharmacological alternative to anticoagulation. However, due to the anatomical singularity of the LAA, the accurate sizing and selection of the ideal prosthesis becomes a complex task.
Objectives: In an attempt to mitigate the risks of inadequate sizing and to enable better standardized choice, this study proposes a new technique for sizing the Amplatzer Cardiac Plug prosthesis(ACP-AMULET)(Abbott Vascular).
Methods: The current proposal was based on the consensus between experienced operators, who recommend that sizing should be performed by measuring the area and perimeter of the prosthesis landing zone(LZ), according to the measurements acquired by three-dimensional reconstruction of the LAA neck planes by Computed Tomography Angiography(CTA). In addition, a consolidated table was created from the manufacturer’s recommended data, where the range of the different sizes and oversizing was accounted for to enable anchorage and safe implantation. Hence, after the proper sizing of the LZ measurements, the results are crossed with the table and choice is made with greater precision.
Discussion: The rationale for the proposal derives from the irregularity and heterogeneity of the LAA shapes, making the use of bidimensional sizing methods based on the average of the diameters a less accurate decision-making criteria of prosthesis selection. Although TEE is still the most widely used method, it is also subject to biases such as echocardiographer experience and volume status, which may restrict the widespread treatment success when used as a stand-alone decision-making strategy. Moreover, by performing the choice through CTA, it allows a lower dependence of choice during the procedure, avoiding its possible biases.
108992
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
ANGELA SICHINEL1, JOLIANE ALVES DE MORAES ROTILLI,1, LUCI MATSUMURA1, MARILENA INFIESTA ZULIM1, LUCIANE PEREZ DA COSTA1, CLAUDIA GONÇALVES GOUVEIA1, CAMILA SICHINEL SILVA DA CUNHA SOUZA1, MARIA LÚCIA SALAMENE DE OLIVEIRA KROLL1, GABRIELLA P PELLIZZER1, MARCIA MARIA DA COSTA1, MATHEUS PORTOCARRERO PETERLINKAR1, ERIVALDO ELIAS JR1
(1) SAO JULIAO HOSPITAL-HSJ; (2) SAO JULIAO HOSPITAL-HSJ; (3) SAO JULIAO HOSPITAL-HSJ; (4) SAO JULIAO HOSPITAL-HSJ; (5) SAO JULIAO HOSPITAL-HSJ; (6) SAO JULIAO HOSPITAL-HSJ; (7) SAO JULIAO HOSPITAL-HSJ; (8) SAO JULIAO HOSPITAL-HSJ; (10) SAO JULIAO HOSPITAL-HSJ; (11) SAO JULIAO HOSPITAL-HSJ; (12) SAO JULIAO HOSPITAL-HSJ
Introduction: The risk factors of falls in the elderly are consequences that occur due to internal or external changes; The internal modifications are those physiologically associated to the aging process, emphasising difficulties walking, lack of muscular strength, movement range restrictions, balance issues and lack of physical exercise; The external ones are those that depend on social or environmental circumstances that represent difficulties to the elder.
Objective: To analyze the relationship between gait speed and the occurrence of falls amongst elderly that participate in the MAE Project (Multidisciplinary Assessment in the Elderly).
Method: A cross-sectional study was carried out with 109 elderly individuals associated to the MAE Project, 72 of them (66,05%) being female and 37 (33,94%) being male. The data collection took place at the physiotherapy outpatient clinic of São Julião Hospital, from April of 2017 to November of 2019, through application of the gait speed test, in which was measured the time, in seconds, the patient coursed the distance of 20 meters, not taking into account the 5 first meters because it is the acceleration period, nor the 5 last meters which is the deceleration period, and a questionary which contained name, sex and the question: Have you had falls in the last 12 months?
Results: The sample was composed by 109 elders. 41 of those (37,6%) reported having falls in the last 12 months. Amongst those, 32 (78,04%) were female and 09 (21,95%) were male. Of the elderly that presented falls, 31 (75,60%) showed reduced gait speed, taking into consideration that the normal gait speed score, which ranges between 1,2 meters per second (m/sec) and 1,4 m/sec. Amongst the elderly with reduced gait speed, the female sex predominated with the number of 25 (80,64%) and average age of 70 years.
Conclusion: Gait speed showed significative relationship with the occurrence of falls, being spotted reduced gait speed on more than half of the elders that had falls. However, when analyzing the study sample, in which less than half of the elderly has had falls, it was concluded that active elderly people have better results, that is, with the practice of physical activities, the functional capability increases and so the risk of falls is reduced.
108994
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
EDUARDO PITTHAN1, Vânia Hirakata2, Juarez Barbisan2
(1) Universidade Federal da Fronteira Sul Passo Fundo; (2) Instituto de Cardiologia do Rio Grande do Sul
Introduction: The diagnosis of HF in elderly patients in clinical basis is difficult due to comorbidities. The BNP is used as a diagnostic and prognostic tool in HF but is not sufficiently studied in the elderly.
Hypothesis: To evaluate the association of plasma BNP levels with diagnostic accuracy of HF and longterm prognostic validation.
Methods: Six hundred and thirtyfour consecutive patients presenting with suspected HF in the Emergency Room of a tertiary hospital in southern Brazil participated in this cohort study. All patients underwent BNP measurement (Biosite POCT) as the institution protocol were included between March 2008 and September 2014. Following the Gold Standard for diagnosis of HF consisting of history and physical examination ECG chest Xray echocardiogram Uni and Two Dimensional Color Doppler. The sample was divided into 3 groups: SHF (Systolic Heart Failure) HFPEF (Preserved Ejection Fraction Heart Failure) and NHF (No Heart Failure) and patients were followed for 78 months. The study endpoint was mortality identified by the certificate of death of the Mortality Information Service (SIM).
Results: Most patients (59.6%) were female the mean age was 77 ± 8 years 40.5% over 80 years. The majority (46.8%) had a diagnosis of HFPEF and BNP median 335 pg/ml 25% presented SHF and BNP median of 573 pg/ml and 28% did not meet the criteria for NHF and median BNP 45 pg/ml (KruskalWallis’s test p < 0.005). Half of the deaths were caused by HF. In the group with SHF was 79 deaths (49%) with a BNP median of 800 pg/ml and the 80 survivors median 383 pg/ml (p < 0.005). In HFPEF group occurred most deaths that computed 157 deaths (52% of the group) with a median of BNP 380 pg/ml and 140 survived with a median 245 pg/ml (p < 0,005). The NHF group had 40 deaths (22% of the group) with BNP median of 59 pg/ml and 138 survivors median of 36 pg/ml (p < 0,005). Survival analysis in 78 months (6.5 years) was performed by KaplanMeier curve. Two hundred seventh six deaths were recorded in the total group (42%). The group SHF with a 27month mean survival time (MST) the group HFPEF with a 52month MST the NHF group more than 50% survived.
Conclusions: The BNP level showed association with the mortality index. BNP is an independent prognostic biomarker for longterm mortality in patients with HF in all ages.
109019
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
EDUARDO PITTHAN1, Vânia Hirakata2, Juarez Barbisan2
(1) Universidade Federal da Fronteira Sul Passo Fundo; (2) Instituto de Cardiologia do Rio Grande do Sul
Introduction: Btype natriuretic peptide (BNP) is used as a shortterm biomarker for prognosis in patients with heart failure (HF). The prognostic role for longterm mortality is insufficiently studied.
Hypothesis: To validate the BNP test as a biomarker of longterm mortality prognosis in patients with suspected HF, comparing the non-elderly 80 years old.
Methods: The sample consisted of 634 patients with suspected HF, attended at the emergency room between March 2008 and September 2014. The efficacy of BNP to identify patients with heart failure and the association between the level of BNP (POCT Biosite) and longterm prognosis were evaluated. The study was divided into three age groups, Elderly (E) 60–79 years (46%), major-elderly ≥80 years (38%) and Non-Elderly <60 years old. Cause of death was identified through a search of death certificates in registry offices, informed by the Brazilian Mortality Information System.
Results: Most patients were white (93%), female (64%), with a mean age of 77 (±8.6) years. HF was diagnosed based on a new gold standard that considered the Framingham and Boston criteria, plus echocardiography and ECG. HF was present in 340 patients (53%). Most of these patients (63%, n = 216) had HF with PreservedEjection (HFPEF). In bivariate analysis a BNP > 180 pg/ml was associated with a higher risk of mortality. In multivariate analysis BNP > 180 pg/ml remained associated with increased risk of mortality, with an HR of 3.4 (CI95%: 1.2 to 9.6;p80 years group with HF was 595 pg/ml, with a 27month mean survival time (MST) and 47% mortality rate. The median BNP for the Elderly between 60–79 years group was 369 pg/ml, with a 52month MST and 38% mortality rate. The Non-Elderly group BNP was 222 pg/ml, with an MST >50% and 26% mortality rate.
Conclusions: The BNP level showed association with the mortality index. BNP is an independent prognostic biomarker for longterm mortality in patients with HF in all ages.
109029
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
GRACIA LUZ DON1, Eugenia Machbeth1
(1) Hospital San Martín, Paraná, Entre Ríos, Argentina
Dyslipidemia has been identified as the risk factor that has the greatest impact of suffering ischemic heart disease. Triglyceride/HDL-cholesterol ratio (TG/HDL-C) was proposed as the best marker of insulin resistance and is considered an atherogenesis marker. It is obtained from triglycerides (mg/dl)/HDL-cholesterol (mg/dl) calculation. The cutoff point of 3.0 correlates with insulin resistance and cardiovascular risk, >3.5 with small and dense LDL-C particles, coronary atherosclerosis and risk of myocardial infarction. The present study was conducted to evaluate the relationship between TG/HDL-C index and cardiovascular diseases that led to hospitalization in the Department of Cardiology of San Martín Hospital. Method Ninety-one patients admitted to the hospital over a four-month period were evaluated according age, gender, TG/HDL-C ratio (triglycerides in mg/dl and HDL-C in mg/dl), BMI, admission blood glucose, coronary lesions and discharge diagnosis Results 30 women, 59 men and two without declaring gender were analyzed. The highest concentration of patients corresponds to ages between 60 and 69. Risk factors of the studied population were: • Hypertension 66% • Diabetes Mellitus 25% • Smoking 20% • Dyslipidemia 19% • Overweight/obesity 67% Variable evaluated -Percentage TGL/HDL Index >3.5 IMC 25–29,9 51% IMC > 30 60% Admission Blood glucose 111–199 mg/dl 61% Admission Blood glucose >200 mg/dl 54% Severe coronary lesions >70% DA: 56% CX 72% CD 72% discharge diagnosis: ischemic heart disease 74% heart failure 48% Previous myocardial infarction 81% history of coronary artery bypass grafting or angioplasty 50% Dyslipidemic patients 52% Total evaluated patients 74% Conclusions TGL/HDL-C index >3/>3.5 is observed in hospitalized patients with high prevalence. This demonstrates the impact of insulin resistance and phenotype B on severe cardiovascular complications such as ischemic heart disease and heart failure.
109036
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
IVANA PICONE BORGES DE ARAGÃO1, Ricardo Trajano Sandoval Peixoto1, Rodrigo Trajano Sandoval Peixoto1, Caio Teixeira dos Santos1, Raul Ferreira de Souza Machado1, Thaís Lemos de Souza Macedo1, Ivan Lucas Picone Borges dos Anjos1, Sara Cristine Marques dos Santos1, Edison Carvalho Sandoval Peixoto1
(1) Universidade de Vassouras
Background: Mitral balloon valvuloplasty is not Always successful and free from complications.
Objectives: To determine the independent risk factors for an unsuccessful procedure, severe mitral regurgitation and major complications in mitral balloon valvuloplasty.
Methods: Longitudinal prospective study of 518 mitral balloon valvuloplasties performed between July 6, 1987 and December 31, 2004, on 429 (82.8%) female patients and 89 (17.2%) male patients with a mean age of 37.5 ± 12.8 years. Major complications were considered to be: perforation with cardiac tamponade, stroke and severe mitral regurgitation per procedure. The continuous variables were transformed in categorical variables and the chi-square or Fisher exact tests to compare the categorical variables, and logistic regression and multiple logistic regression were used to identify independente factors for predicting success, incomplete procedure, severe mitral regurgitation and major complications.
Results: Success was noted in 452 (94.2%) procedures, with major complications occurring in 22 (4.2%) patients, of which ten were severe mitral regurgitation; there were no per-procedure deaths, with four (0.8%) in-hospital deaths. In the multiple logistic regression, lower age predicted success in the procedure; the only variable that predicted an incomplete procedure was the initial period of the procedure, and a score >11 points predicted severe per-procedure mitral regurgitation. There was no independent predictor of major complications in this study.
Conclusions: Success was related to younger patients, an incomplete procedure to the initial period of the procedure and severe per-procedure mitral regurgitation to an echocardiography score >11 points.
109044
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
IVANA PICONE BORGES DE ARAGÃO1, Lívia Liberata Barbosa Bandeira1, Simone Aparecida Simões1, Tatiana Soares Spritzer1, Caio Teixeira dos Santos1, Raul Ferreira de Souza Machado1, Thaís Lemos de Souza Macedo1, Ivan Lucas Picone Borges dos Anjos1, Sara Cristine Marques dos Santos1, Vanessa de Freitas Marçolla1
(1) Universidade de Vassouras
Cardiovascular disease (CVD) may be clinically different in women compared to men being underdiagnosed and treated. Worldwide, CVD and stroke are the leading causes of death in females reporting 8.6 million deaths/year in the literature. The objective of this study was to identify the self-knowledge (SK) and prevalence (P) of risk factors (RF) for CVD and stroke in female populations of different age groups and work activities: students of basic cycle medical students (group MS), Police Pacifying Units Police (PPU) (group PPU) and government employees (group GE).
Methods: Cross-sectional, observational study of P of RF for CVD and stroke in female populations of different ages and labor activities between: group GE-27/09/13 and 10/24/2013; group PPU-10/05/2013 and 10/10/2013; groups MS-06/2016 and 12/2016; through the filling of a similar and anonymous questionnaire with 30 objective questions of quick answers about SK of RF: age, stress level, smoking, hypertension (H), dyslipidemia, sedentary lifestyle, obesity, diabetes. weight, height. pregnancy, menopause, gynecological (G/Y) and cardiological/year (C/Y) consultations. A positive response or ignorance equaled one point. Considered a risk group: women with ~2 points for positive or unknown response.
Results: A total of 961 women interviewed were divided into groups MS (total 159), PPU (602) and GE (200), respectively: mean age 20.62, 28.1 and 44.3; high stress 44%, 31%, without report; smoking 3.8%, 7.0%, 16%; H 2.5% (1.3% unaware), 7% (3%), 13% (3%); 76.7% had they cholesterol levels measured (10.0% total cholesterol >200 mg/dl and 33.3% did not know, 62.9% did not know HDL <40 mg/dl), 76.0% (7% and 59%, 87%), 95% (22% E 25%, 62%); 89.9% had measured blood glucose, 76%, 88%; S 45.3%, 53%, 36%; BMI calculated 88.7% (weight and height reported) 12.57% ;?25 and 0.0% ;?30, BMI 51% being 23% ;?25 and 0.0% ;?30 and 49% being 17% ;?25 and 8% ;?30; they did consultations G/Y: 79.9%, 90.0% 98% and C/Y: 7.54% 12% and 33%; score i?2: 98.75%, 97.0%, 74.0%.
Conclusion: Most women, in different age groups and work activities, were at risk of developing CVD and stroke due to the high prevalence of RF or their lack of knowledge, after applying a similar questionnaire. It was highlighted the importance of primary prevention and awareness programs.
109046
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
IVANA PICONE BORGES DE ARAGÃO1, Ricardo Trajano Sandoval Peixoto1, Rodrigo Trajano Sandoval Peixoto1, Caio Teixeira dos Santos1, Raul Ferreira de Souza Machado1, Thaís Lemos de Souza Macedo1, Ivan Lucas Picone Borges dos Anjos1, Sara Cristine Marques dos Santos1, Edison Carvalho Sandoval Peixoto1
(1) Universidade de Vassouras
Objective: To compare the results, in-hospital evolution and cost of 468 percutaneous mitral balloon valvuloplasties (PMBV) with Inoue balloon (IB) and single Balt balloon (SBB).
Methods: IB group (IG): 73 procedures and SBB group (BG): 395 performed between 06/1987 and 12/1999. Mean age: IG 37.1 ± 10.1 years and BG 37.3 ± 12.8 (p = 0.71745); 59 women in IG and 327 in BG (0.685255); NYHA functional class in IG and BG, respectively: I in 4 and 4 patients, II in 23 and 87, III in 40 and 265 and IV in 6 and 39 procedures (p = 0.010929). Atrial fibrilation: 7 in IG and 55 BG (p = 0.315511). Echocardiographic score 7.2 ± 1.2 IG and 7.3 ± 1.5 BG (p = 0.958911). Mitral valve área (MVA) Echo pre-PMBV: 0.98 ± 0.19 cm2 IG and 0.94 ± 0.21 BG (p = 0.143954).
Results: Within-group comparison IG and BG, respectively: Pre-PMBV: mean pulmonar pressure (MPP) 33.9 ± 13.5 and 38.6 ± 14.3 mmHg (p = 0,007662); mitral gradient (MG) 17.3 ± 6.4 and 19.8 ± 7.0 mmHg (p = 0.013180); MVA Gorlin pre-PMBV 0.90 ± 0.20 and 0.91 ± 0.21 cm2 in BG (p = 0.8228449). Post-PMBV: MPP 25.3 ± 8.6 and 27.2 ± 10.6 mmHg (p = 0.261415); MG 5.9 ± 3.1 and 5.5 ± 3.7 mmHg (p = 0.083664); MVA Gorlin 1.98 ± 0.46 and 2.04 ± 0.40 cm2 (p = 0.419208). Complications: 5 cardiac tamponade in BG: 3 treated by surgery with 2 deaths, 2 with pericardial drenage without death. 1 stroke in BG. Severe mitral regurgitation (MR) 1 patient of each group, treated by surgery. Calculated cost of both technique 2 consecutive years with reuse and price of acquision at current prices demonstrated: IB technique U$1,286,32 and SBB U$309.94 for procedures.
Conclusions: Both techniques were efficients. IG less symptomatic; MPP and MG were higher in BG; results post-PMBV were similar. MR were similar. Other complicaion only in BG. Lower cost for material acquisition in BG.
109047
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
IVANA PICONE BORGES DE ARAGÃO1, Ricardo Trajano Sandoval Peixoto1, Rodrigo Trajano Sandoval Peixoto1, Caio Teixeira dos Santos1, Raul Ferreira de Souza Machado1, Thaís Lemos de Souza Macedo1, Ivan Lucas Picone Borges dos Anjos1, Sara Cristine Marques dos Santos1, Edison Carvalho Sandoval Peixoto1
(1) Universidade de Vassouras
Introduction: Percutaneous mitral balloon valvuloplasty is effective in mitral stenosis.
Objectives: To evaluate prior mitral surgical commissurotomy (PMC) and echocardiographic score (ES) in the results and complications of mitral balloon valvuloplasty (MBV).
Methods: From 1987 to 2013, 526 procedures with Inoue balloon, double or single Balt balloon technique; 480 without PMC named primary MBV group (PMBVG) and 46 that have been submitted to PMC, the PMC group. The PMCG was older than PMBVG (42.7 ± 12.4 vs 36.9 ± 12.5 years, p = 0.0030). Gender, atrial fibrilation and NYHA functional class were similar. In PMBVG and PMCG, respectively, ES were 7.2 ± 1,4 and 7.7 ± 1.5 points (p = 0.0158) and mitral valve area (MVA) 0.94 ± 0.21 and 1.00 ± 0.22 cm2 (p = 0.0699).
Results: Pre-MBV: mean pulmonary artery pressures (MPAP) were 37.8 ± 14.2 and 37.6 ± 14.4 mmHg, p = 0.9515; mean gradient (MG) 19.6 ± 6.9 and 18.3 ± 6.9 mmHg, p = 0.2342; MVA 0.90 ± 0.21 and 0.93 ± 0.19 cm2, p = 0.4092, respectively, whem compare PMBVG and PMCG. Post-MBV: MPAP were 26.8 ± 10.2 and 26.6 ± 10.9 mmHg, p = 0.9062; MG 5.4 ± 3.5 and 6.3 ± 4.2 mmHg, p = 0.1492; MVA 2.04 ± 0.42 and 1.92 ± 0.41 cm2, p = 0.0801, respectively. Mitral regurgitation (MR) were similar pre and post-MBV. Severe MR post-MBV in 10 patients: 8 in PMBVG and 2 in PMCG, p = 0.2048. As there were not found significant diferences, the total group were divided in ES ≤ 8 and >8 groups: Pre-MBV: MPAP 37.5 ± 13.9 and 39.3 ± 16.6 mmHg, p = 0.4041; MG 19.7 ± 6.8 and 18.3 ± 7.3 mmHg, p = 0.1753; MVA 0.90 ± 0.21 and 0.94 ± 0.20 cm2, p = 0.0090 respectively. Post-MBV: MPAP 26.7 ± 10.1 and 28.0 ± 10.6 mmHg, p = 0.3730, MG 5.5 ± 3.6 and 5.5 ± 3.3 mmHg, MVA 2.06 ± 0.42 and 1.90 ± 0.40 cm2, p = 0.0090.
Conclusion: The groups with and without prior mitral commissurotomy in MBV were compare and no differences were found in pre- and post-procedure, as mean pulmonary artery pressure, mean mitral gradient, mitral valve area, and mitral regurgitation. Although PMCG was older, with higher ES, its hemodynamics datas were similar. Whem the entire group was divided based on echo scores, those with echo scores >8 had highse MV (p = 0.0090). and smaler mitral valve areas post-valvuloplasty. The valve anatomy were more important than prior commissurotomy.
109049
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
IVANA PICONE BORGES DE ARAGÃO1, Ricardo Trajano Sandoval Peixoto1, Rodrigo Trajano Sandoval Peixoto1, Caio Teixeira dos Santos1, Raul Ferreira de Souza Machado1, Thaís Lemos de Souza Macedo1, Ivan Lucas Picone Borges dos Anjos1, Sara Cristine Marques dos Santos1, Edison Carvalho Sandoval Peixoto1
(1) Universidade de Vassouras
Introduction: The single balloon (SB) is the less expensive technique to perform mitral balloon valvuloplasty (MBV).
Objectives: This study aimed to demonstrate that MBV with the Balt single (BSB) and Inoue ballon, the wordwire accepted technique, had similar outcome and long-term follow-up (FU).
Methods: From 1987 to 2013, 526 procedures were performed, being 312 with a FU, 56 (17,9%) with Inoue balloon (IB) and 256 (82,1%) with BSB. The mean FU 156 ± 144 months, p < 0.0001. Univariate analysis (UA) and multivariate Cox analysis (MCA) to determine independent predict variables of survival and event free survival (EFS) of death, cardiac surgery and new MBV, in both techniques groups.
Results: In IB and BSB groups there were, respectively: female 42 (75.0%) and 222 (86.7%); mean age 37.3 ± 10.0 (19 to 63) and 38.0 ± 12.6 (13 to 83) years, p = 0.7138; sinus rhythm 51 (91.1%) and 215 (84.0%), p = 0.1754; echo score (ES) 7.6 ± 1.3 (5 to 10) and 7.2 ± 1.5 (4 to 14) points, p = 0.0528; echo mitral valve area (MVA) pre-MBV 0.96 ± 0.18 and 0.93 ± 0.21 cm², p = 0.2265; post-MBV mean MVA (Gorlin) were 2.00 ± 0.52 and 2.02 ± 0.37 cm², p = 0.9554; MBV dilatation área 6,09 ± 0,27 and 7,02 ± 0,30, p < 0,0001. At the end of the FU, there were in IB and BSB groups, respectively: echo MVA 1.71 ± 0.41 and 1.54 ± 0.51 cm², p = 0.0552; new severe mitral regurgitation in 5 (8.9%) and 17 (6.6%) patients, p = 0.5633; new MBV in 1 (1.8%) and 13 (5.1%), p = 0.4779; mitral valve surgery in 3 (5.4%) and 27 (10.4%), p = 0.3456; deaths 2 (3.6%) and 11 (4.3%), p = 1.000; cardiac deaths 1 (1.8%) and 9 (3.5%), p = 1.000; ME 5 (8.9%) and 46 (18.0%), p = 0.1449. In UA and MCA the BSB or IB technique do not predict survival or EFS. The independent risk factors to survival were: age <50 years (p = 0.016, HR = 0.233, 95% IC 0.071–0.764), ES ≤ 8 (p < 0.001, HR = 0.105, 95% IC 0.34–0.327), MBV dilatation area (p < 0.001, HR 16.838, 95% IC 3.353–84.580) and no mitral valve surgery in the FU (p = 0.001, HR0.152, 95% IC 0.050–0.459). Independent risk factors to EFS: no prior commissurotomy (p = 0.012, HR = 0.390, 95% IC 0.187–0.813) and post-MBV MVA ≥ 1.50 cm² (p = 0.001, HR = 7.969, 95% IC 3.413–18.608).
Conclusion: In 25 years, survival and EFS were similar in BSB and IB technique. Independent predictors of surviva: age < 50 years, ES ≤ 8 points, MBV dilatation area > 7 mm2 and no mitral valve surgery in the FU. Independent predictors of EFS: no prior commissurotomy and post-MBV MVA ≥ 1.50 cm².
110916
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
SATYENDRA TEWARI1, SOHAM CHAUDHARI2, ANKIT SAHU3, ROOPALI KHANNA4, SUDEEP KUMAR5, NAVEEN GARG6, ADITYA KAPOOR7
(1) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (2) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (3) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (4) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (5) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (6) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India); (7) Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow (India)
Introduction: CAD is one of the principle cause of mortality and morbidity. Considerable data suggests involvement of Lipoprotein (a), apolipoprotein B, apolipoprotein A-I, its ratio and abnormal lipids.
Objectives: To compare the risk factor profile, clinical presentation, and angiographic severity of CAD in young patients (Age ≤ 45 years) and elderly patients (Age > 45 years). To correlate the level of Lipoprotein (a), Apolipoprotein (a), Apolipoprotein (b) and Apo B/Apo-A1 with the angiographic severity of CAD.
Methods: This a retrospective, observational, single-centre study performed at tertiary care hospital. Angiographically proven CAD patients of all age groups were enrolled.
Results: In our study, 714 patients (12.49%) belonged to group 1 (age ≤ 45 years) and 5003 patients (87.51%) belonged to group 2 (age > 45 years). Mean value of age(years) of study subjects was 56.92 ± 9.8. Distribution of gender was comparable between age group <=45 and >45 years. (Female:– 17.23% vs 17.49% respectively, Male:– 82.77% vs 82.51% respectively) (p value = 0.863). Proportion of patients with number of vessels involved:– 1 (single vessel) was significantly higher in age group <=45 years as compared to >45 years (1:– 79.97% vs 76.31% respectively). Proportion of patients with number of vessels involved:– 2 (double), 3 (triple) was significantly lower in age group <=45 years as compared to >45 years (2:– 19.33% vs 21.75% respectively, 3:– 0.70% vs 1.94% respectively). (p value = 0.017) There is statistically significant rise in the level of Lp (a) (mg/dL) and Apolipoprotein B/Apolipoprotein A-1 ratio with number of vessels involved in age group <=45 years and >45 years (p value < .05).
Conclusion: Elevated Lp(a) is strongly associated with the development of high-risk vulnerable plaques that are prone to rupture. The ratio of Apo B to Apo A-I represents the ratio of total atherogenic to antiatherogenic lipoproteins. We observed a gradual increase in Lp(a) and Apo-B/A1 levels with the increasing number of stenotic vessels and an independent association between Lp(a) and Apo B/Apo A-1 with the severity of CAD after adjusting for other possible confounding factors. Effort should also be made to assess the atherothrombotic risk due to the Lp (a) particles on one hand and to apolipoproteins on the other hand. It is also essential that Lp (a), apo B, and ratio of abo B/apo A as an independent risk factor should be integrated into the treatment guideline.
109096
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
FARID SAMAAN1, Gianna Mastroianni Kirsztajn2, Ricardo Sesso2
(1) Instituto Dante Pazzanese de Cardiologia; (2) Universidade Federal de São Paulo
Introduction: Chronic kidney disease (CKD) is common, preventable and silent in its early stages. Therefore, early detection of this condition in the population at risk, through laboratory tests, is essential.
Objectives: To estimate the CKD prevalence and perform its risk stratification in a tertiary health service specialized in cardiology.
Methods: The study was cross-sectional and based on laboratory records of patients from a public hospital specialized in cardiology. The evaluated tests were serum creatinine and urinary albumin/creatinine ratio (ACR, random sample) performed on an outpatient basis between 01/01/2021 and 12/31/2021. Duplicate exams and patients under 18 years of age were excluded. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI creatinine equation. CKD was defined by eGFR <60 ml/min/1.73 m² and classified into the following stages: 3a (45–59 ml/min/1.73 m²), 3b (30–44 ml/min/1.73 m²), 4 (15–29 ml/min/1.73 m²) and 5 (<15 ml/min/1.73 m²). Albuminuria was classified into three levels: A1 (<30 mg/g), A2 (30–300 mg/g) and A3 (>300 mg/g). According to the CKD risk map, individuals with simultaneous creatinine and ACR measurements were stratified into low, moderate, high or very high risk.
Results: The sample consisted of 36,651 patients in whom the same number of serum creatinine results and 19,031 ACR results were evaluated (median patients‘ age 72.5 [51.0–73.6] years, 51.3% male). The prevalence of CKD was 30.9% and patients with stages 3a, 3b, 4 and 5 corresponded to 15.3%, 10.2%, 3.6% and 1.7%, respectively. CKD was more frequent in older age groups: 18–29 years (2.5%), 30–44 years (8.4%), 45–59 years (25.5%), 60–74 years (30 .7%) and ≥75 years (56.8%) (p < 0.001). Patients with albuminuria categories A1, A2 and A3 were 71.5%, 22.6% and 5.9%, respectively. ACR ≥ 30 mg/g was not associated with age: 18–29 years (23.3%), 30–44 years (23.4%), 45–69 years (26.0%), 60–74 years (28 .5%) and ≥75 years (36.9%) (p = 0.671). Patients with simultaneous measurements of serum creatinine and ACR were 19,031 and their distribution in the CKD risk categories was: low (52.0%), moderate (23.8%), high (13.1%) and very high risk (11.2%).
Conclusions: The results showed that CKD is present in about 30% of the patients assisted in the cardiology institute evaluated. In up to half of the patients, the risk of major outcomes such as hospitalization, need for renal replacement therapy, and death was moderate, high, or very high.
109100
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
LUIZ FERNANDO KUBRUSLY1, Douglas Mesadri Gewehr2, Jéssica Ferreira Eduardo1, Izabele Maria Geri1, Allan Fernando Giovanini1, Fernando Bermudez Kubrusly3
(1) Mackenzie Evangelical School of Paraná, Curitiba, Paraná, Brazil; (2) Denton Cooley Institute of Research, Science and Technology, Curitiba, Paraná, Brazil; (3) Curitiba Heart Institute, Curitiba, Paraná, Brazil
Introduction: Pulmonary arterial hypertension (PAH) is a high severity vascular disorder with fast progression, which clinical spectrum is related to the reduction of the pulmonary arteries lumen with an increase in pressure and vascular resistance. These changes result from many mechanisms such as medial hypertrophy, concentric intimal fibrosis and necrotizing vasculitis, which are responsible for the remodeling of pulmonary artery wall, the reduction of pulmonary compliance and leads to cardiac muscle overload.
Objective: To evaluate the severity of pulmonary arteriopathy in an animal model of Monocrotaline-induced Pulmonary Arterial Hypertension, through histological morphometric analysis of pulmonary vessels.
Methodology: Morphometric analysis was performed in Zen 3.2 Software and 50 PAH animal model slides, with random selection of 10 arterioles and 10 pulmonary non-arteriolar vessels for each animal. The gravity was delimited through three pulmonary systems elements (1) medial layer thickness, (2) microvascular muscularization of non-muscle vessels, and (3) obliteration of muscle arterioles and non-muscle vessels. We also assess cardiac overload thought right ventricular freewall thickness and the right ventricular chamber area.
Results: There was a gradual onset of pulmonary disease in MCT animals, whose evolution was followed by histological findings of pulmonary arteriopathy, including arterioles’ muscularization, medial layer hypertrophy, concentric and “plexiform-like” laminar and non-laminar neointimal lesions. There was an important increase in the thickness of the tunica media and the degree in microvascular muscularization through the experimental groups compared with the control. There was a significant increase in luminal obliteration of muscle arterioles and non-muscular vessels, measured by the luminal obliteration ratio. The right ventricular hypertrophy (HVD), assessed by measuring the thickness of the right ventricle, had increased significantly on 30-to-37-day groups, represented almost twice the value of the control group. Besides that, there was a significant dilatation of the Right Ventricular Chamber on 30-to-37-day groups.
Conclusion: The MCT application proved the effective inducing PAH, being able to generate changes in vessels through the lower exposure group. Furthermore, lungs lesions are intensified over time, and the observation of plexiform lesions were not registered in a similar model.
109135
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ROMERO HENRIQUE DE ALMEIDA BARBOSA1, Emerson Silva de Jesus1, Eldys Myler Santos Marinho1, Johnnatas Mikael Lopes1
(1) Universidade Federal do Vale do São Francisco
Background: Heart disease burdens individual health, limiting life activities such as people’s productive capacity and quality of life. In addition to understanding the clinical characteristics of heart diseases, identifying subjects at risk prior to the installation of limitations helps in directing preventive therapeutic and multiprofessional actions.
Objective: To develop an algorithm to screen people with heart disease in an outpatient setting for their risk of future functional life activity limitations (LAL).
Methods: Cross-sectional study with data from the 2019 National Health Survey in Brazil. The general sample consisted of 90846 interviews, being selected individuals aged 18 years and some type of heart disease diagnosed for more than a year by physicians. The outcome was current usual LAL due to the disease. Independent variables were grouped into cardiac, self-care and social morbidities. The data were analyzed using the CHAID-type decision tree algorithm, and the sample was divided into training (70%) and testing (30%). Sensitivity (S), specificity (SP), positive (PV+) and negative (PV-) predictive values for the outcome were estimated.
Results: 4711 (5.3%;95%CI: 5.0–5.6) individuals have a diagnosis of heart disease, of which 4409 (94.4%; 95%CI:93.4–95.3) have been diagnosed for more than one year and mean age of 59.31 (95%CI: 58.31–60.31) years. 2374 (49.2%; 95%CI 46.5–51.8) of those with heart disease reveal LAL. 2830 observations were used to train the algorithm and 1171 to test it. Five attributes remained in the final model, two of morbidity, two of self-care and one of social, generating 13 nodes and a thickness of 3 in the decision tree. An algorithm with S = 81.9%, SP = 43.2%, PV+ = 58.94%, PV– = 70.54% was obtained. In the test, S = 83.8%, SP = 43.6%, PV+ = 60.67% and PV– = 72.04%.
Conclusion: The algorithm has a relevant rate of true positives, however it has a low rate of true negatives for LAD. As the damage caused by LAL and its high prevalence are much greater than the damage caused by the provision of care and follow-up, its application in clinical and community contexts in Brazil is justified.
109138
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
LUCIANO DE MORAIS PINTO1, Marcelo José Böck1, Vitor Pires Pereira1, Marcelo Leite da Veiga2, Claudia de Melo Bertoncheli dos Santos3, Luciano de Morais-Pinto1
(1) Laboratório de Design Anatômico – Universidade Federal de Santa Maria; (2) Laboratório de Morfofisiologia Experimental – Universidade Federal de Santa Maria; (3) Laboratório de Anatomia Patológica – Hospital Universitário – Universidade Federal de Santa Maria
Aortic rupture is relatively common in horses. However, architectural differences have not yet been considered in the pathogenesis of aortic catastrophe in this species. Thus, our objective was to describe the morphological and morphometric aspects of the tunica intima (TI) and media (MT) in the aortic bulb (AB) and ascending aorta (AA). 52 healthy aortas from adult horses were processed according to standard optical and scanning electron microscopy protocol. TI and TM thickness as well as aortic lamellar units were digitally measured. The aorta was pale yellow and had a rigid texture and distinct thicknesses. The AA wall was thicker than the BA, in totality and in the thickness of the layers (Tab.1). The lamellar units were better defined in AA and arranged in interleaved layers of elastic lamellae, smooth muscle cells and collagen fibers, while in BA the trilaminar aspect was not maintained and the muscle tissue bands were arranged in mosaic. The increase in the thickness of the aortic wall in the BA-AA direction suggests that blood flow is clockwise helical. It is assumed that blood pressure was higher in the septal AB for the left AA; from left BA to right AA and from BA to septal AA. As dissection/rupture involves failure of tissue structure, it is expected that a better understanding of the normal tissue architecture of the aorta in horses will contribute to future studies of the pathogenesis involving aortic catastrophes in animals and humans.
109147
Modality: E-Poster Researcher – Non-case Report
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
SILVIA INES GARCÍA1, Maria Silvina Landa1, Maia Aisicovich1, Mariano Luis Schuman1, Ludmila Soledad Péres Díaz1, Graciela Giardino2, Carlos Jose Pirola1, Silvia Inés García1
(1) Molecular Cardiology Laboratory, Institute of Medical Research-IDIM University of Buenos Aires-CONICET; (2) Experimental Medicine Laboratory, Hospital Aleman, Buenos Aires
Cardiac TRH (cTRH) induces cardiac damage and its inhibition attenuates heart injury in different models: SHR and cTRH overexpression (Schuman 2011,2014); Angiotensin II infusion and doxorrubicin cardiotoxicity (Peres Diaz 2018,2020) and LVH induced by obesity or leptin infusion (Aisicovich 2019,2021). We described that cTRH inhibition increase LVEF% and preserve cardiac function after acute MI in rats (Schuman 2021). Histone acetylation (HDACs) modulates gene expression by epigenetic alterations as DNA methylation. VPA, an FDA approved drug for bipolar disease and epilepsy, protects heart against MI injury (Tian 2019). As VPA is an inhibitor of HDACs, we hypothesized that inhibition of HDACs with VPA might attenuate LVH and fibrosis in SHR by the modulation of cTRH. 7 w-old male SHR and WKY received VPA and hearts were used after 10w of treatment. BP, LVH index and cTRH expression significantly increased in SHR. VPA slightly attenuated (p < 0.05) the higher SHR BP, without effect in WKY. LVH index decreased (p < 0.05) only in SHR. LVPWT significantly decreased (p < 0.05) only in SHR. As hypothesized, VPA normalized cTRH mRNA expression in SHR (WKY = C:0.61 ± 0.7vs VPA:0.41 ± 0.97; SHR = C:5.72 + 0.9 vs VPA:0.61 + 0.9, p < 0.05) and TRH IHQ confirmed these results (p < 0.05) which brought a strong reduction in fibrosis in LV, by decrease in BNP and 3-collagen expression in SHR+VPA. This was confirmed by Masson’s an d Sirius Red stainings (p < 0.01). SHR offspring born from VPA-treated parents with a 2-week washout period before mating, wich never received VPA, surprisingly had a significant decrease in hypertrophy (LVW/BW) vs offspring of both SHR untreated parents, showing a transgenerational inheritance. Indeed, SHR showed a decrease in % TRH promoter methylation (Increase in gene expresion) that is significantly reverted in offspring of VPA treated parents (methylation-specific PCR). Consistently, we observed a decrease in cTRH expression (p < 0.05), and therefore, a significant reduction (p < 0.05) in BNP and type 3 Collagen expression, despite the high BP in VPA parents offsprin. To sum up, we described for the first time that VPA treatment modulates cTRH gene and consequently attenuates heart fibrosis and hypertrophy in the SHR, without affecting BP. We show an epigenetic modulation of VPA over cTRH promoter that could be responsible not only of cardiac alterations during VPA treatment, but beyond affecting next generation with results still unknown.
109150
Modality: E-Poster Researcher – Non-case Report
Category: NUTRITION
RENATA BORBA DE AMORIM OLIVEIRA1, Renata Borba de Amorim Oliveira1, Ingrid Beranger da Costa Pereira1, Ana Paula Menna Barreto1, Monica Feroni de Carvalho1
(1) Centro Multidisciplinar UFRJ-Macaé
Obstructive Sleep Apnea Syndrome (OSAS) is a very common disorder of breathing during sleep, characterized by recurrent episodes of total interruption (apnea) and/or partial interruption (hypopnea) of ventilation resulting from collapse of the upper airways. Obesity, systemic arterial hypertension and cardiovascular diseases are risk factors of the disease, being related to a major risk of morbidity and worsening of the already installed disorder. The objective of study was to assess the frequency of obesity by different anthropometric measures of total and central body adiposity in adult individuals with OSAS, and its association with excessive daytime sleepiness and severity of the syndrome. The present study was a prospective observational study, in which adults who underwent polysomnography for the diagnosis of OSAS were evaluated. Were evaluated variables: socio-demographic, sleep-related complaints, degree of daytime sleepiness, which was evaluated by the Epworth Sleepiness Scale developed by Johns (1991) and validated in Brazil by BERTOLAZZI et al. (2009), and also to risk factors for OSAS and anthropometric: weight, height, Body Mass Index (BMI) and Waist Circumference (WC). In the 64 patients evaluated, only 43 subjects (67.2%) were diagnosed with OSAS and entered the study. Regarding the classification of OSAS, 44.2% presented mild degree, 23.2% moderate and 32.6% severe degree. Excessive Daytime Sleepiness (EDS) was present in 72.1% of the patients. The classification by BMI is 11.6% of eutrophy, 18.6% of overweight, 25.6% of obesity grade I, 27.9% of obesity grade II and 16.3% of obesity grade III. Regarding the classification of WC, 62.8% presented a much increased risk. Analyzing the morbidity profile of the studied population, 39.50% had systemic arterial hypertension and 11.60% cardiovascular disease. There was a statistically significant association between obesity and WC (p = 0.001), otherwise was not found between obesity and severity disease (OSAS) (p = 0.76) or with SDE (p = 0.127). To conclude, the studied group presented high prevalence of obesity, arterial hypertension and cardiovascular diseases and changes in weight and in the health condition are important to manage symptoms and aggravation of the OSAS and cardiovascular disease.
109167
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
GERARDO GARCIA-RIVAS1, Omar Lozano1, Christian Silva-Platas1, Judith Bernal-Ramírez1, Hugo Alves1, Carlos Jerjes-Sánchez1, Guillermo Torre-Amione1
(1) TECNOLOGICO DE MONTERREY
Increasing evidence points to CBD as a promissory therapeutic molecule for diverse inflammatory pathologies, including cardiovascular diseases such as coronary disease and myocarditis. Our study evaluates the application of CBD as a potential therapy for heart failure (HF). Here we assessed the cardioprotective effects of CBD administration in a non-ischemic HF model in mice. Every 3rd day a dose of 1 mg/kg of synthetic CBD was administered via a subcutaneous injection. After four weeks of treatment, the animals were euthanized, and their heart was collected for further analysis. Fibrosis development and myocyte hypertrophy was determined by histopathologic imaging quantification. Additionally, to explore the CBD-antihypertrophic mechanisms, we used cultured cardiomyoblasts to explore the role of cytosolic and mitochondrial oxidative stress and NF-kB pathway intermediates. We developed a multi-center, double-blind, placebo-controlled, randomized trial for the clinical translation, considering the preclinical data. The primary objective of this study is to evaluate the effect of CBD on the prevention of cardiovascular and COVID-19 complications in patients hospitalized for COVID-19. We observed a significant reduction of fibrosis and cell hypertrophy in CBD-treated animals. The expression by qPCR of BNP and collagen1 as a pathological remodeling marker was significantly reduced when CBD was administered in contrast with the HF mice. Pro-inflammatory cytokines expression was observed in IL1b and IL6 expression. At the cellular level, a significant reduction in cell area was observed in CBD treated groups even when exposed to Ang II, achieving sizes comparable to those of the controls. CBD significantly reduced the generation of mitochondrial ROS entities in our hypertrophy model and showed an increase in NF-kB activation that can be reversed by CBD treatment. Also, CBD normalizes the expression of mechanical stress and remodeling markers such as BNP, TGFa, SOD2, IL6, and IL10 involved in inflammation. 23 Non-critical patients hospitalized within the previous 48 hours who tested positive for COVID-19 within seven days and have a prior history of cardiovascular disease (CVD) and significant risk factors for CVD were enrolled. Preliminary results indicate the safety of CBD in patients with COVID-19 infection and cardiovascular disease.
109186
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
NATALIA CARRO1, Graciela María Rousse1, Cabrejos Gustavo1, Matilde Del Campo Contreras1, Leandro Parrilla1, Nudelman Ezequiel Adolfo1, Rubio Edgardo1
(1) Division of Cardiology. Echocardiography Laboratory, Hospital of the Government of the city of Buenos Aires
Introduction: Global Longitudinal Strain (GLS) is a sensitive method for the early detection of myocardial damage. The latest AHA classification of Chagas disease (ChD) includes, in stage BI, a population with preserved Ejection Fraction (EF) heterogeneous due to ECG changes and/or segmental wall motion abnormalities. The evaluation of abnormal Segmental Longitudinal Strain (SLS) and its comparison with MRI has not been sufficiently evaluated in this population.
Objective: In patients (p) with ChD in Stage BI the aim was1)To evaluate the usefulness of GLS in comparison with p with the indetermined form of ChD or Stage A 2) To compare abnormal SLS with cardiac MRI in detecting the anatomical substrate of the arrhytmia.
Methods: Transversal, monocentric study. 55p were included January 2018-March 2020: 17p with ChD in Stage B1 with frequent ventricular arrhythmia, cardiac Echo-Doppler with Longitudinal Strain assessment, and gadolinium-enhanced cardiac MRI (Group B); they were compared with 38 p Stage A of ChD (Group A). The association between Strain and abnormal cardiac MRI in group B patients was analyzed.
Results: 2 p were excluded due to inadequate ultrasonic image quality. The p from Group B compared to those from Group A were older, had higher Left Atrial volume, lower MAPSE, lower TDI, lower absolute value of GLS (18.3 +– 2.3% stage B vs 21.81 +– 2.5% stage A, p < 0.001) and similar EF. Through ROC curve between group A and B patients, the best cut-off point GLS was determined, a value of –20.5% with sensitivity of 93% and specificity of 70%, and area under the curve of 0.83 CI 95% (0.71–0.95). A cardiac MRI was performed in 11 out of 16 p; in 6 of them it was abnormal: due to late enhancement (4 p), edema plus enhancement (1 p), and thinning and akinesia (1 p). 5 of the 6 p with pathological cardiac MRI presented abnormal SLS and none of the p with normal cardiac MRI. The association between cardiac MRI alterations and SLS abnormal evaluated by means of the Kappa index was 0.82.
Conclusions: In our limited population: 1.GLS was significantly lower in in group B1.2. The accurate association between cardiac MRI and abnormal SLS shows the latter as a useful alternative for the diagnosis of the anatomical substrate of arrhythmia.
109181
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
RITA ELIZABETH IBARRA CASTILLO1, JORGE LUIS ARBAIZA SIMON2, JOSE LUIS LASO BAYAS1
(1) Hospital de Especialidades Carlos Andrade Marín; (2) Hospital Vozandes Quito HVQ
Introduction: Cephalic vein cutdown (CVC) and subclavian vein puncture are the most widely used techniques for leads insertion during the implantation of cardiac stimulation devices (CSD). Lately, axillary vein access (AVA) has emerged as an alternative. Many approaches have been described for AVA, including the ultrasound (US) guided technique which seems to be fast and safe.
objective: Our purpose was to assess whether the US guided puncture of the axillary vein was as efficient as the CVC for CSD implantation.
Methods: This was a multicenter prospective trial. All patients undergoing first pacemaker or implantable cardiac defibrillator implantation were submitted to an US scanning of the site of implantation to determine if the axillary vein was visible. Only those with a clear axillary vein were included. None of the operators had previous experience in US AVA. All procedures were planned as ambulatory. We randomized 76 patients to either US AVA (n = 38) or CVC (n = 38). We included only patients with CSD with ≤2 leads. Primary endpoint was success in introducing all the intended leads through the selected access. Secondary endpoints were: complications during the first week after the implantation, time of fluoroscopy, duration of the procedure, use of local and general anesthesia and need of hospitalization. We used X squared and T-tests to compare results from categorical and continuous variables. Analyses were performed according to the intention-to-treat principle.
Results: There were no differences in the demographic characteristics. The mean age of all patients (n = 76) was 70.8 years, with 56.6% (n = 43) being male. In the AVA group, access success was achieved in all the subjects (n = 38), and in 78.9% of patients (n = 30) the vein was gained with US. The mean of attempts to gain the first access was 1.8. In the CVC group, the access success was lower, 76.3% (n = 38, p = 0.002). Regarding the rate of complications, there were no differences (AVA 5.2%, CVC 7.8%; n = 76, p = 0.64). Furthermore, we found no differences in time of X-ray exposure, procedure duration, quantity of local anesthetic used, need of general anesthesia or hospitalization (n = 76, p > 0.05).
Conclusion: We found that, in comparison to CVC, US AVA was a more efficient technique, allowing successfully insertion of all leads from a conventional bicameral CSD, without increasing complications or issues of the implantation procedure. Our results are in concordance with other randomized clinical trials.
109233
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
MIGUEL MEIRA E CRUZ1, Germaines Escames2, Jose Fernandez Martinez2, Dario Acuña Castroviejo2
(1) Centro Europeu do Sono; Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon, Portugal; (2) Centro de Investigación Biomedica, Departamento de Fisiologia, Facultad de Medicina; Instituto de Biotecnologia, Universidad de Granada, Spain
Introduction: Cardiovascular diseases (CVD) constitute the leading cause of death in the world, and aging is by far the major risk factor for cardiac dysfunction. Aging involves subclinical inflammatory activation, with NF-kb and NLRP3 inflammasome as the main components of such response. But inflammation also induces a pro-oxidative response, responsible for the oxidative damage to the cell and mitochondria, leading to a bioenergetic failure. In turn, melatonin exerts profound anti-inflammatory and antioxidant properties, with the mitochondria as the main intracellular target. Here, we analyzed the impact of the NRLP3 inflammasome in the myocardial aging and the role of melatonin in preventing it.
Methodology: For this study, we used wild-type and NLRP3-deficient mice of 3, 12, and 124 months of age, with and without melatonin treatment.
Results: The absence of NLRP3 prevented the age-dependent myocardial failure and mitochondrial impairment, affecting the Bax/Bcl2 ratio. The Nef2-dependent antioxidant response was unaffected by the lack of NLRP3. In wild-type mice, melatonin treatment produced counteract the age-dependent damage, providing similar protective features than the absence of NLRP3. Melatonin also improved mitochondria structure and enhances the Nrf2 antioxidant response.
Conclusions: NLRP3 inflammasome-dependent chronic inflammation during ageing is main responsible for myocardial loss of function, causing proapoptotic phenomena, free radicals’ formation and oxidative damage, and mitochondrial bioenergetic deficit, suggesting a molecular target for cardiac protective therapies. Melatonin, which reaches all subcellular compartment of the myocardial, blocks the NLRP3 inflammasome response and maintains the integrity of the heart, doing it a drug of choice for this age-dependent preventive therapy.
109239
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
KLEIBER MARCIANO LIMA BOMFIM1, Alan Alves de Lima Cidrão1, Pedro Braga Linhares Garcia1, Leonardo Miranda Macêdo1, José Doriberto Freitas1, Giovanna Rolim Pinheiro Lima1
(1) HOSPITAL REGIONAL DO SERTÃO CENTRAL
Introduction: Stroke is one of the main causes of morbidity and mortality, currently representing the second leading cause of death worldwide. Regarding the etiologies, the cardioembolic type is responsible for 14 to 30% of the ischemic cases and presents higher mortality and worse functional complications. In terms of structural heart diseases, the increase in left atrial volume is an independent factor for stroke, in which the chance of thromboembolism is 20% per year.
Objective: To evaluate left atrial volume increase, determined by transthoracic echocardiographic study, as an independent variable for risk of ischemic stroke and transient ischemic attack.
Methods: This is a quantitative descriptive, cross-sectional, prospective cohort study conducted between April 2020 and April 2021 in the stroke unit of a tertiary public hospital. Data analysis was performed using the statistical package SPSS, version 22 (IBM – 2017), in which it was possible to perform descriptive analysis to characterize the sample, student’s t test for independent samples, correlation analysis and simple linear regression. The calculation of the left atrial volume was performed by two-dimensional echocardiography in the apical projections of two and four chambers, indexed by the body surface.
Results: The study included 308 patients from the State of Ceará who had ischemic stroke and transient ischemic attack. Age ranged from 50 to 98 years (M = 72; SD = 10.8), being 53.7% male and 46.3% female. Most had a diagnosis of ischemic stroke 93.9% and 6.1% transient ischemic attack. Results revealed that the variable “left atrial volume” did not have a normal distribution (K-S (308) = 0.46, P < 0.05; S-W(308) = 0.55, P < 0.05). The Pearson correlation analysis between left atrial volume and diagnosis of ischemic stroke/transient ischemic attack evidenced a positive linear correlation (0.021).
Conclusion: The present data demonstrate a positive correlation between increased left atrial volume and the occurrence of ischemic stroke/transient ischemic attack.
110338
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
JC PACHON-M1, Enrique I. Pachon-M1, Juan C Zerpa-Acosta2, Carlos TC Pachon2, Tomas G Santillana-P1, Tasso J Lobo2, Felipe A Ortencio2, Ricardo C Amarante1, Juan C Pachon-M1
(1) São Paulo University; (2) São Paulo Heart Hospital; (3) Semap Arrhythmia’s Service
Background: Vagal tone predominates most of the time. Therefore, isolated sinus heart rate(HR) is higher than the in-situ sinus rate. Atropine stops vagal action by blocking muscarinic receptors. Cardioneuroablation (CNA) also abolishes vagal action by eliminating the postganglionic vagal neuron, causing HR increase. Knowing previously whether HR will increase with CNA is very important since CNA is not indicated if there is no atropine response.
Objective: To assess the correlation between HR and Wenckebach point(PW) determined by the atropine test (AT) and that one resulting from CNA.
Methods: 76p, 41 females (54%), 14–67 (37 ± 13.2) years, with reflex functional bradyarrhythmias (neurocardiogenic syncope) or non-reflex (sinus dysfunction, vagal AF or bradytachycardia) submitted to CNA controlled by extracardiac vagal stimulation. AT was performed with IV infusion of 0.04 mg/kg. CNA was performed by ablation of the P-point, the presumed 4 main GPs areas and spare AF-Nests, at least 02 days post-AT. The maximum HR and PW obtained under the atropine and at the end of the CNA were compared.
Results: There were significant HR and PW increases with atropine and with CNA. The increases were smaller with CNA probably because CNA also eliminates sympathetic fibers and AT does not.
Conclusion: There is a strong correlation between HR and PW determined by atropine and those resulting of CNA. Thus, atropine test can be used as a good predictor of the CNA result.
110339
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
JC PACHON-M1, Enrique I Pachon-M1, Carlos TC Pachon2, Tasso J Lobo2, Tomas G Santillana-P1, Juan C Zerpa-A2, Felipe A Ortencio2, Maria Zelia C Pachon3, Ricardo C Amarante1, Juan C Pahon-M1
(1) São Paulo University; (2) São Paulo Heart Hospital; (3) Semap Arrhythmia’s Service
Background: Symptomatic reflex and non-reflex functional bradyarrhythmias are related to vagal hyperactivity. Cardioneuroablation[CNA] provides vagal denervation through endocardial RF ablation of the post-ganglionic vagal neurons. Neuro-myocardium interface identification, stepwise denervation control and denervation validation are critical. Several findings have shown that the Arial Fibrillation-Nest[AFN] are intrinsically related to the vagal innervation.
Objective: To verify whether CNA based on AFN ablation promotes enough vagal denervation compared to a control group with non-AFN ablation.
Method: Prospective, controlled study with 54 p gathered in two groups: AFN group (AFNG-24 p) with functional or reflex bradyarrhythmias treated with AFN ablation, and a control group (CG-30 p) with anomalous bundles, ventricular premature beats, atrial flutter, nodal reentry and atrial tachycardia, treated with conventional ablation (non-AFN ablation). Ablation of AFNG was targeted to AFN detected by fragmentation of the endocardial electrograms and/or by Fractionation Software. Vagal response was evaluated before, during, and post-ablation by 5s non-contact vagal stimulation at the jugular foramen, through the internal jugular veins[ECVS], analyzing longest RR, pauses, and AV block induced by ECVS. All patients had current guidelines arrhythmia ablation indications.
Results: There was found a high density of AFN over the P-Point (right half of the left interatrial septum), over the presumed areas of the main 4 ganglionated plexi, over the coronary sinus roof, and over the Waterston’s groove. Pre-ablation ECVS induced sinus pauses, asystole and transient AV block in both groups, showing normal vagal response (p = 0.94). Post-ablation ECVS in the AFNG showed complete elimination of the cardiac vagal response in all cases (Pre/Post-ablation ECVS = p < 0.01), demonstrating acute and complete vagal denervation. In the CG, vagal response remained practically the same as pre-ablation (p = 0.31) showing that non-AFN ablation caused no significant denervation.
Conclusion: CNA based on AFN ablation attained an excellent degree of acute vagal denervation while non-AFN ablation did not cause denervation. This fact suggests that AFNs are directly related to vagal innervation and may be a good alternative for CNA. Additionally, ECVS was remarkably valuable for CNA control.
109246
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
PEDRO GABRIEL MELO DE BARROS E SILVA1, RD. Lopes4, RHM. Furtado5, AVS. Macedo1, B. Bronhara1, E. Ramacciotti6, PA. Martins7, AL. De Oliveira7, VS. Nunes7, LEF. Ritt8, AT. Rocha8, L. Tramujas2
(1) Brazilian Clinical Research Institute; (2) IP-HCor; (3) Hospital Samaritano Paulista; (4) Duke Clinical Research Institute, Durham, United States of America; (5) Hospital Israelita Albert Einstein, Sao Paulo, Brazil; (6) Loyola University, Chicago, United States of America; (7) Hospital Estadual Dr Jayme Santos Neves, Serra, Brazil; (8) Cardio Pulmonary Hospital, Salvador, Brazil
In the ACTION trial, therapeutic anticoagulation did not show benefit on mortality, days of hospitalization and oxygens therapy at 30 days among patients with COVID19. However, this strategy was associated with higher rate of bleeding and a potential reduction in the rate of clinical thrombotic events. The current analysis evaluated which variables were independently associated with both outcomes in order to help the identification of the risk for thrombotic and hemorrhagic events among patients with COVID19.
Methods: A total of 615 patients hospitalized with COVID-19 and elevated D-dimer were randomly assigned to prophylactic anticoagulation (mainly in-hospital heparin) or a therapeutic-dose strategy that used in-hospital rivaroxaban 20 mg/day for stable patients, or full-dose enoxaparin for unstable patients, followed by rivaroxaban through 30 days. One patient withdrew consent and was not included in the analysis. The current analysis tested baseline clinical characteristics and laboratorial exams one by one with independent logistic regressions for the composite of bleeding (major bleeding and clinically relevant nonmajor bleeding) and thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, and major adverse limb events). Significant variables (p < 0.05) were selected to adjust several multiple logistic models. Final models were chosen based on Akaike information criterion and therapeutic anticoagulation was included in the final model based on the primary results of the trial.
Results: The model for bleeding events showed an accuracy of area under the curve (AUC) of 0.635 while the model for thrombotic events had an AUC of 0.725. Level of respiratory support (especially invasive ventilation) was associated with both outcomes in the multivariable analysis. Beyond respiratory support, level of creatinine and history of coronary disease were also independently associated to the risk of thrombotic events. When the utilization of therapeutic anticoagulation (mainly with rivaroxaban) was included in the multivariable analysis, this variable was strongly associated with higher risk of bleeding (model AUC of 0.718) but was not associated with lower rate of thrombotic events.
Conclusion: Variables associated with higher risk of thrombotic events commonly are associated also to bleeding complications. The models developed in ACTION may help the selection of patients with better balance of risk vs. benefit to anticoagulation.
109274
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ALESSANDRO ROCHA MILAN DE SOUZA1, Bernardo Queiroz de Carvalho Souza1, Davi da SIlveira Barroso Alves1, Glenda Borges de Lacerda1, Paulo Henrique Godoy1
(1) Universidade Federal do Estado do Rio de Janeiro – Federal University of the Rio de Janeiro State
Introduction: Cerebrovascular diseases (CBVD) and cardiovascular diseases represent the leading cause of death in the world. In Brazil, these diseases correspond to 32% of deaths per year.
Objective: To analyze the trend of causes of death due to ischemic CBVD (ICBVD) and hemorrhagic CBVD (HCBVD) in Brazil, from 2000 to 2019.
Method: Ecological study, in which the data of deaths due to CBVD, according to ICD 10, were obtained from the Mortality Information System. The codes for CBVD were divided into: ICBVD, HCBVD and CBVD not specified as ischemic nor hemorrhagic (NSCBVD). The age groups in years were divided as 20–39, 40–59, 60–79, and 80 or above. Crude and standardized rates were estimated according to sex and age group. The variation in mortality rates was also estimated, comparing 2000 and 2019.
Results: There were 1,766,788 deaths from CBVD in the period. The following distribution by causes was observed: ICBVD – 362,666; HCBVD – 409,079; NSCBVD – 1,009,927. The rates in all causes were higher in males. In the HCBVD higher death rates were observed in younger age and in the ICBVD in the older age. Stability trend was observed in the ICBVD, with a small decrease in females and a small increase in males, and a decrease trend in HCBVD and NSCBVD for both sexes.
Conclusion: In general, the trend of deaths from ICBVD and HCBVD seems to be decreasing in Brazil, for the period studied, although this trend is lower in ICBVD.
109281
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
CLAUDIO QUERIDO FORTES1, Natália Rodrigues Querido Fortes3, Plínio Resende Jr4, Juliano Carvalho G. de Almeida4, Roberto Muniz Ferreira4, Ana Claudia Pinto de Figueiredo Fontes4, Luiz Felipe de Abreu Guimarães4, João Roquette Fleury da Rocha4, Vlander Gomes da Costa Jr.4, Marina da Costa Carvalheira4, Ronir Raggio Luiz2, Mauro Paes Leme de Sá5
(1) Hospital Universitário Clementino Fraga Filho HUCFF/Universidade Estácio de Sá UNESA; (2) Instituto de Estudos em Saúde Coletiva IESC; (3) Hospital Universitário Antonio Pedro HUAP/Hospital Universitário Clementino Fraga Filho HUCFF; (4) Hospital Universitário Clementino Fraga Filho HUCFF; (5) Hospital Universitário Clementino Fraga Filho HUCFF/Instituto do Coração Edson Saad ICES
Background: Infective endocarditis (IE) is one of the most dreaded infectious complications in hemodialysis (HD) patients.
Methods: Descriptive analysis of HD and non-HD patients with IE.
Results: Of the 505 patients (540 episodes) admitted to university hospital between 1978–2021 with definite IE according to the modified Duke criteria, 54 patients (57 episodes) had undergone HD and 451 (483 episodes) had not. Vascular access for HD was central catheter in 75.4% and 49,1% had arteriovenous fistula but some of them with fistula failure. The mean age of HD patients was not statistically different from that of non-HD patients (47.5 vs 43.3, p 0.117). More female gender (57.9% vs. 34.6%, p = 0.001) was observed in HD patients. Diabetes mellitus was significantly more frequent in the HD-patients (36.8% vs. 6.6%, p < 0.001), while intravenous drug use (0% vs 13.9%, p 0.029) and prosthetic valve (7.0% vs 20.7%, p 0.013) were more commonly in non–HD-patients. The mitral valve was the most affected (50.9% vs 51.1%, p 0.773), followed by aortic valve (38.6% vs 43.1%, p 0.416) and tricuspid valve (19.3% vs 13.3, p 0.212). The proportion of Enterococcus spp. was significantly higher in HD group than in non-HD group (33.3% vs. 5.4%, p < 0.001). Staphylococcus aureus was the second most frequent one (29.8% vs 22.0%, p 0.183). Valve replacement for active IE was less frequently performed among HD patients but without statistical significance (35.1% vs 42.2%, p 0.300). In-hospital mortality was significantly higher in hemodialysis than in non-hemodialysis patients (52.6% vs. 37.7%, p 0.030).
Conclusions: IE is a serious complication in HD patients. Enterococcus spp. is the most common causative organism in this group. Mortality is very high and significantly higher than in non-HD patients.
109299
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
PEDRO GABRIEL MELO DE BARROS E SILVA1, Renato Delascio Lopes4, Charlene Troiani5, Rodrigo Pinto Pedrosa6, Marcelo Nakazone7, Sérgio Luiz Zimmermann8, Rodrigo Morel9, Ricardo Reinaldo Bergo10, Dalton Bertolim Précoma11, Lucas Tramujas1, Ricardo Pavanello1, Eduardo Ramacciotti12
(1) IP-Hcor; (2) Brazilian Clinical Research Institute; (3) Hospital Samaritano Paulista; (4) Duke Clinical Research Institute, Durham, United States of America; (5) Hospital Regional de Presidente Prudente; (6) PROCAPE; (7) Fundação Faculdade Regional de Medicina São José do Rio Preto; (8) Clínica Procárdio; (9) Hospital Ana Nery; (10) Hospital Santa Lucia – Hospital do Coração de Poços De Caldas; (11) Sociedade Hospitalar Angelina Caron; (12) Loyola University, Chicago, United States of America
Background: There is limited contemporary prospective real-world evidence of patients with chronic arterial disease in Latin America.
Methods: The Network to control atherothrombosis (NEAT) registry is a national prospective study of patients with known coronary (CAD) and peripheral arterial disease (PAD) in Brazil. A total of 2,015 patients were included among 21 sites from September 2020 to March 2022. The follow-up of all patients was one year by the protocol. Patient characteristics, medications under use and laboratorial data were collected. The primary objective is to assess the utilization of evidence-based therapies (EBT) at baseline.
Results: From the total of patients enrolled, 56.6% had isolated CAD, 29.6% had PAD and 13.8% had both diagnoses. The overall mean age was 66.3 (±10.5) years and 65.7% were male patients. The median glomerular filtration rate was 76.4 [57.2–96.1] and 72.3% of the patients had an evaluation of microalbuminuria which was detected in 6.2% of the cases. Regarding EBT, 4.0% were not using any antiplatelet and/or anticoagulant therapy but only 0.9% were using low dose of rivaroxaban (2.5 mg BID); 5.0% were not using statins and 55.6% of the patients were not using high intensity statin therapy; ACE inhibitors or ARBs were used in 76.2% of the overall population while, among patients with isolated CAD, 10.3% were not using betablockers. Among diabetic patients, 67.8% were using metformin and only 12.5% were using SGLT2 inhibitors and/or GLP1 agonists. Regarding the targets for secondary prevention, 33.0% had a body-mass index between 18.5 and 24.9; 44.4% were doing at least 150 minutes of exercise per week; 15.7% continued to smoke; 41.0% had a blood pressure <130 × 80 mmHg; 38.7% and 14.7% had LDL-cholesterol below 70 and 50 mg/dl, respectively. Among diabetic patients, 41.2% had a glycated haemoglobin <7%. Patients with PAD had lower use of EBT and lower percentage of patients on target of risk factors control. Among all cases without use of EBT, the main barrier identified was related to the physician perception that did not consider a formal medical indication of these therapies.
Conclusion: Our findings highlight that the contemporary practice still has important gaps in the treatment of patients in secondary prevention, especially among patients with PAD. Populational interventions addressing these gaps have the potential to produce a major impact, reducing the burden of atherothrombotic complications in Brazil.
109312
Modality: E-Poster Researcher – Non-case Report
Category: CARDIO-ONCOLOGY
FERNANDO PIVATTO JÚNIOR1, Marco Aurélio Lumertz Saffi2, Guilherme Oliveira Magalhães Costa1, Vinícius Henrique Fritsch1, Eduarda Foresti Englert1, Ângela Barreto Santiago Santos2, Géris Mazzutti2, Pedro Emanuel Rubini Liedke2, Andreia Biolo1
(1) Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre-RS, Brazil; (2) Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre-RS, Brazil
Introduction: Patients with positive troponin (Tn+) during breast cancer treatment are considered to be at high risk for cardiotoxicity, and cardioprotection with ACE±BB is indicated. Doubts persist about the ideal time to collect Tn.
Objective: To compare the incidence of cancer therapy-related cardiac dysfunction (CTRD) in the Tn+/onset of cardioprotection and Tn-/no additional intervention groups. Patients and methods. Prospective cohort including consecutive female patients with HER-2+ early breast cancer who consulted at the institution’s breast cancer outpatient clinic between march/19-march/22. CTRD: drop in LVEF > 10 p.p. to <53% (ASE/EACI). Tn collection was performed together with the lab tests requested by Oncology before the 1st and 2nd cycles of trastuzumab (TTZ), in addition to 3 months after its initiation. Tn+: TnTus ≥ 14 ng/L or TnIus > 15.6 pg/mL. It was not considered as Tn+ if baseline Tn+ without previous cancer treatment or if absence of increase >20% after its beginning. Patients with Tn+ were referred to the institution’s Cardio-Oncology outpatient clinic to begin cardioprotection, as were those with CTRD. Comparison between groups: Fisher’s exact test. P < 0.05 was considered statistically significant.
Results: We studied 46 patients, mean age 53.1 ± 13.1 years, 21 (45.7%) in a therapeutic protocol including doxorubicin (ACdd-TH). Regarding risk factors, 21 (45.7%) had a history of smoking, 18 (39.1%) were obese and 15 (32.6%) had hypertension. Of the 138 troponins analyzed, there were 18 (13.0%) Tn+, the majority being detected before the 2nd cycle of TTZ (12/18, 66.7%). Of the total number of patients, 12 (26.1%) had ≥1 Tn+, with the majority (7/12, 58.3%) having only one of the three collected. In the Tn- group (n = 34), only 6 (17.6%) had hypertension and used ACEi/ARB as treatment. The incidence of CTRD was 10.9%, 8.3% in the Tn+ group and 11.8% in the Tn- group (P = 1.0).
Conclusions: Although patients with Tn+ had a higher risk of CTRD, there was no difference in the incidence in those with Tn+/onset of cardioprotection in relation to those with Tn-/without additional intervention. This finding suggests that the cardioprotection strategy based on the detection of Tn+ collected together with the lab tests requested by Oncology may have been effective, equating the occurrence of this adverse event between the groups.
109383
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
PAULO EDUARDO BALLVÉ BEHR1, Rafael Vianna Behr1, Leonardo Henrique Bertolucci1, Gabrielly Burkhard Vilasfam1, Lara Helena Zortéa1, Luiza Zwan Dutra1, Maiara Both1, Mariana Saadi de Azevedo1, Paulo Ernesto Leães1, Fernando Antônio Lucchese1
(1) Hospital São Francisco – Santa Casa de Misericórdia de Porto Alegre
Introduction: Traditional risk factors (RF) are used to predict the probability of cardiovascular events. However, it is still uncertain whether they are able to predict the probability of subclinical atherosclerosis. Therefore, our objective is to evaluate the association between the number of RF and coronary calcification measured by the calcium score (CAC).
Methods: Cross-sectional study, including patients seen as outpatients between 2012 and 2020, aged between 45 and 75 years, in primary prevention. To assess coronary calcification, the CAC percentile (PCAC) was used, considering PCAC > 75 as an important calcification. The RF evaluated were: hypertension, diabetes, current smoking, dyslipidemia and family history (FH) for coronary artery disease.
Results: 444 patients were included, mean age 59 ± 7 years, 54% female, all Caucasian, 54% hypertensive, 41% dyslipidemic, 9% diabetic, 11% smokers; 59% with FH. Table 1 shows the association between the number of RF and coronary calcification. The higher the number of RF, the higher the prevalence of PCAC > 75 (p < 0.01) and the lower the prevalence of PCAC = 0 (p < 0.01). Compared to patients without RF, the prevalence of PCAC > 75 was 1.86 times higher in patients with 1 risk factor (CI 0.60–5.81), 3.59 times higher with 2 RF (CI 1.20–10.76), 3.89 times higher with 3 or more RF (CI 1.27–11.90). However, even in patients with zero, 1, or 2 RF, significant calcification was observed in 9.1%, 16.9%, and 32.6% of patients, respectively. In multivariate analysis, smoking [PR 1.68 (CI 1.16–2.43)] and FH [PR 1.96 (CI 1.37–2.79)] were independent RF.
Conclusion: There was an association between the number of RF and coronary calcification. However, a considerable percentage of patients with none or fewer RF had significant coronary calcification.
109364
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
MARCOS DANILLO PEIXOTO OLIVEIRA1, Lélio Lemos Pinto Neto1, Ednelson Navarro2, Adriano Caixeta1
(1) Universidade Federal de São Paulo, UNIFESP; (2) Hospital Regional do Vale do Praíba
Background: Post-CABG coronary and grafts angiography (CGAG) and interventions (PCI) have historically been performed via classic transfemoral approach. Particularly for those with left internal mammary artery (LIMA) grafts, left standard transradial access (lsTRA) represents a feasible alternative, with significant fewer vascular complications, but it has ergonomic disadvantage for the operator because of the need to bend over the patients, especially in obese ones. Distal transradial access (dTRA) may provide important advantages, including shorter hemostasis and greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim to describe the feasibility and safety of right and left dTRA for post-CABG CGAG and PCI.
Material and methods: From February 2019 to February 2022, 151 consecutive post-CABG patients submitted to CGAG and/or PCI via dTRA have been enrolled.
Results: Mean patient age was 67.81 years old. Most were male (82.1%) and had chronic coronary syndromes (59.6%). Overall, 40.3% had acute coronary syndromes. Distal RA was successfully punctured in all patients, always without ultrasound guidance. All procedures involving LIMA grafts were done via ipsilateral ldTRA. We had only 9 (6.0%) access site crossovers. Successful dTRA sheath insertion was then achieved in 94% of all patients, mostly (66.9%) via ldTRA and with standard 6Fr sheath (98%). Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications related to dTRA were recorded.
Conclusions: dTRA for routine post-CABG CGAG and PCI by experienced transradial operators appears to be feasible. Further randomized and larger trials are needed to assure clinical benefits and safety of this new technique.
109367
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
MÁRIO CLAUDIO SOARES STURZENEKERM1, Mauricio Montemezzo2, Dalton Bertolim Précoma2, Paola Gonçalves Moreira de Oliveira1, Bruna Karas1, Ana Carla Dlugosz1, Alice Magro Koscianski1, Larissa Almeida Busnello1, Francielle Nocera Viechineski1, Camilla Mattia Calixto1, Júlia Henneberg Hessman1
(1) Universidade Estadual de Ponta Grossa; (2) Pontifícia Universidade Católica do Paraná
Introduction: Cross-sectional studies have widely described the relationship between non-alcoholic fatty liver disease (NAFLD) and atherosclerotic coronary artery disease. A clinical study reported an increased risk for cardiovascular events in NAFLD patients, and this relation was suggested in a retrospective study. However, the role of NAFLD in atherosclerotic disease remains inadequately elucidated. Furthermore, the potential correlation between NAFLD severity and the clinical expression of acute coronary syndrome (ACS) remains undetermined.
Purpose: To assess whether there is a correlation between NAFLD severity and ACS severity.
Methods: Were selected data of 99 adult patients without previously known coronary artery disease or liver disease, without a history of significant alcohol consumption and other common causes of secondary steatosis, who presented to the emergency room with chest pain between March 2015 and March 2016. The diagnostic criteria for acute myocardial infarction with ST-segment elevation (STEMI) were based on ST-elevation ≥1 mm in ≥2 contiguous leads (2 mm for leads V1 to V3). The acute myocardial infarction without ST-segment elevation (NSTEMI) diagnostic was established in patients who did not meet the criteria for STEMI and who had elevated necrosis markers (creatine kinase-MB isoform and troponin I). Unstable angina (UA) diagnostic was established in patients who did not meet the criteria for STEMI and NSTEMI but had more than three cardiovascular risk factors and typical thoracic pain. The presence of steatosis and its degrees were assessed using ultrasound, and the diagnosis of NAFLD was based on the presence of steatosis and clinical history.
Results: UA, NSTEMI and STEMI diagnosis were established in 40, 33 and 26 patients, respectively, and NAFLD was observed in 30%, 66.6% and 76.9% of these patients. The diagnostic of STEMI and NSTEMI were more frequently than UA in NAFLD patients (P < 0.01, p < 0.001). NAFLD diagnosis and its degrees were significantly correlated with the three presentations of ACS (P < 0,001) for both. The STEMI and NSTEMI diagnosis frequency was similar in NAFLD patients. Diabetes, obesity and hypertension were not correlated with NAFLD diagnosis and degree.
Conclusion(s): In this study, NAFLD diagnosis and its degrees were significantly correlated with ACS and its severity. Therefore, NAFLD could be considered a potential risk marker for coronary atherosclerotic disease progression and instability.
109382
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
DALMA ALVES PEREIRA1, Priscila Valverde de Oliveira Vitorino2, Katarinne Lima Moraes3, Vanessa da Silva Carvalho Vila2, Marina Aleixo Diniz Rezende2, Maria Alves Barbosa1, Claudia Regina de Oliveira Zanini1, Virginia Visconde Brasil1
(1) Federal University of Goiás – UFG; (2) Pontifical Catholic University of Goiás – PUC Goiás; (3) Brasília University – UnB
Background: Support for self-management of chronic conditions is essential in the development of patient-centered care. The use of integrated care models that focus on the person and not only on the disease represents a viable solution for effective care. The Chronic Care Model is based on the relationship between motivated and informed users, and a proactive and prepared health team. According to this model, support for self-management is associated with significant results, especially in hypertension and diabetes. It includes the Patient Assessment of Care for Chronic Conditions (PACIC) instrument to assess and monitor the integrated care and support for self-management, as perceived by the patient.
Aim: To assess the quality of care for people with arterial hypertension and diabetes mellitus treated at a specialized service, according to the Chronic Care Model.
Methods: Cross-sectional study, carried out in a reference outpatient clinic of hypertension care in Brazil. Eighty-two people with diabetes and hypertension were evaluated, with a follow-up of at least 5 years. Participants completed the 20-item PACIC, as well as measures of demographic and clinical aspects during the nursing appointment. PACIC has 5 scales and 3 of them assess support for self-management. Higher scores (>3.0) indicate greater involvement in self-management and team support. For analysis, the Mann-Whitney Test, Spearman Test, and a significance level of 0.05 were used.
Results: The mean age was 68.98 ± 8.79 years, female (82.93%), and median 4 years of study (IQR 3–8). Most parents (70.73%) did not study. The median time from diagnosis of diabetes was 8 years (IQR 6–12). Less than half of the patients had controlled glycated hemoglobin – HbA1c (34.15%) and blood pressure (36.59%). There was a positive correlation between the time of diabetes diagnosis and the (HbA1c) value. The Overall PACIC mean was 3.4 (IQR 2.8–3.8). The scales scores that map onto self-management support were Patient Activation – 3.0; Problem-Solving/Contextual – 3.0 and Goal Setting/Tailoring – 3.8. Patients with controlled (HbA1c) were significantly different on the Goal Setting/Tailoring scale. Having parents with some schooling was significantly different on both the Overall PACIC and Patient Activation scale.
Conclusion: Quality of care was high considering the overall PACIC, but was moderate on scales that assess greater patient participation and involvement in decision-making and treatment plans.
111107
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ROBERTA DA SILVA TEIXEIRA1, Arise Garcia de Siqueira Galil2, Ana Paula Cupertino3, Francisco Cartujano-Barrera3, Fernando Antonio Basile Colugnati2
(1) Instituto Nacional de Cardiologia – INC; (2) Universidade Federal de Juiz de Fora – UFJF; (3) University of Rochester Medical Center – URMC
Introduction: E-health technologies such as the Pare de Fumar Conosco software can be effective for smoking treatment. This intervention is a web-based tool for decision-making about quitting smoking, drawn on principles of social cognitive theory, comprising motivational messages, behavioral change support, and pharmacotherapy use. Efficacy and effectiveness evaluations are not enough. Before being adopted in the health system, technologies must be adequately evaluated in the economic sphere.
Objective: To evaluate the cost-effectiveness of the Pare de Fumar Conosco software versus the standard of care according to Brazilian Ministry of Health guidelines.
Methods: We developed an analytical decision model for engagement in the smoking cessation counseling group and smoking cessation under service providers‘ perspectives and the public health system. We measured costs by primary and secondary sources and a randomized clinical trial for effectiveness. The temporal horizon adopted was one year. The TreeAge Pro Suite 2018 software guided the development of the analytical decision model. The analysis comprised the incremental cost-effectiveness ratio (ICER), deterministic sensitivity analysis, and Monte Carlo probabilistic analysis (1,000 simulations). As the outcomes are intermediary, no willingness to pay threshold was adopted.
Results: The software had a lower cost and greater effectiveness than its comparator. ICER for the engagement and smoking cessation were dominant in both perspectives adopted ($ – 464, 125.36 to $ – 58,348.50). Quadrant II (lower cost and higher effectiveness) presented higher percentages (53,6% to 82,5%) on Monte Carlo simulations.
Conclusions: Pare de Fumar Conosco software is a cost-saving technology for smoking treatment. This cost-effectiveness analysis provides objective and explicit data that support the decision of health managers in evaluating the adoption of a promising web-based decision tool for smoking cessation.
109401
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
TOMASZ CHWYCZKO1, Edyta Smolis-Bak1, Laura Zalucka1, Agnieszka Segiet-Swiecicka1, Ewa Piotrowicz1, Joanna Was1, Magdalena Niedolistek1, Malgorzata Sobieszczanska-Malek1, Tomasz Zielinski1, Mariusz Kusmierczyk1, Ryszard Piotrowicz1, Rafal Dabrowski1
(1) National Institute of Cardiology, Warsaw, Poland
Background: The novel method of comprehensive rehabilitation after LVAD implantation was developed in our institution in order to rehabilitate the growing LVAD patients population. Study group: 47 recent LVAD (32 HeartMate III, 15 HeartWare) recipients (19–68 years, mean 58,7 years, 43 men) participated in the rehabilitation program. 4–5 week program included supervised endurance training on a cycle ergometer (5 times per week). The training was programmed on the basis of the cardiopulmonary exercise test results. Other exercises included: resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). The hospitalization was followed by 6–8 weeks of individual exercises performed at home. 6-minute walking test (6MWT), cardiopulmonary exercise test (CPET) and prognostic biomarkers of heart failure: NT-proBNP, Galectin-3 and ST2 were investigated at the beginning and at the end of the rehabilitation program.
Results: Table 1. An increase of 6MWT distance, higher maximal workload, peak VO2 and upward shift of anaerobic threshold in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitation.
Conclusions: Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of functional tests and biomarkers of heart failure.
109413
Modality: E-Poster Researcher – Non-case Report
Category: NUTRITION
ELISA ALBERTON HAAS1, Mario Jose Abdalla Saad2, Andrey Santos2, Nicola Vitulo3, Wilson José Fernandes Lemos Junior4, Aline Maria Araújo Martins5, Carolina Raíssa Costa Picossi6, Desiderio Favarato1, Renato Simões Gaspar1, Peter Libby7, Francisco Rafael Martins Laurindo1, Protasio Lemos da Luz1
(1) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; (2) Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil; (3) Department of Biotechnology, Verona University, Verona, Italy; (4) Faculty of Science and Technology, Libera Università di Bolzano, Bolzano, Italy; (5) Department of Medical Science, University of Brasilia (UnB), Brasilia, Brazil; (6) Institute of Chemistry, University of Sao Paulo, Sao Paulo, SP, Brazil; (7) Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Gut microbiota profile closely relates to cardiovascular diseases through mechanisms including the reported deleterious effects of metabolites, such as trimethylamine-N-oxide (TMAO), highly studied as a diagnostic and therapeutic target. Moderate red wine (RW) consumption is reportedly cardioprotective, but RW effects on gut microbiota and plasma TMAO are not fully understood. We conducted a randomized, crossover, controlled trial involving 42 males, average 60 yr with documented coronary artery disease, comparing 3-week consumption of 250 mL of RW/day, 5 days/week, with an equal period of alcohol abstinence, given adequate washouts. RW consumption significantly remodeled gut microbiota, with a difference in beta diversity. Plasma metabolomic analysis (n = 20) revealed changes after RW consistent with improved redox homeostasis modulation, such as an increase in precursors of riboflavin and ascorbate metabolism. In contrast, plasma TMAO did not differ with the RW intervention and TMAO levels showed a low intra-individual concordance over time. Thus, modulation of the gut microbiota may contribute to the putative cardiovascular benefits of moderate RW consumption.
109418
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ERITO MARQUES DE SOUZA FILHO1, Erito Marques de Souza Filho1, Helena Cramer Veiga Rey2, Rose Frajtag2, Daniela Matos Arrowsmith Cook3, Lucas Nunes Dalbonio de Carvalho1, Antonio Luiz Pinho Ribeiro4, Samuel Santana de Oliveira5, Filipe Silva Neves Nogueira dos Santos5, Jorge Amaral6
(1) Universidade Federal Rural do Rio de Janeiro; (2) Instituto Nacional de Cardiologia; (3) Pró-Cardiaco; (4) Universidade Federal de Minas Gerais; (5) Senai Cimatec; (6) Universidade do Estado do Rio de Janeiro
Cardiovascular disease and depression are prevalent. Patients with cardiovascular disease are more depressed than the normal population. Depression is associated with an increased risk of cardiovascular disease (CVD) and death. People with CVD who are also depressed fare worse than patients who are not depressed. Depression’s intensity influences one’s risk of death and other cardiovascular problems. Depression is a multifactorial disease that has a high socio-economic impact. Currently, many patients do not receive adequate treatment or diagnosis. In this context, the present work proposes a Deep Learning model for diagnostic screening of patients in primary care using clinical, laboratory, and sociodemographic data. These data were obtained from a telecardiology project of the Cardiovascular Disease Research Network from 2016 to 2018. Due to the complexity and processing demand, we used a high-performance supercomputer (OGBON – Senai/Cimatec) in the hyperparameter search process, training, and testing the models. We utilized a cross-validation strategy to aim at a better evaluation of the external validation of the model. We designed SMOTE and TOMEK links for data augmentation. We implemented the models in Python and used the Optuna package in searching best parameters. We used the area under the receiver operating characteristic curve, recall, precision, F1-score, and accuracy in models evaluation. Our best model reached, respectively, 0.81, 0.76, 0.88, 0.81, and 0.76. These results indicate that Deep Learning has great potential in terms of screening patients with depression based on data from routine use in primary care.
109428
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
RODRIGO DE CARVALHO MOREIRA1, Anny Rodrigues22, Beatriz Leonardo1, Daniel Arabe1, Sandra Wagner1, Beatriz Grinsztejn1, Valdilea Veloso1, Antonio Pacheco3
(1) Evandro Chagas National Institute of Infectious Diseases; (2) Universidade Federal do Rio de Janeiro; (3) Programa de Computação Científica, Oswaldo Cruz Foundation
Background: Smoking is highly prevalent in people living with HIV/AIDS (PLHA) producing detrimental effects in different organs and leading to illness. There is limited evidence about pharmacological interventions for treating nicotine dependence in PLHA. We examined if Nicotine replacement therapy (NRT) is an option for smoking cessation and ameliorates vascular health in this specific population.
Methods: From December 2019 to October 2021, we prospectively enrolled PLHA who were actively smoking in our center. The primary outcome of interest was to assess the effect of NRT plus counseling on smoking cessation and endothelial function measured by brachial artery flow-mediated dilatation (FMD). Statistical analysis evaluated the change in %FMD (Δ%FMD = %FMD at week12-%FMD at baseline) to test the hypothesis that Δ%FMD would improve among participants who quit smoking compared to those who relapse. To confirm the results, we have run multiple linear regression to account for classical cardiovascular (CV) confounders. Results are presented in medians (interquartile ranges) and percentages.
Results: We included 115 participants with median age of 45.5 years (IQR = 36.4–54.8); 22 (20.4%) had hypertension, 9 (8.3%) had diabetes and 30 (27.8%) had dyslipidemia, almost half were smoking 20+ cigarettes/day (41.7%). Individuals were living with HIV for a median of 10.9 years (5.7–17.4) and were on antiretroviral therapy for 8.6 years (3.7–13.6) with median Nadir of CD4 of 307 (153–490.5). Baseline of median brachial artery diameter was 3.6 mm (IQR = 3.2–4.1). Unadjusted analysis showed that years of smoking, younger age and white race were associated with poor %FMD (75th per centile). After 12 weeks 29.6% participants quit smoking. Comparison of Δ%FMF showed that among participants adherent to therapy, there has been an increase in Δ%FMD when compared to those who relapsed (1.11% [0.29–2.93] vs –0.15% [–1.8–0.91], p < 0.001). After adjustment for CV factors, multiple linear regression showed that participants who quit smoking present a mean 2.53 (p = 0.007) points increase in Δ%FMD in comparison to those who continued to smoke.
Conclusion: This study provides evidence that a strategy of NRT and counseling is effective for smoking cessation in PLHA and improves their vascular health in a short period of time. This reinforces the importance of the widespread anti-tobacco programs in HIV clinics and the expected impact lowering incidence of future cardiovascular events.
109452
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
TOMASZ CHWYCZKO1, Laura Zalucka1, Agnieszka Segiet-Swiecicka1, Edyta Smolis-Bak1, Ilona Kowalik1, Malgorzata Sobieszczanska-Malek1, Tomasz Zielinski1, Anna Borowiec1, Mariusz Kusmierczyk1, Rafal Dabrowski1, Ryszard Piotrowicz1
(1) National Institute of Cardiology, Warsaw, Poland; (2) National Institute of Oncology, Warsaw, Poland
Background: Iron Deficiency (ID, ferritin <100 ng/mL or 100–300 ng/mL with transferrin saturation <20%) is present in up to 70% of LVAD (left ventricular assist device) recipients. It causes severe anemia, impairs exercise tolerance, and may worsen the prognosis. Aim of the Study: To determine, which method of iron supplementation: oral or intravenous, is more efficient in LVAD patients.
Methods: In 47 recent LVAD recipients (19–68 years, median age 58.7 yrs, 43 men) iron parameters were investigated. 35 patients (74.5%) were diagnosed with ID and 44 patients (93.6%) had anemia. 27 patients were treated with intravenous iron (ferric carboxymaltose, average dose 1248 mg), 9 pts were treated with oral iron, 11 pts did not receive iron (high ferritin level). Blood morphology and iron management markers: serum iron level, transferrin, ferritin, transferrin saturation – TSAT, were measured before and 3 months after the therapy.
Results: Resolution of ID was observed in 19 pts from IV Iron Group (73.1%), and in one patient from Oral Iron Group (12.5%), p = 0.002. 8 pts from no treatment group developed ID. Intravenous repletion was more efficient than oral supplementation in ID resolution: OR = 16.29, 95% CI = 2.25–338.1, p = 0.017. IV treatment was more effective than no treatment strategy in anemia resolution: OR = 18, 95% CI = 3.03–159.4, p = 0.003.
Conclusions: The study proves the advantage of intravenous over oral iron treatment in LVAD patients.
109460
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
PAULO EDUARDO BALLVÉ BEHR1, Rafael Vianna Behr1, Leonardo Henrique Bertolucci1, Gabrielly Burkhard Vilasfam1, Lara Helena Zortéa1, Luiza Zwan Dutra1, Maiara Both1, Mariana Saadi de Azevedo1, Paulo Ernesto Leães1, Fernando Antônio Lucchese1
(1) Hospital São Francisco – Santa Casa de Misericórdia de Porto Alegre
Introduction: It is still uncertain how the family history (FH) for coronary heart disease (CAD) should be assessed: at any age or through the inclusion of an age cutoff. In this work, we evaluated the association between FH at any age and coronary calcium score (CAC). Additionally, we analyzed the influence of the number of family members on the probability of having significant subclinical atherosclerosis.
Methods: Cross-sectional study, including patients seen as outpatients between 2012 and 2020, aged between 45 and 84 years, in primary prevention. For FH, parents or siblings were considered, with sudden death, AMI, coronary angioplasty or CABG, at any age. To assess coronary calcification, the CAC percentile (PCAC) was used, with PCAC > 75 being considered important calcification.
Results: 509 patients were included, mean age 60 ± 8 years, 54% female, all Caucasian, 55% hypertensive, 36% dyslipidemic, 11% diabetic, 11% smokers; 58% with HF for CAD. The table shows the distribution of PCAC according to FH. Compared to patients without FH, the prevalence of PCAC > 75 was 1.65 times higher in patients with FH (CI 1.20–2.26); 1.59 times higher with a family member with CAD (CI 1.14–2.22); 1.58 times higher with two family members (CI 1.00–2.48); and 2.52 times higher with three or more family members (CI 1.51–4.23). The prevalence of PCAC > 75 with 1 or 2 family members was 31%, while with 3 family members it was 50% (p = 0.053). In addition, the greater the number of family members, the greater the prevalence of PCAC > 0 (p = 0.002).
Conclusion: In this study, the presence of FH for CAD was associated with a higher prevalence of significative coronary calcification. In addition, the greater the number of family members, the greater the chance of coronary calcification.
109873
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
SERGIO GUSTAVO TARBINE1, Costantino R Costantini1, Costantino Ortiz Costantini1, Shibata Vinicius1, Marcos Denk1, Rafael Macedo1, Marcio M. Luize1, Everton Cardoso Dombek1
(1) Hospital CArdiologico Costantini
Background: The Amplatzer™ and the Watchman™ are dedicated devices for percutaneous left atrial appendage (LAA) occlusion. This is an elective procedure planned to avoid thrombus-embolizaton in patients with atrial fibrillation, unable to use anticoagulation.
Objectives: The aim of the study was to describe the initial experience with both devices for percutaneous LAA occlusion.
Methods: This is a single-center study of patients undergoing percutaneous LAA occlusion. Inclusion criteria considered a formal contraindication for oral anticoagulation, previous history of stroke due to INR lability, left atrial thrombus in use of NOACs, and patient preference. All procedures were done under general anesthesia and transesophageal echocardiography (TEE) guidance. Transthoracic echocardiography was performed during the first 24hs after the procedure in order to rule out complications. Further follow-up was done with clinical visits and TEE.
Results: Between 09–2010 and 10–2021, patients with a mean CHA2DS2-VASC of 4.6 ± 0.8 and Has-bled of 4,5 underwent LAA occlusion with the Amplatzer™ device (24) and the Watchman™ device (8). Both were successfully implanted in 32 patients (100%), 75,1 ± 2,7 yrs old, 75% male, without any procedural stroke or device embolization. TEE showed complete LAA sealing in all patients with no residual leaks. Pericardial effusion needing successful pericardiocentesis in 3 patients. During follow-up, 1 patient had minor retinal embolization and 3 patients died (1: cancer; 2: not related osteomyelitis; 3: chronic renal failure.).
Conclusion: In this initial series of patients, both devices showed a good acute and short-term performance considering feasibility and safety regarding the successful implantation rate and the low incidence of complications.
109495
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
WILSON PASCOALINO CAMARGO DE OLIVEIRA1, Fatima Rodrigues Freitas2, Maurício Tavares Costa2, Aline de Oliveira Silva2, Roberto Kalil Filho2, Marco Aurélio Santo3, Raul Cavalcante Maranhão2
(1) Department of Clinical Analysis – FCF-USP; (2) Laboratory of Metabolism and Lipids – InCor; (3) Department of Clinical Analysis – FCF-USP/Discipline of Surgery of the Digestive System at HCFMUSP
Introduction: Obesity leads to decrease in HDL-C, which is an independent risk factor for cardiovascular events. Bariatric surgery is an effective treatment for grade III obesity, which leads to decreased LDL-C, triglycerides and increases HDL-C. The impact of bariatric surgery on anti-atherosclerotic functions of HDL, such as transfer of cholesterol from other lipoproteins to HDL was not yet explored.
Aim: To evaluate the effects of weight loss by bariatric surgery on the transfer of lipids to HDL and plasma lipids and apolipoproteins (apo) 1 year after bariatric surgery.
Methods: Fifteen individuals with grade III obesity (43 ± 6 years, BMI 49 ± 3 kg/m2, 14 women) were evaluated before and 1 year after bariatric surgery. Blood samples were obtained after a 12-hour fast. Lipid transfer to HDL was measured by in vitro assay, using an artificial emulsion labeled with 3H-cholesteryl ester and 14C-cholesterol as lipid donor. Lipids, apo A-I, apo B, glucose, insulin, and C-reactive protein (CRP) were determined by commercial kits. Insulin resistance was estimated by HOMA-IR index. HDL diameter was measured by laser light scattering method.
Results: As expected, BMI decreased after surgery (49 ± 6 vs 35 ± 5 kg/m2; p < 0.0001). Total cholesterol (174 ± 43 vs 154 ± 25 mg/dL; p = 0.022), LDL-C (105 ± 34 vs 78 ± 19 mg/dL; p = 0.007), non-HDL-C (128 ± 39 vs 91 ± 19 mg/dL; p < 0.0001), triglycerides (113 ± 39 vs 72 ± 19 mg/dL; p = 0.0012) and apo B (105 ± 27 vs 78 ± 13 mg/dL; p < 0.001) decreased after surgery. On the other hand, HDL-C (46 ± 9 vs 62 ± 10 mg/dL; p < 0.0001), apo A-I (136 ± 24 vs 157 ± 25 mg/dL; p < 0.0029) and diameter of the HDL (8.88 ± 0.39 vs 9.12 ± 0.34 nm; p < 0.05) were increased. CRP (9.77 ± 6.23 vs 1.75 ± 1.90 mg/dL; p < 0.0001) and HOMA-IR index (10.4 ± 12.2 vs 2.07 ± 0.97; p < 0.05) decreased compared to pre-surgical values. Transfer of unesterified (3.64 ± 0.86 vs 3.79 ± 1.05%) and esterified cholesterol (3.42 ± 0.48 vs 3.20 ± 0.52%) to HDL were not changed after surgery.
Conclusions: The weight loss 1 year of after bariatric surgery improved plasma lipids, including HDL-C and promoted reduction of insulin resistance and systemic inflammation associated to grade III obesity, and all those changes conceivably contribute to the diminished cardiovascular risk reported in the literature. However, the surgery did not impact the transfer to HDL of both cholesterol forms, which is also involved in atherogenesis.
109526
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
ASSAD MIGUEL SASSINE1, José Carone Filho1, Elisa ito mendes de Andrade1, Ramon Ott Vargas1, José Silva Henrique1, Márcio Luiz Roldi1, Lúcio Pereira Guarçoni1, Dalton Vinicius Menin1, Carlos Alberto Sancio Junior1, Ana Carolina Simões Ramos1, José Carone Junior1, Schariff Moyses2
(1) Hospital Evangelico de Vila Vleha; (2) Instituto de Cardiologia Do Espirito Santo
Introduction: Coronary artery bypass grafting (CABG) surgery is an important weapon in the therapeutic arsenal of coronary artery disease. The aim is to perform a safe procedure, with myocardial preservation and a low rate of perioperative complications. The purpose of this study is to evaluate myocardial injury and clinical evolution in patients undergoing CABG in a referral hospital in Espírito Santo state, where intermittent aortic clamping in hypothermia is used as a myocardial protection strategy.
Methods: Observational, cross-sectional and prospective study were developed in a referral Hospital in Espirito Santo state.
Results: 108 patients were included in the study between April and December 2019. The mean age of patients was 65 years. The mean EuroSCORE II was 2.54 and the mean Society of Thoracic Surgeons (STS) score was 1.54. Most patients were male (62%) and 75.9% had hypertension. Approximately half of patients had diabetes mellitus and dyslipidemia. Less than a fifth of the sample reported prior acute myocardial infarction. Mean cardiopulmonary bypass (CPB) time was 56 minutes and the average period of cross-clamping time was 43 minutes. Cardiac troponin I alterations were associated with death when considered from 6.1 ng/mL on the 1st postoperative day; values >6.1 ng/mL were related to longer CPB and cross- clamping times.
Conclusion: The technique of intermittent aortic cross-clamping in CABG surgery proved to be safe, with a low rate of postoperative morbidity and mortality. New studies, including analyzes with a larger sample, should be carried out to better understand this relationship.
109552
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
PAULO EDUARDO BALLVÉ BEHR1, Rafael Vianna Behr1, Leonardo Henrique Bertolucci1, Gabrielly Burkhard Vilasfam1, Lara Helena Zortéa1, Luiza Zwan Dutra1, Maiara Both1, Mariana Saadi de Azevedo1, Paulo Ernesto Leães1, Fernando Antônio Lucchese1
(1) Hospital São Francisco – Santa Casa de Misericórdia de Porto Alegre
Introduction: The ACC/AHA 10-year Atherosclerotic Cardiovascular Disease Risk Score (ACC/AHA Score) is one of the most used to assess the risk of MI or stroke. However, it was not evaluated whether it is able to identify individuals with greater or lesser coronary calcification. Therefore, our objective is to assess whether the risk categories of the ACC/AHA Score are able to predict coronary calcification.
Methods: Cross-sectional study, including patients seen as outpatients between 2012 and 2020, aged between 41 and 69 years, in primary prevention. Patients were divided into the four risk categories of the ACC/AHA Score: low (<5%), borderline (≥5% and <7.5%), intermediate (≥7.5% and <20%) and high (≥20%). Coronary calcification was measured by the Calcium Score (CAC), using absolute values (in Agatston), and CAC ≥ 100 was considered a significative calcification.
Results: 518 patients were included, mean age 59 ± 8 years, 52% female, all Caucasian, 54% hypertensive, 59% dyslipidemic, 11% diabetic, 11% smokers. The Table shows the distribution of CAC according to the ACC/AHA risk category. The increase in risk category was associated with a progressively higher prevalence of CAC ≥ 100 (p < 0.01), just as the reduction of category was associated with a higher prevalence of CAC = 0 (p < 0.01). Compared to low-risk patients, the prevalence ratio for CAC ≥ 100 was 2.35 in borderline-risk patients [(CI 1.44–3.82) (p = 0.01)]; 2.88 in intermediate risk [(CI 1.89–4.39) (p < 0.01)] and 4.32 in high risk [(CI 2.73–6.82) (p < 0. 01)].
Conclusion: In a population sample from southern Brazil, we observed that the ACC/AHA Score categories are able to predict the probability of significant subclinical atherosclerosis, assessed by coronary calcification.
109571
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
ÉRICA SOBRAL GONDIM1, Emiliana Bezerra Gomes1, José Hiago Feitosa de Matos1, Ana Camila Gonçalves Leonel1, Sarah de Lima Pinto1, Amanda da Costa Sousa1, Antônia Elizângela Alves Moreira1, Raynara Augustin Queiroz1, Ana Luiza Rodrigues Santos1, Mariane Ribeiro Lopes1
(1) Universidade Regional do Cariri – URCA
Introduction: Critical care units are characterized by the continuous monitoring of physiological parameters essential to the maintenance of life and the immediate conduct of health interventions. Subtle changes in organic functioning variables are indicative of potential risks to homeostasis, which can cause events that culminate in interruption of blood flow to vital organs and cardiorespiratory arrest. Heart rate, the number of beats per minute that determines the effectiveness of blood pumping from the heart to the other organs, is one of the vital parameters in controlling the proper functioning of the cardiovascular system. Although it may indicate a cardiac disorder itself, tachycardia is also present in non-cardiac conditions common in the Intensive Care Unit (ICU), such as delirium, shock, sepsis, anxiety, pain, inadequate management of sedation and respiratory distress. In this context, a nursing guide was developed to approach tachycardias in the ICU, seeking to optimize the time to restore hemodynamic balance and prevent cardiorespiratory arrest.
Objective: The present study, therefore, aims to report the experience of an intensive care nurse in the development of an instrument that classifies tachycardias according to intervention priorities and action packages.
Method: This is an experience report on the development of nursing technology by the professional, whose 12-year experience in intensive care and immersion in studies on the subject provided subsidies to identify priorities and conduct them properly according to their own professional skills.
Results: The elaborate script identified cardiac and non-cardiac causes, directing a direct nursing intervention to each cause and its time of completion according to the required urgency, citing in each intervention the subsequent steps and the professionals who must be activated according to the limits of professional exercise.
Conclusions: The development of this technology, based on the technical competence and experience of the professional nurse, followed an approach, although simple, practical and directed to the most prevalent causes in the ICU. The instrument resulting from this perception demonstrates practicality and applicability in routine care and nursing in the prevention of adverse events in intensive care units, optimizing the quality of care provided.
109608
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
JACQUELINE VAZ ALENCAR1, Caroline Naidon Coelho1, Clarissa G. Rodrigues10, Liliana Fortini Cavalheiro Boll1, Luiza Junqueira Trarbach Lovato2, Renata Póvoas3, Nicole Saldanha de Souza5, Emily Justiniano6, Fernanda Consolim-Colombo7, Katia de Angelis8, Maria Claudia Irigoyen3, Danielle Irigoyen da Costa9
(1) Instituto de Cardiologia da Fundação Universitária de Cardiologia (IC/FUC) – Porto Alegre, RS – Brasil; (2) University of Technology Sydney (UTS) – Austrália, Sidney; (3) Instituto do Coração da FMUSP (InCor) – São Paulo, SP – Brasil; (4) Universidade Nove de Julho (Uninove) – São Paulo, SP – Brasil; (5) Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) – Porto Alegre, Rio Grande do Sul – Brasil; (6) Hospital de Clínicas de Porto Alegre (HCPA) – Porto Alegre, RS – Brasil; (7) Universidade Nove de Julho (Uninove) – São Paulo, SP – Brasil; (8) Universidade Federal de São Paulo (Unifesp) – São Paulo, SP – Brasil; (9) Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) – Porto Alegre, Rio Grande do Sul – Brasil; (10) Global Research and Innovation Network (GRINN) – Curitiba, Paraná – Brasil
Introduction: Multicenter registries that represent the real-world provide important information, but there are few studies describing how to implement it.
Objective: To describe the feasibility pilot project of a database on systemic arterial hypertension in children and adolescents in a reference hospital.
Methods: Prospective, observational study to document and assess the feasibility of a multicenter registry of systemic arterial hypertension in children and adolescents. 3 steps were performed. Step 1: ethical aspects, contact with the school management, project pitch meeting and team training. Step 2: participants and workflow, variables included, action at school (screening and confirmatory phase). Step 3: evaluation of protocols, variables analyzed.
Results: Sample composed of 80 students, average age of 15.73 ± 0.77 years, 77.5% female and 22.5% male. The mean BMI was 23.58 ± 4.11 kg. Students who presented at least two altered measured pressures in the screening phase were: altered BP 42 (52.5%) and normal BP 38 (47.5%). In the Confirmatory Phase: 22 (32.8%) maintained altered BP. These will be monitored at a specialized center. The data was analyzed with the “REDCap” software. After the viability of the Registry, other centers participated through training. Data quality reports were generated for quality control.
Conclusions: The description of the methodology makes HASCA possible, enabling other centers to standardize data collection and promote the development of new health technologies, assisting in public policies on systemic arterial hypertension in children and adolescents.
109786
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
FIRMINO HAAG FERREIRA JUNIOR1, Rosa Maria da Costa Simões1, Diany Priscilla Oliveira1, Carolina Vieira1
(1) Hospital Geral de São Mateus
Objective: To analyze the accuracy index of electrocardiogram reports performed in Intensive Care, reported by an artificial intelligence platform, compared with reports performed by cardiologists in person. The electrocardiograms were randomly assigned and reported “blind” to the results provided by the artificial intelligence, and then both results were compared.
Report: Thirty (30) electrocardiograms of different patients were analyzed, randomly chosen, admitted to an intensive care unit, with a baseline diagnosis of cardiovascular diseases. Among the electrocardiograms analyzed, artificial intelligence was able to accurately diagnose 16 (sixteen) cases of inactive zone/myocardial infarction, 2 (two) cases of ST segment elevation, 2 (two) cases of atrial flutter, 5 (five) cases of atrial fibrillation, 5 (five) cases of diffuse changes in ventricular repolarization, 1 (one) case of left ventricular overload, 1 (one) case of anterior superior divisional hemiblock. Artificial Intelligence was able to identify electrode failures, as it did not consider the report. There was 100% compatibility of the artificial intelligence reports with the reports prepared by the cardiologists in person.
Conclusion: The introduction of new technologies such as artificial intelligence producing reports in electrocardiography is of significant importance, due to the reliability of the reports presented, not different when compared with reports prepared by experienced cardiologists in person, being therefore an important tool in helping to physicians in identifying and confirming the diagnosis, especially for non-specialists, often present in emergency services and intensive care units.
109612
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ALEXANDRA CORRÊA GERVAZONI BALBUENA DE LIMA1, Caroline Barreto Cavalcanti1, Paula Fernandes Freitas Lima1, Barbara Cunha Barreto2, Bruno Ramos Carneiro2, Gabriela de Oliveira Silva2, Maria Alice Ramalho Bragatto2, Luís Moreira da Silva de Azevedo Meireles3, Sergio Henrique Rodolpho Ramalho4
(1) North Wing Regional Hospital – Brasilia – Brazil; (2) School of Health Sciences – Brasília – Brazil; (3) MDI Industrial, Salvador – Brazil; (4) Clinical Research Center of the Brasilia of the Dasa Hospitals Network – Brasilia – Brazil
Background: Rapid differentiation the cause of dyspnea from other heart or respiratory causes, is very important for choosing an appropriate therapy. Capnography is a non-invasive and accurate method to measure end-tidal carbon dioxide (PETCO2) and can help physicians in some critical situations. Although this is not used in many emergency situations and it is not used routinely in the emergency department, its application is increasing in many emergency situations, such as patients undergoing mechanical ventilation, procedural sedation and analgesia, pulmonary disease, heat failure, shock, metabolic disorder and trauma.
Aim: To evaluate the PETCO2 in differentiating heart and/or pulmonary disease from non-heart and non-pulmonary related dyspnea in hospital setting.
Methods: This was observational prospective study performed in the North Wing Regional Hospital, Brasilia, Brazil, August 2021–Febuary 2022. 254 Adults, conscious and spontaneous breathing hospitalized individuals were evaluated and divided in four groups of patients: heart disease (heart failure, ischemic heart disease) group 1 (n = 54), pulmonary disease (chronic obstructive pulmonary disease, asthma) group 2 (n = 68), heart and pulmonary disease group 3 (n = 74) and non-heart and non-pulmonary disease group 4 (n = 56). PETCO2 was measured by a portable capnograph, using a nasal catheter, without supplemental oxygen.
Results: The groups were similar in age (group 1 62.2 ± 15,7 vs group 2 64.5 ± 18.0 vs group 3 62.0 ± 15.6 vs group 4 66.9 ± 17.4, p = 0.33) and gender (male, group 1 23% vs group 2 26% vs group 3 28% vs group 4 22%, p < 0.82). The PETCO2 was lower and similar in the heart and/or pulmonary groups and higher in non-heart and non-pulmonary group (group 1 29.2 ± 6.9 vs group 28.6 ± 5.7 vs group 3 28.7 ± 5.8 vs group 4 31.2 ± 5.0, p = 0.05). The PETCO2 in non-heart and non-pulmonary disease (area under the curve, 0.63; 95% confidence interval, 0.57–0.71, p = 0.03).
Conclusion: The PETCO2 was able to screen individuals without heart and pulmonary disease in treatment of dyspnea in a public hospital. Capnography can be an easy, cost-effective and non-invasive tool to evaluate dyspnea and does not require cooperation of the patient. Other studies are necessary to different heart from pulmonary disease as cause of dyspnea.
109619
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
RENATA JUNQUEIRA MOLL BERNARDES1, Julia Barroso1, Andréa Silvestre de Sousa1, Eduardo Schaustz1, João Dario Mattos1, Emiliano Medei1, Olga Ferreira de Souza1, Denilson de Campos Albuquerque1, Ana Cristina Baptista da Silva Figueiredo1, Mariana Tortelly1, Juliana Ferreira1, Gabriel Cordeiro Camargo1
(1) D’Or Institute for Research and Education, Rio de Janeiro, Brazil
Background: The pathophysiological mechanisms associated with cardiac symptoms in post-acute COVID-19 are still poorly understood. A high prevalence of myocardial injury, associated with higher in-hospital mortality has been reported and one of the postulated mechanisms is an autoimmune inflammatory response. Cardiovascular magnetic resonance (CMR) is the best non-invasive method for the assessment of myocardial and pericardial inflammation, allowing the detection of edema and fibrosis. AIM To characterize the presence and prevalence of myopericardial inflammation in a population with a high prevalence of cardiac injury, recently discharged from COVID-19 hospitalization.
Methods: In this prospective study, 190 hospitalized COVID-19 patients with clinical or laboratory cardiovascular abnormalities were included in a multicentric registry between November 2020 and December 2021. After discharge, all patients were contacted and 48 consented to return for CMR exam.
Results: Of 48 included patients, 33 (68.8%) were male, the mean (SD) age was 57.0 (18.9) years, 24 (50%) were hypertensive and 12 (25%) had diabetes. Chronic cardiac disease was reported in 6 (12.5%), asthma in 4 (8.3%), and chronic obstructive pulmonary disease in 3 (6.3%). Thirty-one patients (64.6%) were overweighed and 37 (77.1%) had myocardial injury detected by increased troponin levels. The median (IQR) time interval between hospital admission and CMR was 74 (26–157) days. Myocardial late gadolinium enhancement (LGE) was observed in 20 (41.7%) patients, including 5 with subendocardial, 11 mesocardiac, and 4 with transmural LGE. Patients with transmural and subendocardial LGE were diagnosed with ischemic heart disease (5), hypertrophic myocardiopathy (2), and right ventricular muscular band (1). Fourteen patients (32.6%) had pericardial LGE, and the prevalence of this finding reduced from 41.7% to 30% and 11%, according to the time interval from hospital discharge to the CMR exam (0–3, 3–6, and 6–12 months, respectively). Small pericardial effusion was detected in 11 (25.6%) patients, and the frequency decreased from 37.5% to 10% and 11%.
Conclusion: There is a high incidence of post-COVID myopericardial inflammation in patients who presented with cardiac abnormalities during acute illness, particularly myocardial injury. These findings indicate that myocardial injury may be related to late myocardial inflammation and might explain some of the long-term cardiovascular symptoms of COVID-19.
109651
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ANA CARLA DANTAS CAVALCANTI1, Ana Carla Dantas Cavalcanti1, Lyvia da Silva Figueiredo1, Jessica Santos de Souza Leal1, Mellissa Barreto Oliveira Da Silva1, Flavio Luiz Seixas1, Caroline Barboza Braga1, Kelly Maria Augusta Tavares Bentes1, José Paulo de Mello Gomes1, Paula Vanessa Peclat Flores1, Evandro Tinoco Mesquita1
(1) Universidade Federal Fluminense
Introduction: Heart failure is a clinical condition associated with morbidity and mortality, and it is necessary to manage the disease, relieve symptoms, prevent hospitalization and reduce mortality. Therefore, the use of mobile applications represents a strategy to optimize care.
Objective: To compare self-care, quality of life, and depressive symptoms in patients with chronic heart failure using a mobile app with conventional follow-up.
Method: The study was carried out in two phases, the first, a technological development study, and the second, a (pilot) randomized clinical trial. For the application development, the following software was used: Android Studio, Flutter and the Android operating system. Prospective validation was carried out with experts in heart failure through the System Usability Scale (SUS). In the pilot study, patients were divided into two groups. Patients in the intervention group used the application for 30 days, and patients in the control group used the conventional telephone follow-up. Outcomes were assessed using the European Heart Failure Selfcare Behavior Scale, the Minnesota Living with Heart Failure questionnaire, and the Beck Inventory. Data were analyzed using SPSS v.24 and a repeated-measures ANOVA. The study was registered in ReBEC (RBR-2w7wkb) and approved by an Ethics Committee.
Results: The “Card.io” application features, as a resource, the sending of notifications and alarms reminding the patient of a certain action defined by the professional. The prospective validation was performed by 39 experts, mostly nurses (89.7%), with a mean age of 33 years, mostly female (82.1%), and 35 (89.7%) residing in Brazil. The application was considered excellent based on the SUS score. The pilot clinical trial was carried out with 42 patients. There were significant differences in the interaction regarding depressive symptoms (p = 0.016), self-care (p = 0.019), and quality of life (p < 0.001).
Conclusion: The Card.io application for remote monitoring effectively improves the quality of life of patients and offers an alternative for healthcare professionals, with an innovative and low-cost proposal that can be implemented in healthcare services.
111068
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
RICARDO MOURILHE-ROCHA1, Bruno Reznik Wajsbrot1, Marcelo Luiz da Silva Bandeira1, Julia Paulo Mourilhe Rocha1, Thiago Matos Barcellos1, Flávia Prado Fialho Santos1, Eric Costa de Almeida1, Roberta Siuffo Schneider1, Ricardo Mendes Carneiro1, Claudia Lanzillotti Weksler1, Fernando Oswaldo Dias Rangel1, Daniel Xavier de Britto Setta1
(1) HOSPITAL PRÓ-CARDÍACO
Background: Measuring the quality of care indicators enable the recognition of weaknesses in health care. Based on this assessment, it will be possible to improve outcomes.
Objectives: To evaluate the quality of care based on ventricular dysfunction, length of stay, coronary angioplasty and hospital mortality rates.
Materials and Methods: Observational, retrospective, cohort study of 398 patients admitted with a diagnosis of AMI, with and without ST-segment elevation between January 2018 and January 2022; 69.3% male with a mean age of 65 years. Data were analyzed by the SPSS software.
Results: They had the following comorbidities: 47.5% dyslipidemia, 77.9% hypertension, 50.5% previous CAD, 41.2% diabetes, 8.5% heart failure, 37.2% stroke, 15.1% coronary artery bypass surgery, 29.6% previous AMI, 10.1% chronic kidney disease, 43.0% smoking, and 10.3% atrial fibrillation. There were 31.2% with STEMI and 68.8% with NSTEMI, with 83.4% in Killip I, 8.4% in II, 3.1% in III, and 5.0% in IV. The median length of stay was 4 days (IQR 3–8) in the overall population, 4 days in NSTEMI and 5 days in STEMI; p = 0.02. The rates of events at discharge in the overall population and subgroups were: hospital mortality = 7.5% (4.7%, NSTEMI and 13.7%, STEMI; p = 0.002), ventricular dysfunction = 34.4% (28.1%, NSTEMI and 49.1%, STEMI; p < 0.001), being mild dysfunction in 15.5%, moderate 12.6% and severe 5.3%. The angioplasty rate was 79.1% (74.4% NSTEMI and 89.5% STEMI; p < 0.001).
Conclusions: The mortality rate was higher than predicted by the Killip score. The incidence of ventricular dysfunction was high, but it was not possible to determine how many of these patients presented ventricular dysfunction prior to the event. The length of hospital stay was within the recommended range and the coronary angioplasty rate was also high.
111069
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
ANA INÊS GONZÁLES1, Ana Inês Gonzáles1, Guilherme Michels1, Jackson da Silva Gullo1
(1) Universidade Estácio de Santa Catarina – São José
Introduction: Studies on “Long Covid” suggest that long-term persistent clinical manifestations can last even months after infection. In this sense, post-covid rehabilitation programs are essential. Due to the restrictions imposed by the pandemic, carrying out rehabilitation programs in closed environments has become a concern, leaving home rehabilitation as the only option, also called Home Based (HB).
Objectives: To verify the benefits of a post-covid-19 cardiopulmonary rehabilitation program in Home Based format.
Method: Longitudinal, interventional study, with an accessibility sample, with individuals of both sexes, ≥30 years old, with a clinical diagnosis of COVID-19 infection by the reverse-transcriptase polymerase chain reaction (RT-PCR) method, already completed, and who have remained with cardiopulmonary complications. Patient recruitment occurred publicity on social media and radio. The recruited individuals were submitted to the 30-second sit-and-stand test (30CST) and the 2-minute stationary gait test (2MWT) remotely during the pre- and post-rehabilitation program period. The intervention protocol took place synchronously, in a home-based format, using video calls via Whatsapp app, based on: 1) respiratory kinesiotherapy exercises, 2) aerobic training; 3) resistance training with localized muscle strength exercise, 4) stretching, two days a week for approximately 60 minutes, and individuals performed rehab with the help of tutors. The Borg Subjective Scale was used to monitor the intensity of the exercises, and should remain between 3 and 4 points.
Results: Twenty-eight individuals were treated, 12 men (43%) and 16 women (57%), mean age of 50 ± 5 years, who performed 16 ± 1.2 sessions. There was a mean improvement of 8 ± 1.2 elevations (p = 0.002) to 30CST and 10 ± 2 elevations (p = 0.01) of the dominant limb to TME2 in the post-intervention values, with Borg subjective scale to 2MWT falling from 5 to 3 during testing after intervention.
Conclusions: A home-based post-covid 19 rehabilitation program promotes improvement in functional capacity, proving to be an applicable and beneficial intervention method for these patients.
110374
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
FERNANDA SAHAR LUCAS VIDAL DOMECG2, Fabricio Braga da Silva1, Marcelo Kalichsztein3, Gustavo Nobre3, José Kezen3, Gabriel Espinosa1, Christiane Prado1, Marcelo Faccio1, Illan Gotlieb3, Ronaldo Leão Lima2
(1) Laboratório de Performance Humana; (2) Universidade Federal do Rio de Janeiro; (3) Casa de Saúde São José
Background: Limited exercise capacity (LEC) is a prevalent complaint in COVID-19 survivors. The cardiopulmonary exercise test (CPET) is the gold standard in determining LEC mechanisms.
Objectives: To analyze LEC mechanisms in COVID-19 survivors of different clinical severities and compare them with a non-COVID-19 control population.
Materials and methods: Cross-sectional analysis of CPET was performed between July/19 and March/21. Patients were divided into 3 groups: mild COVID-19(L-Cov; outpatient treatment); Severe COVID-19(G-Cov; hospital admission) and non-COVID-19(N-Cov; CPET performed before the start of the pandemic). LEC was defined as VO2 <85% of predicted at peak exercise and classified as: cardiocirculatory(CC), ventilatory(VEN), mixed(MIX; a combination of CC and VEN), or aerobic deconditioning(AD). Furthermore, the prevalence of findings suggestive of vascular-pulmonary involvement(Vas-Pul) was compared between the groups. Based on the values of end-tidal CO2 pressure and the ratio between ventilation and CO2 production, patients were classified at the first ventilatory threshold according to the probability of Vas-Pul involvement as non-suspected, suspected, likely, and very likely.
Results: 702 patients were included(61.1% men; 52.1 ± 14.3 years), 310(44.2%); 305(43.4%) and 87(12.4%) N-Cov, L-Cov and G-Cov, respectively. Table 1 shows the LEC mechanisms between the groups(χ2 = 3.76; df = 6;p = 0.709). Table 2 shows the probability of Vas-Pul involvement(χ2 = 34.26; df = 6; p < 0.001). In the posthoc analysis, a probable and very likely pattern was higher in the G-Cov group (p < 0.05).
Conclusion: AD was the main mechanism of exercise limitation, followed by cardiocirculatory, ventilatory and mixed limitation (CC+Vent.).
110375
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
BRUNO RAMOS NASCIMENTO1, BRUNO RAMOS NASCIMENTO, Maria Carmo Pereira Nunes1, Nicholas Ollberding2, Allison Hays3, Pranoti Hiremath3, Federico Asch4, Chad League4, Chris Fung5, Laurie LeBouef5, Craig Sable6, Andrea Zawacki Beaton2
(1) Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte – MG, Brazil; (2) The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati – OH, United States; (3) Cardiology, The Johns Hopkins Hospital, Baltimore – MD, United States; (4) The Heart and Vascular, MedStar Washington Hospital Center, Washington – DC, Unites States; (5) Cardiovascular Center, University of Michigan Hospital, Ann Harbor – MI, United States; (6) Cardiology, Children’s National Health System, Washington – DC, United States
Introduction: Cardiac involvement impacts prognosis of COVID-19, especially in critically ill patients. We aimed to assess the prognostic value of limited cardiac assessment by bedside triage echocardiography (echo) in patients admitted to emergency departments (ED) in the United States with COVID-19.
Methods: Patients admitted in 4 reference US EDs with confirmed COVID-19 underwent triage echo within 72h of symptom onset, with remote interpretation. Clinical and laboratory data, as well as COVID-19 symptoms, were collected. A comprehensive echo protocol, with quantitative assessment, was applied in high-resource units, while low-resource EDs utilized a focused qualitative protocol. Association between echo variables, demographics and clinical data with all-cause mortality and intensive care unit (ICU) admission was assessed; factors significant at p < 0.10 were put into multivariable models.
Results: A total of 399 patients were enrolled (137 from low-resource EDs), 41% women, with a mean age of 62 ± 16 years. Mean oxygen saturation on presentation was 92.3 ± 9.2%, and the average number of comorbidities was 2.1 ± 1.7. Compared to survivors, non-survivors were older (68 ± 12 vs. 60 ± 17 years, p < 0.01), had lower oxygen saturation (88.8 ± 12.0% vs. 93.1 ± 8.2%, p < 0.01), were more likely to have a chronic condition (2.6 ± 1.6 vs. 2.0 ± 1.7 comorbidities, p = 0.01) and had lower LV ejection fraction (50.3 ± 19.7 vs. 58.0 ± 13.6, p < 0.01). 101 (25%) patients had moderate/severe LV dysfunction and 131 (33%) had moderate/severe RV dysfunction. Older and lower oxygen saturation were independently associated with death (OR = 2.14 (95%CI 1.06–4.32) and OR = 0.67 (95%CI 0.53–0.85), respectively) and ICU admission (OR = 0.65 (95%CI 0.46–0.94) and OR = 0.48 (95%CI 0.37–0.64)). No echo variables, including LV and RV function, were independent predictors of outcomes. The mortality model comprised of age, sex, count of co-morbid conditions, and oxygen saturation, had a C-statistic = 0.68 and Brier score = 0.14. The inclusion of LV/RV dysfunction, and pericardial effusion did not improve performance (C-statistic = 0.67, Brier score = 0.15). A similar pattern was observed for the ICU admission model.
Conclusion: In patients admitted with COVID-19 and undergoing early echo triage, independent predictors of death and ICU admission were age and oxygen saturation. Despite differences in baseline LVEF, no echo variables were independently associated with unfavorable outcomes.
109741
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
MARCELO SABEDOTTI1, Bibiana Guimarães Maggi2, Gabriel Almeida Krul2, Elisa Rocha Nonemacher2, Rafaela Oliveira Leite2
(1) Unimed Nordeste; (2) Fundação Universidade de Caxias do Sul
Introduction: Percutaneous patent foramen ovale (PFO) closure effectively prevents embolic ischemic stroke. However, most studies do not include patients over sixty years of age. This group of patients usually has other causes of ischemic stroke, the main ones including cardiac arrhythmias, small cerebral vessel disease, and atherosclerosis. The present study aims to support the hypothesis that PFO closure is safe in patients over 60 years of age.
Objective: To assess the safety of percutaneous PFO closure in patients over sixty years.
Methods: A retrospective, single-center cohort study. Patients aged over sixty years who underwent percutaneous PFO closure to prevent recurrence of cerebrovascular events at Hospital Unimed Nordeste do the Rio Grande do Sul, between September 2019 and January 2022 were included.
Results: From June 2019 to March 2022, 15 patients were submitted to percutaneous PFO closure (Table 1), with a mean age of 70 ± 7 years, 60% were female. All patients had PFO with ISA, transcranial ultrasound (TU) with more than 100 high-intensity signals (HITS), Holter without atrial fibrillation, and hematological investigation without coagulopathies. As for medications, 53.3% of patients were being treated with Acetylsalicylic Acid (ASA) associated with clopidogrel and 46.7% using anticoagulants being 26% Dabigatran, 13% Apixaban, and 6% Rivaroxaban. Two days before the procedure and three months after, all remained with ASA and clopidogrel. There weren‘t any complications during the procedure. In 30 days, echocardiographic control showed a foramen completely occluded, without a residual shunt.
Conclusion: The procedure for closing PFO in patients over 60 years of age is effective and safe. Careful evaluation is important, including shunt quantification by TU, exclusion of coagulopathies, arrhythmias, and atherosclerotic causes of ischemic stroke. A high-risk PFO morphology can also influence the decision to carry out closure. Data from studies in patients over 60 years of age are limited and additional studies are needed to assess the benefits of this treatment as the population grows old.
109758
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ERLON OLIVEIRA DE ABREU SILVA1, Erlon Oliveira de Abreu-Silva1, Angela C. Bersch-Ferreira1, Rachel H. Vieira Machado1, Lucas R. Silva1, Erica R. Ribeiro Sady1, Debora H. Kodama Miyada1, Bernardete Weber1, Aline Marcadenti1
(1) Hcor Research Institute (IP-Hcor), Hcor, São Paulo, São Paulo, Brazil.
Background: Differences between sexes regarding therapeutic targets of lipid profile in populations at very high cardiovascular risk are not fully elucidated.
Objective: To evaluate the association between sex and therapeutic targets for LDL-cholesterol (LDL-c) and non-HDL-cholesterol (NHDLc) in individuals diagnosed with acute myocardial infarction (AMI).
Methods: Cross-sectional analysis with baseline data from a multicenter randomized clinical trial (DICA-NUTS Trial, NCT03728127) conducted among subjects ≥40 years with previous AMI (60 to 180 days). Sociodemographic, clinical and lifestyle data were collected using specific questionnaires. Therapeutic goals of LDL-c (<50 mg/dL) and NHDLc (<80 mg/dL) were defined according to American Heart Association guidelines. Binary logistic regression was used to evaluate potential associations adjusted for confounders.
Results: In total, 471 individuals with a mean age of 59.6 ± 9.3 years were evaluated; 72.2% were men, the estimated monthly household income was US$ 180.00, 10.2% were smokers and 61.8% had AMI with ST-segment elevation (STEMI). The prevalence of married individuals was higher among men compared to women (61.5% and 45.8% respectively, P = 0.001), and among women there were higher proportions of high levels of physical activity (35.9% vs. 22.9%, P = 0.003) and from lower social classes (D/E classification) (68.7% vs. 53.2%, P = 0.002). The use of simvastatin was more frequent (52.4%), followed by rosuvastatin (21.4%) and atorvastatin (21%), with no difference between men and women. Among men, 14.4% and 18.2% had LDL-c and NHDL-c concentrations in line with the recommended targets; these prevalences were higher than those observed in women (LDL-c: 6.9% [P = 0.028]; CNHDL: 8.4% [P = 0.007]). After adjusting for age, marital status, social class and physical activity levels, there was an association between male sex and achieving therapeutic targets for NHDL-c (OR 2.04; 95%CI 1.003–4.15), but not for LDL-c (OR 1.84; 95%CI 0.84–4.03). However, being in lower social classes conferred a 74% lower chance of reaching LDL-c targets (OR 0.26; 95%CI 0.07–0.92) and 81% lower chance of reaching NHDL-c targets (OR 0.19; CI95% 0.06–0.59) regardless of age, sex, marital status, and levels of physical activity.
Conclusions: There are differences between sexes regarding therapeutic targets for LDL-c and NHDL-c. However, social class appears to be a major determinant.
109784
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
RAFAEL BUARQUE DE MACÊDO GADÊLHA1, Mirela Ávila Litvin1, Lucian Batista de Oliveira1, Cybelle Luza Costa1, Jessica Myrian de Amorim Garcia1, Francisco Bandeira1
(1) Hospital Agamenon Magalhães
Introduction: Heart failure (HF) is associated with a higher risk of osteoporotic fractures, with few studies evaluating the factors related to this increase. The trabecular bone score (TBS) is a tool to assess bone microarchitecture, appearing as an independent predictor of fracture risk and gaining greater importance in populations where there is an increased risk of these events even with preserved bone mineral density (BMD).
Objectives: To evaluate TBS in elderly patients with HF, comparing it with BMD results and with echocardiographic and body composition parameters.
Methodology: Observational, cross-sectional and analytical study involving elderly individuals (≥65 years) diagnosed with HF, followed up in a cardiology service from August 2020 to August 2021. Patients with contact isolation, lipodystrophies or body mass index >37 kg/m² were excluded. All were submitted to dual energy X-ray absorptiometry (DXA) for analysis of body composition, BMD and TBS.
Results: Sixty patients were evaluated, with a mean age of 73.4 ± 5.3 years, 51.7% of which were female. The mean left ventricular ejection fraction (LVEF) was 46.5 ± 16.1%, with 40% having reduced LVEF (<40%). BMD showed osteoporosis (T-Score ≤ –2,5) in 38.3% and osteopenia (T-Score between –1.0 and –2.5) in 46.7%, while TBS showed bone degradation (TBS < 1,230) by 35% and partial degradation (TBS between 1.230 and 1.310) by 30%. There was a statistically significant association between some degree of degradation indicated by TBS with lower lumbar spine BMD (0.99 ± 0.22 g/cm² × 1.21 ± 0.24 g/cm²; p < 0.001), femoral neck (0.78 ± 0.15 g/cm² × 0.88 ± 0.08 g/cm²; p < 0.001) and total femur (0.86 ± 0.16 g/cm² × 0.98 ± 0.13 g/cm²; p = 0.006). There was no association between degraded/partially degraded TBS and lower LVEF means (47.49 ± 16.42% × 44.50 ± 15.66%; p = 0.523). Regarding body composition, an association was observed between degraded/partially degraded TBS with lower means of lean mass in the upper limbs (4.47 ± 1.04 kg × 5.16 ± 1.50 kg; p = 0.041).
Conclusion: Low BMD and changes in bone microarchitecture are frequent in elderly patients with HF. Degradation of bone microarchitecture was associated with a reduction in appendicular lean mass.
109799
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
FIRMINO HAAG FERREIRA JUNIOR1, Rosa Maria da Costa Simões1, Diany Priscilla Oliveira1, Carolina Vieira1
(1) Hospital Geral de São Mateus
Objective: To analyze the accuracy index of electrocardiogram reports performed in Intensive Care, reported by an artificial intelligence platform, compared with reports performed by cardiologists in person. The electrocardiograms were randomly assigned and reported “blind” to the results provided by the artificial intelligence, and then both results were compared.
Results: Thirty (30) electrocardiograms of different patients were analyzed, randomly chosen, admitted to an intensive care unit, with a baseline diagnosis of cardiovascular diseases. Among the electrocardiograms analyzed, artificial intelligence was able to accurately diagnose 16 (sixteen) cases of inactive zone/myocardial infarction, 2 (two) cases of ST segment elevation, 2 (two) cases of atrial flutter, 5 (five) cases of atrial fibrillation, 5 (five) cases of diffuse changes in ventricular repolarization, 1 (one) case of left ventricular overload, 1 (one) case of anterior superior divisional hemiblock. Artificial Intelligence was able to identify electrode failures, as it did not consider the report. There was 100% compatibility of the artificial intelligence reports with the reports prepared by the cardiologists in person.
Conclusion: The introduction of new technologies such as artificial intelligence producing reports in electrocardiography is of significant importance, due to the reliability of the reports presented, not different when compared with reports prepared by experienced cardiologists in person, being therefore an important tool in helping to physicians in identifying and confirming the diagnosis, especially for non-specialists, often present in emergency services and intensive care units.
109805
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
CLAUDIA FETTER1, Maria Cláudia Irigoyen3, Liliane Appratto de Souza1
(1) Instituto de Cardiologia do Rio Grande do Sul; (2) TECNOPUC/RS; (3) Incor/USP
CardioBreath is an application for mobile and tablets available at Google Play and Apple Store (only in Portuguese). This application prescibes, teaches and evaluates slow deep breath for health and performance. The main objective of Cardiobreath is to offer to users an option for practicing respiratory exercises at rates slower than individual spontaneous rate in order to increase vagal modulation, decrease arterial pressure, increase strenght and resistance of respiratory muscles and cardiorespiratory fitness. Together these benefits may represent great achievements in health and performance. Handling CardioBreath App allows the user to be in touch with their own biological signals like respiratory rate and heart rate. For slow breath exercises prescription, some biological information like age, gender, weight, height (and body mass index is calculated inside the app), and including other conditions like smoking, sedentary life style, hypertension, diabetes, obstructive sleep apnea and cardiopaty make a score that drive users to their more reccomendable band of respiratory exercise. Users may chose on position: sit, standing or lying. Audio lessons are available about posture and respiratory technique (victoriuous brath/ujjayi pranayama from yoga). The prescription includes basic, intermedium and advanced exercises in order to identify progression stages. There is the option for the user to chose the respiratory exercise rate (cycles per minutes). The respiratory frequencies of exercise may vary from 15 to 2 cycles per minute using a metronome, either visual as bell sign, or audio lesson recorded. Other option is four frequencies of exercise with respiratory hold (or pause), either in inspiratory or expiratory hold, with metronome, bell or audio lesson. Users may follow their progress by a graphic of exercise respiratory rate X time of exercise, and other functionality available is heart rate before and after the exercises, which are also represented in graphic. And the most easy lesson of the application is available at the first screen, is the 17 minutes guided relaxation based on a specific miofascial and visceral relaxation. CardioBrreath was created in 2018 and a second version is being developed through a grant (Programa doutor Empreendedor/FAPERGS/CNPQ SEBRAE) and will be availabe in June. Any other information may be found at www.cardiobreath.com and includes more functionalities and gamification in order to increase adherence of users.
109813
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
FIRMINO HAAG FERREIRA JUNIOR1, Rosa Maria da Costa Simões1, Diany Priscilla de Oliveira1, Carolina Vieira1
(1) Hospital Geral de São Mateus
Objective: To analyze the main diagnoses found through the use of an artificial intelligence platform for electrocardiogram reports performed in adult intensive care. Patients were randomly selected from November 2021 to March 2022.
Results: Seventy-one (71) electrocardiograms of randomly chosen patients admitted to an intensive care unit with a baseline diagnosis of cardiovascular disease were analyzed. Among the analyzed electrocardiograms, artificial intelligence was able to accurately elaborate the main diagnoses: 13 (thirteen) patients had electrocardiographic alterations compatible with diffuse alteration of ventricular repolarization; 09 (nine) patients had a diagnosis of acute myocardial infarction with ST segment elevation; 12 (twelve) patients had atrial fibrillation; 7 (seven) patients had a diagnosis of subepicardial ischemia and 01 (one) patient had a diagnosis of atrioventricular block. Of the cases analyzed, 28 patients had an electrocardiogram within the normal range. Artificial intelligence was able to identify electrode failures, as it did not consider the report. There was 100% compatibility of the Artificial Intelligence reports with the clinical diagnoses of the patients.
Conclusion: In addition to the precise diagnosis that allowed guiding directed procedures in each case, artificial intelligence was significantly important due to the reliability of the reports presented, helping physicians in the identification and confirmation of the diagnosis, becoming an important tool in the approach of critical patients for physicians not specialists working in intensive care units
110123
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
JULIANA DE MELO VELLOZO PEREIRA TINOCO1, Ana Carla Dantas Cavalcanti1, Bruna Lins Rocha de Padua1, Beatriz Paiva e Silva de Souza1, Tereza Cristina Felippe Guimarães2, Evandro Tinoco Mesquita1
(1) Universidade Federal Fluminense; (2) Instituto Nacional de Cardiologia
Background: Heart failure (HF), a syndrome that requires complex therapeutic regimens, is associated with high rates of hospitalization. Transitional care programs are crucial for encouraging patients to practice self-care and for minimizing preventable readmissions. These interventions are essential in promoting self-care for HF hospitalized patients. However, brazilian clinical evidence on patients from The “Sistema Único de Saúde” is still scarce.
Objective: To compare the effect of intervention with transitional care versus conventional hospital follow-up on self-care skills, knowledge of the disease, quality of life and depressive symptoms of patients hospitalized with HF.
Methods: A blind, randomized clinical trial of 74 patients with HF admitted to two quaternary-care hospitals in Rio de Janeiro was conducted. Criteria for inclusion: age ≥ 18 years; clinical diagnosis of HF, irrespective of etiology; hospitalization for decompensated HF. Criteria for exclusion: hemodynamic instability; neurological/cognitive impairment reported in medical records; participation in previous studies involving educational interventions; perioperative hospitalization; transfer to another hospital; undergoing preparation for heart transplantation. The intervention group (IG) received transitional-care follow-up in the form of five encounters during hospitalization and weekly post-discharge telephone calls for four weeks. The control group (CG) received conventional hospital follow-up. Outcomes scored: self-care, quality of life, knowledge of the disease and depressive symptoms within 30 days post-discharge. Blinding was achieved by designating separate teams for evaluation, randomization, and intervention. Sample size calculation was based on a pilot study of 70 patients. Data were treated with repeated-measures ANOVA and Fisher’s exact test.
Results: Thirty days post-discharge, the scores for IG patients, compared with CG counterparts, were higher for self-care maintenance (74.3 vs. 44.2; p < 0.001), self-care confidence (79.3 vs. 56.4; p < 0.001), knowledge of the disease (41.3 vs. 27.5; p < 0.001), and lower for quality of life (42.1 vs. 64.5; p < 0.001). There was no effect on self-care management skills and depressive symptoms.
Conclusion: The transitional-care program improved the outcomes self-care maintenance, self-care confidence, knowledge of the disease and quality of life. Study is registred in Brazilian Registry of Clinical Trials (RBR-2dpc6b).
109845
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
RENÉE SARMENTO DE OLIVEIRA1, Renée Sarmento de Oliveira1, Renata Junqueira Moll Bernardes1, Adriana Soares Xavier de Brito1, Paulo Henrique Rosado de Castro1, Martha Valéria Tavares Pinheiro1, Sergio Salles Xavier2, Otacilio da Cruz Moreira2, Flavia Vernin de Oliveira Terzi1, Andréa Silvestre de Sousa1
(1) Instituto D’or de Pesquisa e Ensino; (2) Instituto Oswaldo Cruz/Fiocruz
Background: Chagas cardiomyopathy is the most frequent and potentially severe manifestation of Chagas disease, with the highest morbidity among neglected tropical diseases. Although endemic in Latin America, it has become a global problem due to the migration of individuals to non-endemic areas. Sudden death is the main mechanism of death in chronic Chagas cardiomyopathy, being associated with ventricular tachycardia and may even occur in patients in the early stages of heart disease. In addition to fibrosis, persistent inflammation may be implicated in the genesis of arrhythmias. Strategies that identify patients at greater risk of developing complex ventricular arrhythmias in their different mechanisms of presentation would be able to guide the prophylaxis of sudden death more appropriately in chronic Chagas cardiomyopathy. Recent studies showed promising results using radionuclide imaging for the identification of areas of inflammation in the myocardium of patients with non-ischemic cardiomyopathies, such as sarcoidosis.
Objective: To correlate the presence of persistent myocardial inflammation with FDG-18F and DOTATOC-68Ga PET-CT with the severity of ventricular arrhythmias and the presence of parasite in patients with chronic Chagas‘ heart disease.
Methods: Two groups were included, totaling 24 patients. Group 1 consisted of patients with sustained ventricular tachycardia who required implantable cardioverter-defibrillator (ICD). Group 2 was the comparison group composed of patients at the same stage of Chagas heart disease (B1, B2 and C) but without complex ventricular arrhythmia. All patients underwent FDG-18F and DOTATOC-68Ga PET-CT, Holter, and polymerase chain reaction for trypanosoma cruzi.
Results: The presence of the parasite in chronic Chagas cardiomyopathy was higher in patients from the ICD group (66.7%) compared to group 2 (33.3%). There was no statistical difference between the uptake of FDG-18F and DOTATOC-68Ga by PET-CT in both groups. Physiological increased uptake of FDG-18F may have jeopardized the analysis in some patients.
Conclusion: The persistence of chronic parasitemia in Chagas‘ heart disease may be implicated in the genesis of arrythmia, increasing the risk of sustained ventricular arrhythmia; however, larger studies are necessary to investigate this association. PET-CT with FDG-18F and DOTATOC-68Ga are not currently recommended as markers or inflammation in Chagas cardiomyopathy.
111116
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
ADELLE CRISTINE LIMA CARDOZO1
(1) Federal University of Sergipe; (2) Rede D’Or São Luiz – São Lucas Hospital; (3) Primavera Hospital
Introduction: Despite advances in treatment, chronic coronary syndrome (CCS) persists as an important cause of morbidity and mortality worldwide. There is evidence of the influence of the disposition to forgive in the processes of illness and healing of patients with cardiovascular disease, including myocardial ischemia.
Objectives: To evaluate the willingness to forgive in patients with CCS and its association with Spirituality/Religiosity.
Methodology: This is an observational, cross-sectional, analytical study, whose sample included patients with CCS assisted at the cardiology outpatient clinics of three hospitals in Sergipe. Two scales were applied: DUREL (Duke Religious Index) and the BMMRS (Brief Multidimensional Measure of Religiosity and Spirituality), whose domain number 3 assesses forgiveness. This domain is composed of three items: I) disposition to self-forgiveness; II) disposition to forgive those who offend us; III) belief in God’s forgiveness. Each item has an ordinal scale from 1 to 4, corresponding to responses: Never, Rarely, Often, and Always, respectively. The level of forgiveness is determined from the sum of the three items and ranges from 3 to 12. Student’s t test was used for comparison between the groups, with the significance level set at 0.05.
Results: Fifty-three patients with CCS were included, of which 50.9% were female. The mean age of patients was 62.2 ± 10.5 years. Regarding the clinical profile, 81.1% were hypertensive, 80.0% dyslipidemic and 46.2% had diabetes mellitus. Regarding the religious profile, 65.4% were Catholic, 23.1% Evangelical, 5.8% Spiritualist, 1.9% Umbandaist, 1.9% Atheist, and 1.9% believed in God but did not belong to any religion. The patients‘ religiosity was evaluated using the DUREL, and was divided into organizational, non-organizational, and intrinsic religiosity. Patients with high levels of organizational religiosity, non-organizational religiosity, and intrinsic religiosity showed higher levels of forgiveness compared to patients with low levels of religiosity in these categories (11.1 vs. 9.8; p < 0.05) (10.8 vs. 7.0; p < 0.001) (11.0 vs. 8.7; p = 0.001).
Conclusions: The results show that CCS patients who have higher levels of religiosity are more likely to forgive themselves, forgive others, and believe in divine forgiveness when compared to patients with lower levels of religiosity.
109864
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
ELLEN HETTWER MAGEDANZ1, João Carlos Vieira da Costa Guaragna2, Luciano Cabral Albuquerque4, Fernanda Lourega Chieza3, Brenda Gonçalves Donay1, Luize Mancuso Silva1, Jasseane De Borba Sparremberger Vitt1, Luiz Carlos Bodanese1
(1) PUCRS; (2) Hospital Divina Providência; (3) Santa Casa de Misericórdia de Porto Alegre; (4) Hospital São Lucas PUCRS
Introduction: Stroke is a complication that causes considerable morbidity and mortality during the heart surgery postoperative period (incidence: 1.3 to 5%; mortality: 13 to 41%). Models for assessing the risk of stroke after heart surgery have been proposed, but most of them do not evaluate postoperative morbidity.
Objective: The aim of this study was to develop a risk score for postoperative stroke in patients who undergo heart surgery with cardiopulmonary bypass.
Methods: A cohort study was conducted with data from 4,862 patients who underwent surgery from 1996 to 2016. Logistic regression was used to assess relationships between risk factors and stroke. Data from 3,258 patients were used to construct the model. The model’s performance was then validated using data from the remainder of the patients (n = 1,604). The model’s accuracy was tested using the area under the receiver operating characteristic (ROC) curve.
Results: The prevalence of stroke during the postoperative period was 3% (n = 149); 59% of the patients who exhibited this outcome were male, 51% were aged ≥ 66 years, and 31.5% of the patients died. The variables that remained as independent predictors of the outcome after multivariate analysis were advanced age, urgent/emergency surgery, peripheral arterial occlusive disease, history of cerebrovascular disease, and cardiopulmonary bypass time ≥110 minutes. The area under the ROC curve was 0.71 (95% confidence interval 0.66–0.75).
Conclusion: We were able to develop a risk score for stroke after heart surgery. This score classifies patients as low, medium, high, or very high risk of a surgery-related stroke.
110935
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
ELISA ALBERTON HAAS1, Elisa Alberton Haas1, Wilson José Fernandes Lemos Junior2, Laura Treu3, Andrey Santos4, Mário José Abdalla Saad4, Francisco Rafael Martins Laurindo1, Protásio Lemos da Luz1
(1) Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; (2) Faculty of Science and Technology, Libera Università di Bolzano, Bolzano, Italy; (3) Biology Department, University of Padova, Italy; (4) Department of Internal Medicine, State University of Campinas (UNICAMP), Campinas, SP, Brazil
Background: Regular physical activity supports cardiovascular disease (CVD) prevention through mechanisms that include: influences on inflammatory profile, on the autonomic nervous system and endothelial modifications. One potentially beneficial and overlooked mechanism of physical activity is its effects on the gut microbiota.
Methods: This was a cross-sectional cohort analysis of 39 participants of a larger cohort (registered at ClinicalTrial.gov, NCT03232099), evaluating their baseline characteristics. Participants had established coronary artery disease (CAD), were male, aged 46–69 years, had BMI < 30, were stable and non-symptomatic. The cohort was divided into two groups: 21 physically active (PA) participants and 18 physically inactive (PI). The gut microbiota was evaluated with 16S amplicons, and the level of self-reported physical activity was calculated in metabolic equivalents (MET)-hour/week score (METs.h/wk). Patients were considered physically active when levels of Mets.h/wk were >5. A 3-day food frequency questionnaire obtained nutritional information regarding total calories, macronutrients and micronutrients.
Results: The gut microbiota profile of PA and PI individuals were clearly separated by sparse partial least squares discriminant analysis. The main taxa that differed the PA group were Ruminococcaceae_UCG-014 and Coprococcus_2 eutactus, which are associated with reduced visceral adiposity and with butyrate production, respectively. Meanwhile, nutrient consumption was similar in the two groups.
Conclusions: In patients with CAD, physical activity was associated with different and putative beneficial gut microbiota profile. These findings indicate that gut microbiota modifications further support the healthy mechanisms promoted by physical activity to reduce CVD.
109902
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
ADRIANA DA COSTA COELHO1, Dasymar Martins da Silva Lucas1, Milena Preissler das Neves1, Geovane de Kassio Nunes2, Renata Flavia Abreu da Silva3
(1) Federal Hospital for State Servants – HFSE; (2) Hospital Pro Cardiac; (3) Federal University of the State of Rio de Janeiro – UNIRIO
Introduction: The oral anticoagulants are widely prescribed drugs for treatment and prophylaxis of thrombotic diseases, and the antagonists of vitamin K, such as Warfarin, the main protagonists of this pharmaceutical class. Anticoagulation therapy requires specific knowledge from the nursing team for its safe management and training in service is necessary for the improvement of a qualified care, and constitutes a foundation between practice performed by the professionals and their instrumentalization.
Objective: Describing the validation of an educational strategy for capacitation of the nursing team on the management of oral anticoagulants.
Method: Methodological study with elaboration of tools such as word search puzzles and a checklist to be performed by the nursing team in the administration of oral anticoagulants, that was based on an integrative review. The theoretical validation of the products by experts was made by online questionnaire. The content validity index acceptable must be higher than 0.70.
Results: The 16 experts agreed to take part in the research and evaluate the tools. The subject’s profiles were: nurses with professional degrees between 14 and 20 years (43,8%) and working with anticoagulants between 8 and 11 years (37,8%); 8 (50%) of them participated in scientific events about oral anticoagulants in the last 5 years. The Content Validity Index by the experts was 0.83. The suggestions were accepted and modified for the final version of the tools. The statements that showed greater agreement (93,4%) were the ones stating the Content, that included nursing care management. The one that had the minor agreement was the item about the Title clarity (73,4%). Despite the high level of agreement, some experts suggested a few improvements to the word search puzzle, such as: replace the “Stop” sign carried by the character for an “Attention” one, and re-elaborate some sentences.
Conclusion: The word search puzzle has been theoretically validated, therefore it should be used as an educational strategy for the patient’s care in use of the oral anticoagulation by the nursing team.
109914
Modality: E-Poster Researcher – Non-case Report
Category: PHYSICAL EDUCATION
CLAUDIA FETTER1, José Antonio Caçapietra Reteguy1, Juliana Bertoletti1
(1) Instituto de Cardiologia do Rio Grande do Sul
Introduction: Sedentary lifestyle presents deleterious effects over human health and this condition may be reverted through the regular practice of physical exercise. Regular exercise practice offers benefits beyond physical health, with evidence to the improvement of psychosocial factors such as anxiety, depression and stress. Gyms are places destined to the practice of physical exercises, although most of it does not perform the follow-up of benefits to physical and mental health. Besides that, the strong appeal to the search of the perfect body very prevalent in this environment may exert a reverse effect of dissatisfaction with body image.
Method: This pilot study about the viability of follow up of hemodynamic measures (blood pressure and heart rate) psychosocial factors through the DASS-21 (anxiety, depression, stress) and (brazilian scale of silhouette (body image) in gyms recruited 24 sedentary individuals for 4 weeks (men and women) with two weekly sessions of resistance exercises, and evaluated these psychosocial factors in order to verify the efficacy of the exercises and the viability of the follow up. 24 individuals, 12 women with mean age of 51 years and 12 men with mean age of 45 years took part in this research, assessed in one moment (T1) pre wash out of 4 weeks maintaining the sedentary condition, moment T2 immediately before initiating exercise and moment T3 at the end of the exercise intervention. The instruments used for the assessment were: Depression, Anxiety and Stress Scale (DASS-21) and the Brazilian Scale of Silhouettes for Adults. Data analysis was performed by GEE and significance level of p 0,05.
Results: The results of the assessments of T3 were significant in relation to T2 for the variables Body Mass Index (BMI), Systolic Arterial Pressure (SAP) and Diastolic (DAS) and the three variables of DASS 21(anxiety, depression, stress) and relation of actual silhouette to body mass index, both for women and men.
Conclusions: These results suggest that the practice of two weekly sessions of resisted exercise for 4 weeks may have a beneficial effect over psychosocial factors and that it is viable and recommended to implement the follow up of these variables in the context of gyms. Besides, the difference between actual silhouette and BMI very much closer at moment T3 suggests that the positive effect of exercise plays an important role over body image. Data found about blood pressure are promising but better understanding is needed.
109930
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
FÁBIO TANIL MONTREZOL1, Daniel Bannel2, Helen Jones2, Alessandra Medeiros1, David Low2
(1) Federal University of Sao Paulo; (2) Liverpool John Moores University
Ischemic events can cause damage. However, reperfusion can cause more damage. This cluster of injuries are named ischemia/reperfusion injury (IRI). Studies show that short intermittent periods of ischemia can produce beneficial effects, named ischemic preconditioning (IPC), this strategy can reduce the area and injury severity. In humans, IPC have shown reductions on the deleterious effects of an IRI, including in the myocardium. In animal models, previous IPC can preserve systolic function after an IRI. IPC can be applied only remotely (R-IPC) in humans to preserve the myocardium. Then, resistance exercise can be a potential toll to produce such effect. The present study aimed to compare the effects of R-IPC and resistance exercise in lower limbs on the vascular function after a bout of IRI. 13 participants aged 23.61 ± 2.95 (Young group – YG) and 7 participants aged 62.83 ± 2.63 (Elderly group – EG) were evaluated. The protocol was approved by the Liverpool John Moores University (19/SPS/025). Participants showed at the lab in 3 non-consecutive days with interval of at least 72 hours during the morning. The sessions were randomized. Session structure was: participants rested for 20 minutes, then underwent to a brachial artery flow-mediated dilation analysis (FMD), then received the experimental treatment: Control visit rested for 40 minutes, R-IPC visit, cuffs were placed at the medial part of the thighs then inflated for 5 minutes at a pressure of 220 mmHg and deflated for 5 minutes for 4 times, at the Squatting visit performed 5 minutes of squatting without load with cadence of 20 squats per minute and rested for 5 minutes for 4 times. After, for the IRI, a cuff was placed in the humeral midpoint and inflated at 220 mmHg for 15 minutes, after deflation, the reperfusion occurred for 15 minutes. Then, FMD was repeated. 2-factor analysis of variance was performed, p ≤ 0.05. Results are shown in figure 1. We concluded that IRI can produce temporary vascular dysfunction, such dysfunction can be abolished by R-IPC in young adults and in elderly resistance exercise can abolish deleterious effects of IRI.
109955
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
JACQUELINE VAZ ALENCAR1, Emily Justiniano6, Nicole Saldanha de Souza5, Liliana Fortini Cavalheiro Boll1, Luiza Junqueira Trarbach Lovato2, Renata Póvoas3, Danielle Dias8, Fernanda Consolim-Colombo4, Katia de Angelis8, Maria Cláudia Irigoyen3
(1) Instituto de Cardiologia da Fundação Universitária de Cardiologia (IC/FUC) – Porto Alegre, RS – Brasil; (2) University of Technology Sydney (UTS) – Austrália, Sidney; (3) Instituto do Coração da FMUSP (InCor) – São Paulo, SP – Brasil; (4) Universidade Nove de Julho (Uninove) – São Paulo, SP – Brasil; (5) Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) – Porto Alegre, Rio Grande do Sul – Brasil; (6) Hospital de Clínicas de Porto Alegre (HCPA) – Porto Alegre, RS – Brasil; (8) Universidade Federal de São Paulo (Unifesp) – São Paulo, SP – Brasil
Background/Introduction: Hypertension is asymptomatic in childhood and adolescence. We used REDCap to organize the Multicenter Registry of Hypertension in Children and Adolescents (HASCA) survey. Nine Teaching/Health/Research, distributed in different regions, participated in data collection at the national level.
Purpose: This study analyzes the national data reported from the REDCap platform and optimizes the obtained results.
Methods: This is a Longitudinal observational multicenter study of the registry type using the REDCap platform to implement data from 9 national centers, with children and adolescents aged 7 to 18 years, both genders, from public or private schools, with altered blood pressure indicative of hypertension in any level. On the REDCap platform, the input of the data occurred in different stages: – Screening: form for collecting identification data, anthropometric data, and blood pressure values. – Confirmatory: confirmation of blood pressure values. – Registry: one-year follow-up and systematic data collection. The data were collected electronically and inserted in the REDCap software, a safe methodology. The study follows ethical principles and guidelines for good clinical practice.
Results: The HASCA Registry CRF consists of a total of 180 questions. Screening data were collected from July 2018 to December 2019, with 4398 Brazilian children and adolescents, of which 915 had high BP at least twice.
Conclusions: It is possible to make a report with HASCA information generated throughout Brazil by Regions, Coordinating Centers, or by Schools to identify where and which children have high blood pressure levels and need to be monitored.
109983
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
GILMARA RIBEIRO SANTOS RODRIGUES1, Fernanda Sampaio Novaes2, Gabriella da Cruz Silva Dias2, Cláudio Luiz Anunciação Santos Junior2, Paula Silva Peixoto2, Luciana Feitosa1
(1) Universidade Federal da Bahia; (2) Escola Bahiana de Medicina e Saúde Pública
Introduction: Spirituality as an object of study of science in the health area is a recent approach. It consists of an individual’s strategy to transcend the process of illness, losses and existential emptiness. It is anchored in Brazilian culture and is part of common sense, influencing beliefs, behaviors and worldview. It was considered the assumption that there is a possibility of spirituality influencing the adherence to treatment of people with arterial hypertension and diabetes mellitus.
Objectives: To identify whether the representations of people with arterial hypertension and diabetes mellitus about religiosity/spirituality can influence non-adherence to treatment and describe the religious/spiritual practices of these people.
Method: Qualitative and quantitative exploratory research, carried out at a philanthropic medical center in the city of Salvador, Bahia, Brazil, in 2019. Participants were individuals over 18 years of age with arterial hypertension and diabetes. Data were collected through semi-structured interviews and the Drawing-Story with Theme procedure. A form consisting of three sections was used, the first with an approach to sociodemographic and clinical characterization data. The second with the guiding questions: (1) How does religiosity/spirituality influence adherence to the treatment of arterial hypertension and diabetes mellitus? (2) What religious/spiritual practices do you use related to DM and AH treatment? (3) What kinds of religious/spiritual practices do you think other people use related to DM and AH? (4) What types of religious/spiritual beliefs can interfere with adherence to treatment for AH and DM? (5) Do you consider that there is any religious/spiritual practice that can contribute to non-adherence to the treatment of AH and DM? And the third contains the guidelines for the design of a themed story. Thematic content analysis was used.
Results: The data from the interviews were aggregated into two categories: (1) Spiritual/Religious Practices that Assist in Adherence to Treatment and (2) Treatment Dissociated from Faith.
Conclusion: There are several representations about spirituality/religiosity and adherence to the treatment of arterial hypertension and diabetes, however, it is clear that people believe in curing the disease and have hope regardless of the conduct they choose for their treatment.
110030
Modality: E-Poster Researcher – Non-case Report
Category: DYSLIPIDEMIA
ANA CAROLINA MICHELETTI GOMIDE NOGUEIRA DE SÁ1, Elton Junio Sady Prates2, Pedro Cisalpino Pinheiro3, Deborah Carvalho Malta1
(1) Graduate Program in Nursing, Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil; (2) School of Nursing, Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil; (3) Faculty of Medicine, Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil
Introduction: The reference values of laboratory tests are defined by two threshold classes, the reference intervals (RI) derived from a healthy population and the clinical decision limits, in which a medical decision is recommended. Lipid reference limits were established by clinical studies of cardiovascular outcomes in which clinical decision limits were defined. It should be noted that lipid reference values were collected from studies in developed countries and lipid levels are influenced by demographic, environmental, genetic, ethnic, lifestyle factors and chronic diseases. Therefore, even having defined decision limits, it has been encouraged to build lipid RIs specific to the population that will be applied. However, determining RI is a challenge because it requires methodological rigor, such as a representative sample of the population and care in collection and analysis. In Brazil, international IR are used. The National Health Survey (PNS) carried out laboratory tests, thus, it was possible to establish, in an unprecedented way by non-parametric methodology, RI of total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) for Brazilians.
Objective: To estimate RI of TC and fractions for Brazilian adults.
Methods: Cross-sectional study, with data from the PNS, between 2014–2015, in 2,976 adults. To establish RI, exclusion criteria were applied (pregnancy; smoking; chronic diseases), outliers were removed (Tukey’s method) and partitioned (gender; age; race/color). RI were estimated considering 95% of healthy individuals, the lower limit (LL) corresponded to the 2.5th percentile and the upper limit (UL) to 97.5. Differences were evaluated using the Mann Withney and Kruskal Wallis tests (p ≤ 0.05).
Results: HDL RI (mg/dL) were higher in women (29–74) than in men (25–67). Men had lower TC and LDL RI (mg/dL) between 20 and 39 years (115–239; 51–151) compared to 40 and 59 years (131–250; 57–156) and 60 years or older (125–252; 64–156). Women had higher RI for TC and LDL (mg/dL) at age 60 years or older (128.5–264; 59–172) and for HDL (mg/dL), UL were higher between 40 and 59 years (29–75) than at 20 to 39 years old (29–74) and in white race/color (29–75) compared to brown (29–73).
Conclusion: Own lipid RI evidence the health conditions of Brazilian adults and can support the adequate identification of dyslipidemias and prevention of cardiovascular disease.
110043
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
MARTHA V T PINHEIRO1, Renata Junqueira Moll-Bernardes1, Gabriel Cordeiro Camargo1, Marcelo Teixeira de Holanda2, Luiz Henrique Conde Sangenis2, Andrea Silvestre de Souza2
(1) ID’Or; (2) FIOCRUZ; (3) Instituto Nacional de Cardiologia
Background: Chagas disease involves progressive myocardial inflammation leading to myocardial fibrosis, which may predispose to sudden cardiac death. Although focal fibrosis can be detected by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), this technique is not sensible to detect diffuse interstitial fibrosis.
Objectives: The goal of this study was to assess the prognostic value of extracellular volume (ECV) by CMR in predicting ventricular tachycardia (VT) and sudden death in a 4-year follow-up period in Chagas disease.
Methods: This prospective cohort study included patients in the early stages of Chagas disease. Myocardial fibrosis assessment by CMR with measurement of ECV was performed. The patients were followed on an outpatient basis and submitted periodically to electrocardiogram and Holter for a period of 4 years. The combined primary outcome was cardiac sudden death, sustained ventricular tachycardia, or cardioverter-defibrillator (ICD) implantation.
Results: A total of 47 patients were included; the mean age was 58,6 + 10,4 and 44,7% were male. The ECV maintained an association with the presence of non-sustained VT, a surrogate outcome, even after adjustments for fibrosis mass and left ventricular ejection fraction assessed by CMR. Over the follow-up, 3 patients died suddenly (6,4%) and 2 (4,3%) had sustained VT. These patients had a mean of 45,2 + 21,1 non-sustained VT events (group 1) versus 2,29 + 1,0 (p = 0,001) in the group which not reached the combined endpoint (group 2). In group 1, the mean ECV value was 29,5 + 3,8 and 26,7 + 3,4 (p = 0,04).
Conclusion: ECV could be an early marker of increased risk of ventricular arrhythmia in the early stage of Chagas disease, presenting an independent association with NSVT, as a predictor of adverse outcomes.
110045
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
SERGIO GUSTAVO TARBINE1, Costantino R Costantini1, Costantino O Costantini1, Vinicius Shibata1, Marcos Denk1, Rafael Macedo1, Marcio M. Luize1, Everton CArdoso Dombek1
(1) Hospital Cardiologico Costantini
Background: The safety and performance of the Absorb Bioresorbable Vascular Scaffold (BVS) has been previously demonstrated with clinical data. However, these trials included patients with simple lesions. The Absorb III trial demonstrated an excess of adverse events following BVS implantation. Aiming to evaluate clinical outcomes, we analyzed the treatment of real world patients using optimal technique and intravascular image guidance in all cases, at long term follow up from a single center.
Methods: Observational retrospective study, in a single Brazilian center, from 12/2014 to 12/2017, including 128 patients treated with BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and late follow-up (5 years).
Results: All 128 patients completed 4 years 3 months follow-up. Mean age was 58,2 years, 85,9% of the patients were men, and 28,1% were diabetic. Regarding clinical presentation, 54,6% had stable angina or silent ischemia. Intravascular imaging (IVUS-OCT) was used in all cases. Lesion preparation included balloon PTCA, and when necessary Cutting balloon and PTCRA. Device success was achieved in 100% of cases with 99,2% overall procedure success rate (1 case of sub acute thrombosis). Long term major adverse cardiovascular events rate were (including hospital stage): Cardiac death 1,5%, acute stent thrombosis 0,78%, MI 2,34%,TVR 16,4%.
Conclusions: The analysis of this cohort of pts, in a real world setting with more complex scenarios, showed so far to be safe and effective at late follow-up using an enhanced technique, including intravascular imaging in all cases. Wether these results are durable beyond 5 years will be reported. Keywords: Percutaneous Coronary Intervention, Absorbable Implants/utilization, Everolimus, Coronary Artery Disease, Clinical Evolution.
110059
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ANA KAROLINA QUEIROZ DE SOUZA RICARDO1, Natanael Barbosa dos Santos3, Sara Carolline Gomes de Araújo Lima2, Patrícia Caldas de Oliveira1, Eliel Bezerra da Silva Júnior1, Antonio Fernando Barros Pereira Junior4, Isabela de Angelles Floro Alonso1, André Arthur de Souza Lima3, Marcelo Menezes Malta1, Bibiana Toshie Oniki de Mendonça2, Monteiro Pires Bastos Junior3
(1) Hospital do Coração de Alagoas; (2) Centro Universitário Tiradentes de Alagoas; (3) Centro Universitário Cesmac; (4) Universidade Estadual de Ciências da Saúde de Alagoas
Introduction: Cardiovascular diseases are important causes of morbidity and mortality worldwide. In 2019, in Brazil, 95,557 deaths were due to acute myocardial infarction, the main etiology. Treatment systems in STEMI aim to improve care and survival; there is a lack of data on their performance.
Objective: To evaluate the impact of the institution of a STEMI care program on mortality in the public health network of Alagoas.
Methods: Observational, analytical and cross-sectional study, authorized by the CEP (opinion No. 3,283,780), data tabulated between January 2017 and June 2019, analyzed using the Mann-Kendall test, comparison of factors by regression and multiple logistic regression. Census sample of 712 participants.
Results: The mean age was 64.3 (±13.1) years and 58.3% were men and 31.3% of the sample was treated; the main cause of non-treatment was symptomatology >12h in 43.5% of the untreated. The prevalence of risk factors (RF) was: 68.3% hypertensive, 36.5% diabetic and 29.4% smokers. The in-hospital death rate was 5.6%. Temporal trends were observed for treated and untreated groups: at time 1, increasing trend for both treated (p < 0.001) and untreated (p = 0.04); while at time 2, there was no increasing or decreasing trend (p > 0.05); at time 3, there is an increasing trend (p < 0.001) for both groups. At time 4, for treated patients, there is a significant decreasing propensity (p = 0.02). Time 5 reinforces a decreasing trend (p = 0.008). Times 6 and 7, no trend was observed. However, at time 8, there is a decreasing trend in the treated group (p = 0.009). At time 9, there is a significant drop in time (p = 0.003).
Conclusion: It is evident that the care network is viable and allows better access to STEMI treatment. Hospital mortality was similar to systems in developed countries. There is a need for population education revealed by the significant increasing trend of pre-hospital time. There was an improvement in care for the treatment of STEMI, demonstrated by the significant downward trend at times 4, 5 and 8. In addition, the data contribute to helping the construction of public health policies, as well as guiding prevention strategies, especially for those with RF.
110062
Modality: E-Poster Researcher – Non-case Report
Category: HYPERTENSION/RENAL DENERVATION
LÍLIAN SOARES DA COSTA1, Valerio Fuks4, Maria gabriela Pimenta dos Santos2, Julia Resende de Oliveira2, David Ferreira de Lima Duarte2, Antonio Carlos Eberienos Assad Filho2, Gabriela Gama Zagni Jardim3, Paola Pugian Jardim4, Andréa Vaospasse Cocco Faria4
(1) Universidade Estacio de Sá/IDOMED, Campus Città e Presidente Vargas e Instituto Estadual de Cardiologia Aloysio de Castro/IECAC; (2) Universidade Estacio de Sá/IDOMED, Campus Città; (3) Universidade Estacio de Sá/IDOMED, Campus Vista Carioca; (4) Instituto Estadual de Cardiologia Aloysio de Castro/IECAC
Introduction: Renal denervation (RDN) has been shown to be effective in reducing BP in treatment-resistant hypertension. Ambulatory blood pressure (ABPM) and central blood pressure (BP) are better predictors for overall cardiovascular risk and mortality than brachial BP. Renal denervation (RDN) has been shown to reduce these pressure parameters, but data on central ambulatory BP and arterial stiffness (AS) analysis after RDN are limited and have to be highlighted.
Objective: A systematic review on the role of arterial stiffness (AS) in renal denervation (RDN) treated-resistant hypertensive.
Methods: PubMed and Scielo databases, using the descriptors “denervation” AND “hypertension” AND “pulse wave velocity”. Twenty-two citations were identified and being considered.
Results: Some studies sought to investigate the effect of RDN in patients with treatment-resistant hypertension according to the established definition and confirmed by 24-h ABPM. These data indicate that RDN may reduce office and 24-h ABPM substantially in patients with moderate treatment-resistant hypertension. Central ambulatory BP is reduced and ambulatory assessed averaged daytime pulse wave velocity (PWV) improved after RDN and total vascular resistance decreased. Multivariate analysis showed that short-term effects on PWV were BP-related, whereas during 6 months follow-up, improvement of PWV becomes BP-unrelated. RDN improves peripheral and central blood pressure as well as AS and, thus, may improve cardiovascular outcome. The BP changes were associated with reductions in peripheral resistance, whereas cardiac output, plasma renin, aldosterone levels and renal function remained unchanged. The observed effects were not explained by an increased intake of antihypertensive medications. RDN did not result in a statistical significant effect on end organ damage 12 months after treatment. The statment that the arterial stiffness beneficial was observed during follw-up, assumed the supposition that an improvement of arterial mechanical properties coul be related to a reduced sympathetic arterial drive.
Conclusion: Extended assessment of AS can help improve patient preselection for renal sympathetic denervation and identify which subgroup of hypertension patients will benefit by sympathetic modulation. RDN improves brachial and central ambulatory BP, arterial stiffness, and total vascular resistance, indicating an improvement of cardiovascular outcome.
111669
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
PEDRO GABRIEL MELO DE BARROS E SILVA1, Otavio Berwanger2, Renato Nakagawa1, Thiago Macedo3, Lucas Tramujas1, Dalton Precoma4, Oscar Dutra5, John H Alexander6, Christopher B Granger6, Renato D. Lopes3
(1) HCor Research Institute, São Paulo, Brazil; (2) Hospital Israelita Albert Einstein, São Paulo, Brazil; (3) Brazilian Clinical Research Institute, São Paulo, Brazil; (4) Pontificia Universidade Católica do Parana, Curitiba, Brazil; (5) Instituto de Cardiologia Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil; (6) Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
Background: In clinical practice, there is large variability in hospital length of stay among cases of acute coronary syndrome (ACS). Even in ACS patients without major complications, the ideal timing for hospital discharge is unknown.
Objective: To assess the risk of clinical outcomes within 30 days among patients who did not have a major cardiovascular complication in the first 48 hours after the onset ACS.
Methods: SECURE PCI trial and ACCEPT registry enrolled patients admitted with ACS (with or without ST elevation). Patients who had a major cardiovascular event (MACE) within 48 hours were excluded from this analysis since these patients would not have been considered eligible for an early discharge. The rate of MACE between 48 hours and 30 days was described in the overall population and according to the type of ACS and timing of PCI. MACE was defined as myocardial infarction, stroke or death. Multivariable analysis was used to identify factors associated with clinical outcomes. The cases of MACE between 48h and 30 days in the SECURE-PCI trial were further evaluated by source documents and classified according to clinical stability before the occurrence of the events in order to identify patients that indeed would be potentially eligible for early discharge in clinical practice.
Results: From the 9,244 patients enrolled in the both studies, we did analyze 8,684 (93.9%) patients who had a confirmed ACS and did not have a MACE within 48 hours. At 30 days, the rate of MACE was 4.1% varying from 2.4 to 4.8% according to type of ACS. In the multivariate analysis, the following variables were associated with the risk of MACE: Age (HR 1.25 per 10 years increment; P < 0.01); Diabetes (HR 1.44; P = 0.02); Type of ACS (STEMI HR 3.56; P < 0.01; NSTEMI HR 1.68; P = 0.049) and PCI within 24 hours (HR 0.36; P < 0.01). The overall rate of death at 30 days was 2.4% but was 0.9% among patients who underwent PCI within 24 hours and were stable in the first 48 hours.
Conclusion: Patients with ACS undergoing PCI in the first 24 hours who are stable in the first 48 hours after hospital admission presented low risk of MACE in 30 days (mortality <1%). Advanced age, Diabetes, STEMI and PCI after 24 hours were associated with worse 30-day outcomes among patients without MACE after 48 hours of hospitalization due to ACS. Our findings suggest that early discharge of patients around 48 hours seems safe and reasonable and might save costs and resources utilization.
110086
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
PAULA VANESSA PECLAT FLORES1, Paula Vanessa Peclat Flores1, Ana Carla Dantas Cavalcanti1, Lyvia da Silva Figueiredo1
(1) Universidade Federal Fluminense – UFF
Introduction: Heart Failure is a complex syndrome that demands strict commitment to the therapeutic regimen. In addition to the monitoring strategies that will be used, to achieve better results it is vital to motivate the patient to incorporate new habits into the routine of daily life.
Objective: To analyze the effectiveness of the motivational interview in the self-care of patients with chronic heart failure.
Method: A randomized, multicenter clinical trial where the intervention group and the control group were followed for 60 days in each of the centers. A total of 130 patients were included, where the intervention group received 3 appointments per motivational interview, with a 30-day interval, while the control group maintained the conventional follow-up in the clinics they attend. The data were evaluated through the Self Care Heart Failure Index 6.2, before and after the intervention, in each of the centers. Among the several statistical calculations performed, the use of mean, median, simple frequency, chi-square, t-test, mann whitney and wilcoxon is highlighted and the effect of the intervention was calculated by Cohen’s d.
Results: The global sample (Brazil + Uruguay) has 118 patients, 59 in the control group and 59 in the intervention group. Self-care, evaluated through the sub-scales of maintenance, management and confidence, presented Cohen’s d 0.6723 and p-value (<0.001), indicating medium and significant effect; d of Cohen 0.5086 and p-value (0.187), which means a medium effect but not significant; d of Cohen 0.9877 and p-value (<0.001), showing a high intervention effect with significance.
Conclusion: Data from these studies showed that motivational interviewing is effective in self-care of patients with chronic heart failure. Motivational interviewing is a low-cost, effective approach that can be applied by trained professionals who work clinically with patients with heart failure.
110122
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ZAKIR OSSMAN1, Edna Lichucha1, Alcides Munguambe1, Lucio Ribeiro1, Karen Sliwa3, Albertino Damasceno2, Ana Olga Mocumbi1
(1) Instituto Nacional de Saude – INS; (2) Núcleo de Investigação, Departamento de Medicina, Hospital Central de Maputo, Mozambique; (3) Cape Heart Institute, University of Cape Town
Introduction: Delivery of regular long-acting intramuscular benzathine penicillin G (BPG) injections is the most effective method for secondary prophylaxis to prevent recurrence of acute rheumatic fever (ARF).
Objective: We aimed to assess the adherence rates to BPG regimens for prevention of ARF in a low-income setting.
Methods: Between November/2017 and October/2018 we profiled a cohort of patients with RHD on secondary prophylaxis at two hospitals in Mozambique; then we prospectively assessed adherence to secondary prophylaxis using monthly BPG injections. Cultures obtained from throat swabs collected at the 12th month of prophylaxis on 78 patients selected randomly, and were examined by gram stain, catalase test and CAMP test to detect Group A Streptococcus.
Results and Discussion: We enrolled 121 patients, mostly adolescents (mean age 20.8 years; SD 5.9) and females (77; 63.6%). Isolated or combined mitral regurgitation was the commonest lesion (107 patients; 88.4%), followed by aortic regurgitation (54; 44.6%) and mitral stenosis (21; 17.4%). The mean follow up was 19 months. The adherence rate was 86.8%, corresponding to 2228 injections applied out of the 2555 expected; only 1708 (66.8%) were administered at the expected date and 59 patients (49%) were fully compliant. Testing for GAS throat colonization in patients randomly selected on month 12 was negative. One fatal event occurred in relation to BPG injection, not fulfilling criteria for anaphylaxis.
Conclusions: RHD patients on secondary prophylaxis in urban hospitals in Mozambique had good adherence and acceptable compliance to monthly BPG injections. The incidence of ARF during follow-up was low and no classic anaphylaxis occurred. Further research is warranted to address gaps in delivery of secondary prophylaxis.
110435
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
YAROSLAVSKAYA E.I.1, Migacheva A.V.1, Krinochkin D.V.1, Shirokov N.E.1, Gorbatenko E.A.1, Korovina I.O.1, Osokina N.A.1
(1) Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Introduction: Data regarding the influence of arterial stiffness on longitudinal myocardial strain has been scarce. This is especially important for patients who have undergone a complicated course of COVID-19.
Objective: To investigate the associations between brachial-ankle pulse wave velocity (baPWV) and left ventricular (LV) longitudinal strain 3 months after COVID-19 pneumonia.
Methods: 369 patients (52 ± 11 (from 19 to 84) years; 50.9% women) 3 months ± 3 weeks after discharge after COVID-19 pneumonia were prospectively enrolled into the study. All participants underwent conventional echocardiography, including 2D speckle-tracking echocardiography. Measurements of baPWV were made at the same day as echocardiography in 322 patients. Parameters of LV global longitudinal strain (LV GLS) and segmental longitudinal strain were studied in 296 patients with optimal visualization quality in echocardiography. Both baPWV and LV longitudinal strain were measured in 243 patients.
Results: Three months after discharge, obesity was noted in 46.5% of patients, cardiovascular diseases were diagnosed in 73.4%. Arterial hypertension occurred in 71.5% of patients, coronary artery disease – in 22.5%. The median baPWV were 13.3 [11.8; 15.1] cm/s and 13.4 [11.9; 15.1] cm/s for the left and right sides, respectively. Mean LV ejection fraction was 67.8 ± 5.0%, mean LV GLS was –19.6 ± 2.5%. The baPWV showed a weak correlation with longitudinal strain of LV basal level (r = 0.289 for the right side and r = 0.272 for the left side, both p < 0.001) and of LV mid level (r = 0.229, p < 0.001 for the right side and r = 0.218 for the left side, p = 0.001). The baPWV showed a correlation of medium strength only with the longitudinal strain of LV basal anterior segment (r = 0.303 for the right side and r = 0.309 for the left side, both p < 0.001). There were no correlations between baPWV and strain of LV apical level segments.
Conclusion: In patients after COVID-19 pneumonia 3 months after discharge baPWV increase associated with deterioration of LV longitudinal strain at basal and mid levels, more pronounced in LV basal anterior segment.
110457
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
LUIZ GUILHERME PASSAGLIA1, Luiz Guilherme Passaglia1, Carolina Teixeira Cunha Érika1, Erika Nunes de Oliveira Rodrigues1, Flavia Mariana Mendes Diniz1, Darkiane Fernandes Ferreira1, Tiago Almeida de Oliveira2, Maria Augusta Duarte Abreu2, Regina Bicalho Gomes de Faria2, Pedro Henrique Coelho Pinto2, Antonio Luiz Pinho Ribeiro2
(1) Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil; (2) Faculdade De Medicina da Universidade Federal de Minas Gerais (UFMG)
Introduction: In Brazil, low adherence to care guidelines is one of the reasons for the high mortality from acute coronary syndrome (ACS). In view of this, the Brazilian Society of Cardiology (SBC) in partnership with the American Heart Association and with the support of the Ministry of Health developed the Best Practices in Cardiology Program (BPC Program), whose objective is to evaluate the rates of adherence to the SBC guidelines for in institutions of the Unified Health System before and after the implementation of the project.
Method: Prospective observational study with data collection from May 2016 to December 2021. The performance measures analyzed were drugs prescribed at hospital discharge. The primary outcome of the study consisted of the evaluation of performance measures with a minimum stipulated target of 85% of global adherence.
Results: In this sample, 932 patients were included, with a mean age of 61.6 ± 12.1 years, 69.2% of whom were male, with a low level of education (77.1% with incomplete secondary education or less) and low family income (91.5% with ≤5 minimum wages a month). The main comorbidities were current or previous smoking (67.1%), arterial hypertension (65.7%), diabetes (29.7%), and dyslipidemia (23.0%). In the characterization of ACS, ST-segment elevation infarction corresponded to 68.3%, with Killip classification ≤2 in 75.5% of the sample. Most of the patients (92.2%) underwent coronary angiography, which showed the following pattern of coronary disease: 24.1% trivascular, 16.9% bivascular, 17.5% univascular, with the anterior descending artery being affected in 21.8% of the cases. Coronary angioplasty of the culprit’s vessel was performed in 64.9% of the cases, and only 5.4% of the sample was referred to coronary artery bypass graft surgery. Analysis of performance measures showed aspirin (98.5%), beta-blockers (94.5%), angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (96.3%) and statins (96.6%) at hospital discharge. There were 27 deaths during hospitalization (2.9%).
Discussion: The predominance of males, age ≥ 50 years, and high prevalence of comorbidities show characteristics of ACS patients already known by epidemiological data extensively published in the medical literature. Performance measures indicate good adherence to ACS care guidelines in the hospital.
Conclusion: Adherence to quality programs such as the BPC Program is an essential step in improving care for patients with ACS.
110441
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
DIANE XAVIER DE ÁVILA1, Ricardo Vivacqua Cardoso Costa2, Salvador Manoel Serra3, Marcelo Westerlund Montera2, Evandro Tinoco Mesquita1, Alexandre Siciliano Colafranceschi2
(1) Complexo Hospitalar de Niterói; (2) Hospital Pró-Cardíaco; (3) Instituto Estadual de Cardiologia Aloysio de Castro
Introduction: Cardiopulmonary exercise testing (CPET) is a well-established clinical tool to predict outcome, stratifying cardiovascular risk and help to select candidates for heart transplantation (HTx) or left ventricular assist devices (LVAD) in patients with chronic heart failure (CHF).
Purpose: To evaluate CPET measurements in advanced CHF patients that are being considered for HTx or LVAD and its association to early mortality regardless of the performed procedure.
Methods: Maximum intensity CPET was performed on a treadmill and ramp protocol in 73 patients with CHF and reduced ejection fraction, NYHA functional classes III and IV between 2012 and 2021. Measurements derived from CPET were the following: peak V‘O2, V’O2 at the anaerobic threshold (AT), percentage of the V’O2 of the anaerobic threshold in relation to the peak, the slope of oxygen consumption efficiency (OUES), Oxygen uptake efficiency plateau (OUEP), VE/VCO2 slope, maximum heart rate (HR), circulatory power (CP), and the relation (VE/VCO2 slope)/(VO2peak).
Results: Seventy-three patients, 75% males. Mean age of 70 ± 9 years. Almost half (47%) had ischemic etiology. There were no complications related to CPET. Ten patients were transplanted, six had an intracorporeal LVAD implanted and the reminder (57 patients) were kept in supervised physical rehabilitation program. There were 12 deaths, 2 in HTx, 2 in LVAD, 8 in the rehabilitation group. Mean follow-up among the survivors was 43 months ± 40,6 and it was 12,1 ± 10,3 months in those who died. CPET derived measurements between survivors and non-survivors, respectively, were as follows: V‘O2 peak (mL.kg–1.min–1): 12,6 ± 4,6 and 8,5 ± 2,8 (p = 0,001); the V’O2 AT (mL.kg–1.min–1): 9,8 ± 3,3 and 6,0 ± 3,0 (p = 0,0004); VE/VCO2 slope: 34,2 ± 12,1 and 67,3 ± 65,6 (p = 0,0002); R peak: 1,1 ± 0,2 and 1,0 ± 0,1 (p = 0,009); T½, in seconds: 136,1 ± 47,8 and 167,9 ± 78,5 (p = 0,03); HR reduction at the first minute 16,7 ± 13 and 7,2 ± 5 (p = 0,009); OUES (L.min–1): 1,2 ± 0,4 and 1,0 ± 0,3 (p = 0,104) and CP [(ml O2.kg–1.min–1).mmHg] 1.530 ± 671,6 and 960,6 ± 363,6 (p = 0.005), OUEP (ML/L): 34,2 ± 8,3 and 25,1 ± 8,3 (p = 0.001) and the relation VE/VCO2 slope and V‘O2 peak were 3,1 ± 2,0 e 11,4 ± 19,5 (p = 0.001).
Conclusion: The predisposition to early death could be stratified by V‘O2 peak, V’O2 AT, VE/VCO2 slope, T½, recovery HR, CP, the relation VE/VCO2 slope)/(V‘O2 peak) and notably, OUEP can be more one powerful predictor for early intervention due to its association with severity.
110448
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
PETELINA T.I.1, Musikhina N.A.1, Garanina V.D.1, Avdeeva K.S.1, Sharoyan Y.A.1, Gapon L.I.1, Yaroslavskaya E.I.1
(1) Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Introduction: By given pandemic status, the viral infection has shown how SARS-CoV-2 can affect patients involved in other noninfectious epidemics that have been gaining momentum for years.
Objectives: To perform a prospective analysis of blood biomarkers in patients with cardiovascular (CV) diseases (CVD) who underwent COVID-19 associated pneumonia with and without type 2 diabetes mellitus (DM2); to assess the nature of their relationship with instrumental parameters and to identify indicators of long-term adverse CV events.
Methods: Out of 380 patients with SARS-CoV-2 associated pneumonia participating in the study, we used data of 65 patients. They were divided into 2 groups: group 1 included patients with CVD: arterial hypertension (AH) in combination with coronary artery disease (CAD) without DM2 (n = 45), group 2 – patients with CVD and DM2 (n = 20). Patients were examined at baseline and 3 months after discharge. We evaluated parameters of general blood test; biochemical parameters; instrumental parameters – ABPM, PWV in right and left elastic arteries, echocardiography with the study of left ventricular (LV) apical myocardial strain, computer tomography of lungs.
Results: The analyzed leukocyte parameters and their index coefficients – increase in neutrophils/lymphocytes ratio and decrease in lymphocytes/CRP ratio were more significantly changed in DM2 group. Patients in both groups had a significant excess of baseline max CRP concentrations with decrease in parameters after 3 months, but with persistent excess values in group 2 (p < 0.0011). 3 months after discharge patients with DM2 had levels of hs-CRP, IL-1b and TNFa (p < 0.05) that exceeded both the reference values and those in group 1, which reflected the presence of more pronounced vascular inflammatory potential for possible adverse events in this group of patients in post-COVID period. In addition, the exceeding values of NT-proBNP, SBP and DBP 24, PWV-L and apical LV myocardial strain in group 2 compared to group 1 may be indicators of occurrence and progression of adverse CV events in patients with DM2.
Conclusions: In groups of patients with AH and CAD, which differ only by the presence of DM2, it is clearly seen that comorbid condition can significantly affect the development of adverse CV complications due to increased inflammatory potential of blood parameters, increased stiffness of the vascular wall, and the presence of myocardial longitudinal strain of LV apical segments.
110901
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ALBEN SIGAMANI1, PALLAV SINGH1, NUMEN CARE TEAM1
(1) NUMEN HEALTH
Coronary Artery Disease (CAD) is the number one killer of cardiovascular diseases; yearly, nine-million deaths. CABG was first done in India in 1975; the surgery has grown exponentially, to nearly 100,000 every year. Ischemic cardiomyopathy (IC) and delays in undergoing an evidence-based recommended CABG contribute to significant mortality and morbidity over five years of survival (>35% composite event rate). Cardiac rehabilitation, an evidence-based, effective secondary prevention, is scarce in India; there is just one seat for every 30,000 new IC patients. Numen health is an online digital health platform that organizes virtual cardiac rehabilitation. The program is delivered at the patient’s home via a mobile application. Referrals are received from cardiologists and cardiac surgeons at the time of discharge following a coronary artery event or procedure. On establishing contact and intent to perform cardiac rehabilitation, the patient is subjected to several online tele assessment sessions to help the patient and the care team arrive at a baseline of their health status. The discharge summary of their most recent admission is used for setting Specific Measurable, Achievable, Relevant, and Timely (SMART) Goals. All patients are categorized as per age, gender, known history of pre-existing chronic diseases, medication consumption pattern, physical activity input, potential energy output, detailed analysis of the daily diet, habits, and identification of possible nutritional deficiencies. The program is subscription-based, and the fee is collected either monthly. Between February 2021 and April 2022, 83 patients post CABG have been referred to the program. This represents 10% of the overall number of patients who participated in the program and were referred from 15 cities and 33 doctors across India. They spent a median of 90 days (ranging between 30 to 210 days) on the program and had 600 interactive sessions with the assigned health care manager and other health experts. The age was between 38 and 72 years; 53 (64%) were males. 35(42%) had baseline type 2 diabetes, 8(10%) had significant comorbidity. There were zero deaths, and 35(42%) had achieved their assigned goals. Digital health can bridge the widening gap of providing cardiac rehabilitation to the growing prevalence of IC in India. Virtual cardiac rehabilitation effectively delivers comprehensive secondary prevention to patients post CABG and any coronary event or intervention.
110458
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
LUIZ GUILHERME PASSAGLIA1, Luiz Guilherme Passaaglia1, Carolina Teixeira Cunha Érika1, Erika Nunes de Oliveira Rodrigues1, Flavia Mariana Mendes Diniz1, Darkiane Fernandes Ferreira1, Tiago Almeida de Oliveira2, Maria Augusta Duarte Abreu2, Regina Bicalho Gomes de Faria2, Pedro Henrique Coelho Pinto2, Antonio Luiz Pinho Ribeiro2
(1) Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG – Brasil; (2) Faculdade De Medicina da Universidade Federal de Minas Gerais (UFMG)
Introduction: In Brazil, low adherence to guidelines is one of the reasons for the high mortality from heart failure (HF). In view of this, the Brazilian Society of Cardiology (SBC) in partnership with the American Heart Association, and with the support of the Ministry of Health, implemented the Best Practices in Cardiology Program (BPC Program), whose objective is to evaluate the rates of adherence to the SBC guidelines in institutions of the Unified Health System before and after the implementation of the project.
Method: Prospective observational study with data collection from May 2016 to December 2021. The performance measures analyzed were the medications prescribed at hospital discharge and the scheduling of a return appointment. The primary outcome of the study consisted of the evaluation of performance measures with a minimum stipulated target of 85% of global adherence.
Results: In this sample, 431 patients were included. The mean age was 59.0 ± 14.6 years, 55.0% were men and 85.4% had a previous diagnosis of HF. The main comorbidities were arterial hypertension (43.4%), atrial fibrillation/flutter (41.1%), diabetes (26.0%), acute myocardial infarction (16.2%), and hypothyroidism (16.0%), with a high rate of current and/or previous smoking (51.0%). The main etiology of HF was Chagas (25.7%), followed by idiopathic (23.0%), ischemic (22.3%), and valvular disease (15.3%). The predominant hemodynamic profile was wet and warm (67.4%), followed by wet and cold (25.0%). At admission, 61 (14.2%) patients underwent heart transplantation. The mean left ventricle ejection fraction was 35.9% (±17.0), and 83 (19.3%) patients died during hospitalization. The analysis of performance measures showed a return appointment schedule (94.6%), beta-blocker (94.8%), angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (97.3%), and spironolactone (80.9%) at hospital discharge.
Discussion: The clinical characteristics of patients with a high prevalence of comorbidities reflect the profile and complexity of patients hospitalized at the hospital and highlight the need for multidisciplinary care. The values of the performance measures indicate good adherence to HF care guidelines, except for the prescription of spironolactone at hospital discharge.
Conclusion: Adherence to quality programs such as the BPC Program is an essential step in improving care for patients with HF.
110472
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
EDUARDO MARINHO TASSI1, Emilia Matos do Nascimento1, Marcelo Abramoff Continentino1, Basilio de Bragança Pereira1, Roberto Coury Pedrosa1
(1) Universidade Federal do Rio de Janeiro (UFRJ)
In Chronic Chagas Cardiomyopathy (CCC), studies are needed to identify arrhythmogenic risk factors in patients where moderate to severe ventricular dysfunction is not present. The direct relationship between sympathetic neural activity and norepinephrine is known. In patients with heart failure, sympathetic hyperactivity is persistent. However, in CCC, there are indicators that the sympathetic system is heading towards exhaustion as cardiac involvement progresses.
Objectives: To verify the dependence between frequent ventricular extrasystoles (FVE), left ventricular ejection fraction (LVEF), extension of fibrosis by cardiac magnetic resonance (CMR) and urinary norepinephrine (NOREPI) measurement in CCC with preserved or minimally compromised LVEF.
Methods: The presence of ventricular extrasystoles >720 in 24h was analyzed on Holter. In CMR, the biventricular ejection fraction, presence of segmental alteration and detection and quantification of fibrosis mass using the delayed enhancement technique were evaluated. NOREPI was measured using the Muskiet method. The correlation coefficient matrix was calculated to measure the predictive ability of the variables to predict another, with a significant p-value of p < 0.05. A total of 59 patients were included. Mean age was 57.9 + 10.94 years. FVE was detected in 28 patients. The variable fibrosis showed a negative correlation with the LVEF found (R of –0.61) and with NOREPI (R of –0.68), as well as the variable FVE showed a weak negative correlation with the LVEF (R of –0.33) and to NOREPI (R of –0.27). LVEF, on the other hand, showed a positive correlation with NOREPI (R of 0.83). The variables fibrosis, LVEF and NOREPI showed a high power of association with each other according to Cramér’s V statistics (fibrosis and NOREPI 0.64, LVEF and NOREPI 0.63 and fibrosis and LVEF 0.53).
Conclusion: In patients with CCC with preserved or slightly reduced ejection fraction, it is confirmed that the arrhythmogenic substrate is already present in this population, with dependence between NOREPI levels, LVEF and myocardial fibrosis, but not with the presence of FVE (>720 in 24h).
112420
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
MIGUEL MALUF1, Miguel Angel Maluf1, Alfredo Eyer Rodrigues1, Maria Eduarda Siqueira1, Ana Fatima Salles1
(1) Universidade Federal de São Paulo; (2) Hospital Alemão Oswaldo Cruz – SP
Background: Patients with tetralogy of Fallot, undergoing Right Ventricular Remodeling, in childhood, with or without pulmonary valve reconstruction, evolve, in the late follow-up, with pulmonary insufficiency and Right Ventricular dysfunction, requiring the implantation of a pulmonary prosthesis. The anatomical variations of the pulmonary artery, associated with the presence of calcifications, dilations, or stenosis as a result of surgeries performed, require adequate planning in the surgical approach for Transcatheter Pulmonary Valve Replacement – TPVR.
Material: A new Expandable Polyurethane Stent Valve, implanted by catheter, in pulmonary position has been developed and approved in Biocompatibility, Physical, Hydrodynamic, Fatigue, Experimental, and Ultrastructure Study of explanted sheep prostheses after 24 months of follow-up, analysis, following ISO 5840-3, 2015.
Method: In a group of 45 adult patients, in the late follow-up of surgical correction of Tetralogy of Fallot, with late follow-up, at São Paulo Federal University, with an indication for TPVR, they were classified into 6 groups according to the anatomical aspects of the pulmonary artery, analyzed by CT Angiography and scheduled minimally invasive procedure intervention, TPVR: Tipe.1: Pulmonary Valve Insufficiency (PVI) Tipe.2: PVI + Pulmonary Trunk (PT) stenosis Tipe.3: PVI + PT aneurysmal dilation Tipe.4: PVI + PT + Right Pulmonary Artery (RPA) + Left PA (LPA) stenosis Tipe.5: Pulmonary prosthesis dysfunction Tipe.6: Valved Conduit (VC) disfunction Through post-processing images by CT Angiography, it was possible to enlarge them to their natural size, followed by 3D printing, inelastic and transparent plastic mass, keeping the interior of the hollow cardiac cavities. Custom prosthesis manufacturing: 3 transverse diameters (TD) are measured: TD1: At the level of the Pulmonary Ring; TD2: In the middle third of the TP and TD3: At the level of the origin of the RPA and LPA. Also, a longitudinal measure (LM), allows for knowing the length of the prosthesis.
Conclusion: The strategy for the treatment of residual defects, after correction of the Tetralogy of Fallot, is based on the need to have customized devices to obtain successful and lasting results.
110529
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
FLAVIA VERNIN DE OLIVEIRA1, Gabriel Cordeiro Camargo1, Martha Valério Tavares Pinheiro1, Adriana Soares Xavier de Brito1, Renee Sarmento de Oliveira1, Daniella Braz Parente1, Renata de Mello Perez1, Rosana Souza Rodrigues1, Ana Maria Pitella de Souza Leite1, Gilberto Portela1, Andréa Silvestre de Sousa1, Renata Junqueira Moll Bernardes1
(1) INSTITUTO D’OR DE PESQUISA
Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) is the principal cause of chronic hepatic disease in developed countries, reaching almost 30% of the adult population. It has a large spectrum of histological presentation, from steatosis to cirrhosis. It is a multisystemic disease, affecting a variety of organs, including heart and vascular system, and these are the principal cause of death for these patients, beyond the hepatic disease. Interstitial fibrosis is a factor of worse prognosis for heart and liver, individually, but the correlation between cardiac fibrosis and liver fibrosis has not been studied yet.
Purpose: To define the frequency and grade of early myocardial fibrosis in patients with NAFLD and correlate with the intensity of hepatic fibrosis.
Methods: Forty-four patients with NAFLD were included; prospectively, the patients performed echocardiogram, myo-intimal carotid measurement by ultrasound, coronary calcium score by computed tomography, cardiac and hepatic magnetic resonance imaging using elastography and T1 mapping sequences; twenty-eight were allocated in the group without fibrosis or with discrete hepatic fibrosis (Group 1) and sixteen patients with significant hepatic fibrosis in Group 2, defined by the magnetic hepatic elastography.
Results: The mean age was 57.9 years and 59% were women. The group with significant hepatic fibrosis had also more cardiac interstitial fibrosis, compared with Group 1. The median of myocardial ECV for Group 1 was 22.7% and for Group 2 was 26%, with p = 0.002. The correlation between hepatic and cardiac fibrosis was 0.45, with p = 0.02, even when adjusted for age and body mass index. We also found a negative correlation between hepatic fibrosis and the Global Longitudinal Strain of the left ventricle (r = –0.36 and p 0.016) and with the volume of the left atrium (r = 0.30 and p = 0.04).
Conclusion: The study suggests the presence of a correlation between hepatic fibrosis in patients with NAFLD and the presence of diffuse interstitial myocardial fibrosis detected by the cardiac T1 mapping magnetic resonance.
110556
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
MARCOS ROBERTO QUEIROZ FRANÇA1, André Assis Lopes do Carmo1, Gustavo de Araújo Silva1, André Dias Nassar Naback1, Reynaldo de Castro Miranda2, Anna Terra França3, Henrique Barroso Moreira2, Vitor Freitas Fontes1, Leandro Garambone de Cerqueira1, Lucas Ruback1, Antonio Luiz Pinho Ribeiro1, Bruno Ramos Nascimento1
(1) Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte – MG, Brazil; (2) Hospital Felício Rocho, Belo Horizonte – MG, Brazil; (3) Hospital Mater Dei, Belo Horizonte – MG, Brazil
Introduction: Catheter ablation is a well-established therapy for atrial fibrillation (AF), with a promising impact on heart failure (HF) outcomes. We aimed to evaluate the impact of AF ablation on echocardiographic and clinical parameters in patients with HF in Brazil, and to assess factors associated with improvement of the left ventricular ejection fraction (LVEF).
Methods: Patients diagnosed with HF and LVEF <50%, who underwent radiofrequency AF ablation in 5 high-volume centers, were prospectively enrolled. All patients underwent standard transthoracic echocardiography before the procedure and during clinical follow-up, and the analysis by the examiner was considered. The primary outcome was LVEF normalization (LVEF ≥ 50%) at follow-up. Clinical, echocardiographic, and procedure-related variables associated with the primary outcome were assessed by univariate logistic regression. P-value <0.05 was considered significant.
Results: From 2018 to 2022, 77 patients were included, being 52 (68%) males, mean age 66 ± 12 years. Of these, 27 were in NYHA functional class 3/4, 64 (83%) had persistent AF, and only 3 had previous ablations. Pre-procedural LVEF was 38 ± 7%, with 24 (31%) having LVEF < 35%. Complications occurred in only 3 patients (2 in vascular access and 1 endocarditis). In the 13 ± 11 month follow-up, there was a substantial improvement of the LVEF to 54 ± 14% (p < 0.001), and 54 (70%) achieved the primary outcome of LVEF normalization. Fifty-three patients (69%) had LVEF improvement of ≥10%, only 7 remained in NYHA class 3/4, and AF recurred in 13 (17%). Three patients died during follow-up, and none had LVEF improvement. Predictors of LVEF normalization were: pre-ablation LVEF (OR = 1.23, 95%CI 1.11–1.36), baseline left atrial diameter (OR = 0.86, 95%CI 0.79–0.94), ischemic (OR = 0.29, 95%CI 0.08–0.98) and Chagasic (OR = 0.14, 95% CI 0.03–0.78) etiologies and prescription of amiodarone (OR = 0.26, 95%CI 0.09–0.78) and ACEi/ARB (OR = 0.24, 95%CI 0.07–0.81, p = 0.02). In the multivariable model, independent predictors were: baseline LVEF (OR = 1.20, 95% CI 1.06–1.27, p = 0.005), left atrial diameter (OR = 0.88, 95%CI 0.77–0.99, p = 0.03), ischemic (OR = 0.13, 95%CI 0.02–0.85, p = 0.03) and Chagasic (OR = 0.08, 95%CI 0.01–0.76, p = 0.03) etiologies.
Conclusion: AF ablation in patients with HF resulted in remarkable echocardiographic and functional improvement, with low complication rates. Less clinical severity and less morpho-functional impairment were associated with LVEF normalization.
110563
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
EVELYN COSTA CRUVINEL1, Aline Teodoro Mendes1, Denise Mayumi Tanaka2, Fernanda Regina Moraes3, Gustavo José Luvizutto1, Marilita Falangola Accioly1, Luciana Duarte Novais Silva1, Douglas Reis Abdalla4, Eduardo Elias Vieira de Carvalho1
(1) Programa de Pós-graduação em Fisioterapia da Universidade Federal do Triângulo Mineiro.; (2) Departamento de Clínica Médica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo.; (3) Curso de Fisioterapia da Universidade de Uberaba.; (4) Departamento dos Cursos de Saúde do Centro Universitário Talentos Humanos.
Introduction: Aging is a physiological process that leads to decreased heart rate variability. Physical training is an established therapy that induces increased heart rate variability, and transcranial Direct Current Stimulation (tDCS) potentiates this beneficial effect. However, a large part of the elderly population does not have access to adequate physical training programs. Instead, meditation is an easily accessible and useful tool to induce small increases in heart rate variability. However, no studies have evaluated the effects of the association of meditation with tDCS on heart rate variability.
Purpose: To evaluate the influence of meditation associated with tDCS on heart rate variability in the elderly.
Methods: Eleven older adults of both sexes, aged 69.1 ± 7.2 years, were studied. Heart rate variability was collected in the supine position, in a quiet environment, free from the circulation of people and external influences, lasting 80 minutes, with 5 minutes of initial rest to control heart rate, followed by recording the RR intervals at 20 minutes baseline, 15 minutes meditation, 20 minutes tDCS and 20 minutes final/post- tDCS. The meditation technique was mindfulness, applied by a qualified and experienced therapist; tDCS was applied by an anodic current of 2 mA, following the international standards for the system (EEG10–20). Outcomes were analyzed using the ANOVA model with fixed effects.
Results: It was observed a significant increase of the heart rate variability indexes with the techniques association: RMSSD from baseline (27.2 ± 35.9 ms) to post-meditation (33.6 ± 43 ms) and post-tDCS (36.7 ± 50.7 ms), p = 0.04; SDNN from baseline (23.8 ± 26.3 ms) to post-medidation (27 ± 28.3 ms) and post-tDCS (31.8 ± 34.5 ms), p = 0.0001; Low-frequency component from baseline (369.6 ± 602.4 ms2) to post-meditation (352.8 ± 599.1 ms2) and post-tDCS (672.2 ± 1034.1 ms2), p = 0.0001; High-frequency component from baseline (207.4 ± 375.5 ms2) to post-meditation (599.7 ± 1068.5 ms2) and post-tDCS (896.8 ± 1958.7 ms2), p = 0.0009; SD1 from baseline (19.2 ± 25.4 ms) to post-meditation (23.8 ± 30.4 ms) and post-tDCS (26 ± 35.9 ms), p = 0.02; e SD2 from baseline (27.4 ± 27.6 ms) to post-meditation (28.9 ± 27.2 ms) and post-tDCS (36 ± 34 ms), p = 0.0001.
Conclusion: The results of the present study documented for the first time that the application of anodal tDCS can significantly enhance the beneficial effects of meditation on heart rate variability indexes in the elderly.
110632
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
YAROSLAVSKAYA E.I.1, Krinochkin D.V.1, Shirokov N.E.1, Gorbatenko E.A.1, Osokina N.A.1, Migacheva A.V.1
(1) Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences
Background: COVID-19 can result in myocardial injury in the acute phase. The late cardiac consequences of complicated course of COVID-19 is limited.
Purpose: To study the prevalence of disorders and the relationship of left ventricular global longitudinal strain (LV GLS) in patients with proven COVID-19 pneumonia 3 months after discharge from the hospital.
Methods: 369 patients underwent a comprehensive clinical examination 3 months ± 3 weeks after discharge after COVID-19 pneumonia. The mean age was 52 ± 11 (from 19 to 84 years), 50.9% women. Standard echocardiography and myocardial strain assessment were performed. LV GLS was studied in 296 (80%) examined patients with optimal visualization quality. LV GLS was considered reduced when its value was above –18%.
Results: 3 months after discharge, obesity was noted in 46.5% of patients, cardiovascular diseases were diagnosed in 73.4%. Arterial hypertension (AH) occurred in 71.5% of patients, coronary artery disease – in 22.5%. LV GLS was reduced in 25.1% of the patients. LV GLS showed no relationship with the patient age, NYHA functional class and LV ejection fraction (EF). Reduced LV GLS was independently associated with AH (OR 1.174; 95% CI 1.056–1.305; p = 0.003), obesity (OR 1.295; p < 0.0001), male sex (OR 0.734; 95% CI 0.657 –0.821; p < 0.001). LV GLS showed positive correlations of medium strength with echocardiographic parameters: length of the right (r = 0.308) and left ventricles (r = 0.306), LV mass (r = 0.326), anterior-posterior left atrial (LA) dimension (r = 0.303, all p < 0.0001). LV GLS showed a weak positive correlation with the severity of lung lesions during hospitalization (r = 0.134; p = 0.032), diastolic blood pressure (r = 0.230; p < 0.001), LV posterior wall thickness (r = 0.255, p < 0.001) and interventricular septum (r = 0.188, p = 0.001).
Conclusions: Reduced LV GLS 3 months after COVID-19 pneumonia was observed in 25.1% of survivors and is associated with AH, obesity, and male sex. LV GLS was not associated with the patient age, NYHA functional class and LV EF. The correlation between impaired LV GLS and the severity of lung lesions in hospitalization was weak, the correlations with the ventricles length, LV mass, and LA anterior-posterior dimension were of medium strength.
110778
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
ALBERTO FRISOLI JUNIOR1, Elaine Azevedo1, Amanda kimura1, Angela Paes1, Valdir Ambrosio1
(1) Universidade Federal Sao Paulo
The diversity of concepts of sarcopenia makes it difficult to use in clinical practice. Low performance on functional tests (functional sarcopenia) has been shown to be associated with severe outcomes, while low muscle mass (anatomic sarcopenia) has controversial results. Functional sarcopenia has phenotypes determined by the accumulation of physical dysfunctions, whose predictive value for mortality is not yet established.
Objective: To evaluate if Functional Sarcopenia phenotypes are associated with mortality in elderly people with cardiovascular disease (CVD).
Methods: SARCOS is a prospective cohort study on Sarcopenia and Osteoporosis with mortality in elderly with cardiovascular disease.
Sample: Elderly outpatients of the Federal University of São Paulo – Brazil. Physical functions were evaluated by: walking speed (WS) in 4.5 mts, the time to sit and stand up from chair test (CST) and hand grip strength (HGS), by dynamometer. Appendicular muscle mass (AMM) was measured by DXA. AMM/height2, HGS, WS and CST were evaluated in quartiles. Functional sarcopenia (FS) phenotype was characterized according to the presence of weakness (HGS < 26 Kgf M, <16 Kgf W), low WS (LWS, if WS < 0.5 m/s) and high time to CST (HCST > 25s): Robust = 0, Pre- Functional sarcopenia = 1, Functional Sarcopenia ≥2. Mortality was assessed by telephone contact at 6 and 12 months. Significant mortality variables and low AMM according to EWGSOP II* and FNIH# were used in the regression.
Results: Among the 555 subjects, 57.5% (n = 319) were women, mean age 77.91(7.27). Weakness occurred n = 151 (27.2%), LWS n = 156(28.1%) and HCST n = 129(23.2%). The prevalence of phenotypes: Robust n = 281 (50.6%), Pre FS n = 155 (27.9%), and FS n = 119 (21.4%). Mortality was 4.7% (n = 26), of which, n = 5 (19.2%) were robust, n = 7 (26.9%) Pre FS, and n = 14 (53.8%) had FS, (p < 0.001). The FS phenotype was characterized by being female, higher age, lower HGS and WS, higher Time to CST, higher functional loss (IADL and ADL), lower depression score, lower AMM/h2 and higher percentage of total body fat, compared to other phenotypes. In regression analyses for mortality, Pre FS OR: 1.84 (0.45–7.49, p = 0.390)* and OR: 2.30 (0.56–9.48, p = 0.247)#; and FS OR: 4.98(1.35–18.40; 0.016)* and OR: 7.06(1.71–29.09; p < 0.007)#.
Conclusion: In the older adults with cardiovascular disease, Functional Sarcopenia phenotype predicts higher mortality compared to the other phenotypes, regardless of low muscle mass and CVDs.
110761
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
SOLDATOVA A.M.1, Kuznetsov V.A.1, Enina T.N.1, Bogdanova D.S.2, Benzineb F.T.2
(1) Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Sciences; (2) Tyumen State Medical University
Purpose: To access the prevalence of frailty and its impact on long-term prognosis in patients with implanted devices for cardiac resynchronization therapy (CRT).
Methods: 77 patients with congestive heart failure (74% men, 26% women; mean age 58.7 ± 10.7 years) with NYHA class II–IV were enrolled. Frailty index (FI) was calculated using 31 parameters (the ability to perform daily activities, clinical status, laboratory markers, comorbidities). Based on the median of FI value patients were identified as not frail (<0.375; n = 41; 53%), and frail (≥0.375; n = 36; 47%).
Results: The mean follow-up period was 38.0 [21.0; 66.0] months. The 5-year survival was 87.8% for not frail patients compared to 52.8% for frail patients (Log rank p < 0.001). In univariate analysis the presence of frailty was significantly associated with long-term mortality (HR 6.108; 95 CI 2.207–16.907; p < 0.001). After adjustment for age, gender, NYHA class, left ventricular ejection fraction, presence of left bundle branch block and QRS width frailty remained a significant factor associated with 5-year mortality (HR 5.763; CI 95% 1.837–18.083; p = 0.003).
Conclusions: Frailty is widespread in patients with heart failure and implanted devices for CRT and it has an independent association with the risk of 5-year mortality.
110798
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
PRISCILLA MORETTO1, Priscilla Moretto1, Tatiane Boff Centenaro3, Gabriela dos Santos3, Fernando Rosa Inácio1, Ana Inês Gonzáles1
(1) Centro Universitário Estácio de Sá de Santa Catarina; (2) Centro Universitário para o Desenvolvimento do Alto Vale do Itajaí – UNIDAVI; (3) Universidade do Estado de Santa Catarina – UDESC
Introduction: In physical exercise programs aimed at Cardiovascular Rehabilitation, it is important to emphasize the adequate monitoring of these patients for care in the event of a cardiovascular event. Given the above, questions arise whether these care and monitoring are performed by physical therapists who work with the Pilates Method in patients with Cardiovascular Diseases (CVD’s) and if it occurs in an adequate and safe way.
Objectives: To assess the level of knowledge and safety measures adopted by physiotherapy professionals working in pilates studios regarding the care provided to patients with cardiovascular diseases.
Methodology: Cross-sectional research, with a non-probabilistic and quantitative sample, where professionals with active CREFITO, certified in Pilates and active in the method in the states of Brazil were invited. Those who did not provide all the data were excluded from the research. There was the development of a self-response questionnaire containing information related to the professional and the assessment of the level of knowledge regarding the approach and safety measures adopted with the Pilates Method in exercise programs for patients with CVD‘s. Professionals were invited to respond digitally and by publicizing CREFITOS and universities in Brazil. The TCLE was considered electronically signed when the volunteer accepted to participate in the research through an electronic form (Google Forms). The analysis of the study data was carried out using descriptive statistics, based on measures of central tendency (mean and standard deviation), performed in the SPSS statistical program for Windows® version 2.0.
Results: 134 physical therapists answered the questionnaire, 98 (73.1%) do not have a training course in the cardiovascular area, 81 (60.4%) have practical knowledge in cardiopulmonary resuscitation, 68 (50.7%) are not up to date regarding rehabilitation guidelines and approximately more than 90% of professionals consider it important to check safety measures regarding vital signs before, during and after each session. In the event of any cardiovascular intercurrence, only 69 (51.5%) of the professionals stated that their team is prepared to assist.
Conclusion: Most professionals do not have training to care for this type of patients, and have little knowledge of updating in the area, at the same time they consider it necessary to measure vital signs and perception of effort in the sessions.
110832
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
MAKI KOMIYAMA1, Yuka Ozaki1, Yoichi Sunagawa2, Yasufumi Katanasaka2, Masafumi Funamoto2, Kana Shimizu2, Hajime Yamakage1, Noriko Sato-Asahara1, Hiromichi Wada1, Tatsuya Morimoto2, Koji Hasegawa1
(1) Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; (2) Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
Background: Inflammation of blood vessels is key in the process of coronavirus disease 2019 (COVID-19) aggravation. Besides, risk factors for COVID-19 such as cardiovascular disease is strongly associated with smoking habits. Previous studies have reported that neutrophil to the lymphocyte ratio (NLR), the inflammation marker, is associated with the onset and prognosis of cardiovascular (CV) disease. Smoking is a potent CV risk factor, and smoking cessation significantly reduces CV risk. However, the effects of smoking cessation on the NLR remain unknown.
Purpose: The purpose of this study is to demonstrate the effect of smoking cessation on the NLR.
Methods: Among smokers visiting our smoking cessation clinics, we examined changes in the NLR and CVD biomarkers before and after smoking cessation. A total of 389 individuals (301 men and 88 women) were enrolled in the study.
Results: The median NLR was significantly reduced after successful smoking cessation (before: 1.8 [1.5, 2.5], after: 1.7 [1.3, 2.4]; p < 0.001). In a linear regression model adjusted for sex, percent change in NLR comparing before and after smoking cessation was significantly and positively correlated with percent changes in C-reactive protein (β = 0.260, p = 0.001), α1-antitrypsin-low density lipoprotein (β = 0.151, p < 0.05), and serum amyloid A-low density lipoprotein (β = 0.325, p < 0.001).
Conclusion: Our study demonstrated for the first time that smoking cessation significantly reduces the NLR in tandem with markers of inflammation and oxidative stress. These results may suggest that smoking cessation improves the risk of developing cardiovascular diseases and more severe symptoms of COVID-19. Moreover, smoking cessation recovers airway ciliary clearance and immune function as early as one month. Thus, smoking cessation awareness is strongly encouraged as part of the public health measures aiming to limit the global impact of COVID-19.
110803
Modality: E-Poster Researcher – Non-case Report
Category: HYPERTENSION/RENAL DENERVATION
HENRIQUE COTCHI SIMBO MUELA1, Guilherme Passassi1, Angelina Clara Cassoma Francisco1, António Gerson Bastos Francisco1, Isaura da Conceição Almeida Lopes1, Gade Satuala Vasco Miguel2
(1) Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola; (2) Cardiothoracic Surgery Department, Girassol Clinic, Luanda, Angola
Introduction: In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) published a new guideline (JNC 8) on the treatment of hypertension (HTN) that changed the diagnostic standard of high blood pressure (BP) from a BP threshold of 140/90 mmHg, as set by the seventh report of the Joint National Committee (JNC 7) to a BP of 130/80 mmHg.
Objective: To carry out a comparative study on the frequency of HTN and the profile of BP levels in a sample of adult inhabitants in Luanda, Angola, based on the most recent American HTN guidelines.
Methods: We carried out a cross-sectional study was, which included 1480 individuals who participated in the study on high blood pressure between May 2018 and June 2019, and who were recruited at Shopping Xyami, Angolan Public Television (TPA) and Congolenses’ market. Sociodemographic, anthropometric and clinical data were collected. Each participant had his/her BP taken with three measurements on the arm, after a 5-minute rest, using a semi-automatic Omron® device (Kyoto, Japan), with a 1-minute interval between. HTN was defined as the mean of systolic blood pressure (SBP) ≥140 mmHg and/or diastolic blood pressure (DBP) ≥90 mmHg according to JNC 7 and the mean of SBP ≥130 mmHg and/or DBP ≥80 mmHg according to JNC 8 or use of antihypertensive drugs for both guidelines.
Results: The sample was composed mostly by men (69.30%), young people (mean 39.74 ± 11.55 years old, range 18 to 94 years old). Alcohol consumption (74.6%) and overweight/obesity (44.9%) were the most prevalent risk factors. The prevalence of HTN was twice as high using the criteria proposed by the JNC 8 guideline compared to the cutoff points proposed by the JNC 7 (60.20 vs. 34.70; X2 = 519,03; p < 0.001). Both the knowledge and the treatment as well as the control of HTN were worse when using the JNC8 guideline definitions compared to JNC 7 guideline (X2 = 519,03; p < 0,001). Age, weight and alcohol consumption were the main predictors of blood pressure changes.
Conclusion: The use of JNC 8 definition resulted in a significant increase in the prevalence of high blood pressure, placing the BP of a significant proportion of adults in the hypertension range.
110804
Modality: E-Poster Researcher – Non-case Report
Category: HYPERTENSION/RENAL DENERVATION
HENRIQUE COTCHI SIMBO MUELA1, Angelina Clara Cassoma Francisco1, Guilherme Passassi1, António Gerson Bastos Francisco1, Isaura da Conceição Almeida Lopes1, Gade Satuala Vasco Miguel2
(1) Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola; (2) Cardiothoracic Surgery Department, Girassol Clinic, Luanda, Angola
Background: Arterial hypertension (HTN) is an important public health challenge worldwide. Data regarding the burden of hypertension is essential for the development of effective strategies for both treatment and control. Studies on the prevalence and awareness of hypertension in Sub-Saharan Africa (SSA) and especially in Angola are still scarce.
Objective: To assess the prevalence, awareness, treatment and control of HTN in a sample of dwellers of Luanda.
Methodology: We carried out cross-sectional study in a sample of dwellers of Luanda, Angola. Sociodemographic data and cardiovascular (CV) through questionnaires. Blood pressure was measured with semi-automatic sphygmomanometer (Omron®, Model HEM-7131-E), after 5 minutes resting and seated. Three blood pressure (BP) measurements with a 1-minute interval between were used to determine SBP and DBP in each patient. The average of the two last blood pressure readings was used for the analysis. Hypertension was defined as SBP and/or DBP ≥ 140/90 mmHg or current use of antihypertensive drugs. Controlled hypertension was defined as blood pressure <140/90 mmHg under antihypertensive drugs.
Results: Between May 2018 and June 2019, we carried out a cross-sectional study including 1480 individuals was carried out. The majority of the sample was young (mean age 39.74 ± 11.55 years old) and men (69.30%). Alcohol consumption (74.6%) and overweight/obesity was the most prevalent risk factors. The HTN prevalence was 34.9% in the sample. Among the hypertensive patients, 245 (47.4%) were aware of their disease and only 190 (36.8%) were under hypertension treatment; among those were taking drugs, only 68 (35.8%) were under control, defined as BP <140/90 mmHg.
Conclusion: HTN prevalence was high; the awareness, treatment and control levels were low.
110806
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
HENRIQUE COTCHI SIMBO MUELA1, Fernando Muhongo Sandala1, José António Tito2, Guilherme Mendes Lima Franco1, António Gerson Bastos Francisco1, Isaura da Conceição Almeida Lopes1
(1) Department of Physiology, Faculty of Medicine, Agostinho Neto University, Luanda, Angola; (2) Cardiology Department, Sagrada Esperança Clinic, Luanda, Angola
Background: Inflammatory response is one of the main mechanisms in the pathogenesis of atherosclerosis and its progression. The neutrophil-lymphocyte ratio (NLR) has been proposed as an inflammatory biomarker and potential risk and prognosis predictor in cardiovascular disease (CVD).
Objective: To assess the association between the neutrophil-lymphocyte ratio and the severity of coronary artery disease.
Methods: An observational and retrospective study was carried out, including 56 patients aged ≥18 years (41 men and 15 women) who underwent diagnostic and/or therapeutic coronary angiography from 2014 to 2019 at Sagrada Esperança Clinic, Luanda, Angola. Demographic data, risk factors and comorbidities, biochemical tests and full blood count were collected from the patients’ medical reports. The NLR was calculated as the ratio between the total neutrophil and lymphocyte counts from the patients‘ full blood count. For the statistical analysis purposes, the sample was divided into two groups according to the median of NLR (median: 2.02): patients with NLR ≤ median and patients with NLR> median. The statistical significance was set at 5%.
Results: The group of patients with CAD was relatively older than the group without CAD, although without any significant difference (58.49 ± 8.76 vs. 54.74 ± 8.7, p = 0.137). Likewise, the age was similar between groups considering the level of NLR (57.89 ± 8.60 vs. 56.54 ± 9.12, p = 0.571). The risk of having CAD and it being obstructive was twice as high in the group with NLR above the median (NLR > 2.02) compared to the group with a lower NLR (OR: 2.25, CI: 0.722–1.012 and 2.17, CI: 0.717–6.550, respectively). However, in general, our data suggested that there was no association between the neutrophil-lymphocyte ratio and the presence of CAD, nor with its severity (χ2 = 1.991, p = 0.259 and χ2 = 0.760, p = 0.562, respectively).
Conclusion: The risk of CAD occurrence, as well as the occurrence of obstructive CAD was twice higher in the group with higher neutrophil-lymphocyte ratio.
110817
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
SASHA KJAEVA ANASTASOVA1, Prof, d-r Srbinovska -Kostovska1, D-r. Paljoskovska-Jordanova1, D-r. Shehu1, D-r.Risteski1, D-r.Debreshlioska2, D-r. Angelovska2, D-r.Nivicka-Kjaeva3, D-r.Kjaev4
(1) University Clinic of Cardiology, Skopje, North Macedonia; (2) University Clinic of Pulmoallergology, Skopje, North Macedonia; (3) University Clinic of Ophthalmology, Skopje, North Macedonia; (4) University clinic of Gynecology, Skopje, North Macedonia
Aim: The aim of the study was to evaluate which echocardiographic parameters in assessment of right ventricular function may contribute to risk stratification in patients with severe/very severe chronic obstructive pulmonary diseases (COPD) in correlation with biomarker Nt-proBNP.
Material and methods: We have analyzed 38 patients with severe/very severe COPD, stages 3 and 4 according to Gold classification. All patients with heart diseases were excluded from the study. Additionally, all patients were divided into two subgroups: patients with acute exacerbation and chronically stable patients. Echocardiography, analysis included several parameters with emphasis to right chamber echo parameters in correlation to natriuretic peptide. Special emphasis was given to 3 predominant echocardiographic parameters: TAPSE, S’ wave assessed by tissue doppler of the free wall of the right ventricle and FAC%.
Results: Of a total number of 38 patients, 81,6% had elevated values of NT-proBNP and 18,4% had values of NT-proBNP in normal ranges. Analysis of the average values of NT-proBNP showed much higher values in the group of patients with acute exacerbation where the average value of NT-proBNP was 786,73 pg/ml in correlation with chronically stable patients, where NT-proBNP was 141,17 pg/ml. All 20 patients with acute exacerbation had elevated NT-proBNP values (above 125 pg/ml). In the group of patients with acute exacerbation, 13 patients (65%) out of 20 had S’ wave from the tissue doppler below 0,095 m/sec and 8 patients (22,6%) had TAPSE below 16 mm. The group of chronically stable patients (who were 18 in number), showed not convincing results. In this group 61% (11 patients) of the patients had elevated NT-proBNP, 4 of them had S’ wave from the tissue doppler below 0,095 m/sec and TAPSE was in normal range(>16 mm). FAC was below 35% in one patient, where NT-proBNP was 345,4 pg/ml.
Conclusion: In patients with chronic obstructive pulmonary diseases (COPD), echocardiographic parameters TAPSE and S’ wave assessed from the Tissue Doppler of the free wall of the right ventricle can be significant prognostic markers for disease monitoring. These parameters, especially S’ wave, can also be a marker for acute deterioration of the condition of the patients with COPD.
110833
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
RAFAEL ALEXANDRE MENEGUZ MORENO1, J. Ribamar Costa Jr.1, Nisia Lira Gomes1, Auristela IO Ramos1, Alfredo N. Ferreira-Neto1, Dimytri Siqueira1, Mercedes Maldonado1, Zilda Meneghelo1, Cesar A. Esteves2, Sérgio Braga1, Amanda Sousa1
(1) Instituto Dante Pazzanese de Cardiologia; (2) Universidade Federal de São Paulo (UNIFESP)
Background: Percutaneous balloon mitral commissurotomy (PMBC) is an attractive therapeutic approach in patients with mitral stenosis. The aim of this study was to assess the immediate and long-term clinical, echocardiographic and haemodynamic outcomes of PMBC in patients with severe pulmonary hypertension (PH).
Methods: Among all procedures (in more than two decades of experience), PMBC was performed from 1987 until 2011 at a single-center in 147 patients who had significant PH defined as baseline pulmonary artery mean pressure (PAMP) (systolic pulmonary pressure >75 mmHg). All-cause mortality, need for mitral valve replacement (MVR) or new PMBC, and valve restenosis were evaluated during follow-up yearly.
Results: Mean age was 33.8 ± 12.8 years and 83.6% (123 patients) were women. Primary success was achieved in 89.8% of the patients (132 patients). Mitral valve area (MVA) increased from 0.83 ± 0.17 cm2 to 2.03 ± 0.35 cm2 (p < 0.001), and at 20-years, mitral valve area was 1.46 ± 0.34 cm2 (p = 0.235). Systolic pulmonary artery pressure decreased from 87.0 ± 6.0 mmHg to 60.0 ± 0.9 mmHg (p < 0.0001). The rates of all-cause mortality, need for MVR, new PMV, and valve restenosis were 0.67%, 20.0%, 8.78% and 30.4%, respectively, in long-term follow- up (mean 15.6 ± 4.9 years).
Conclusions: PMBC is a safe and effective technique for the treatment of patients with mitral stenosis and PH. A significant decrease in pulmonary pressure was observed after commissurotomy. Although there was a gradual decrease of MVA at long-term follow-up, most patients remained asymptomatic and without major adverse events.
112450
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
FATHIMA AAYSHA AAYSHA CADER1, Ishmum Zia Chowdhury2, Saidur Rahman Khan1, M. Maksumul Haq1, Mashhud Zia Chowdhury1
(1) Ibrahim Cardiac Hospital & Research Institute; (2) BIRDEM General Hospital
Introduction: The impact of the COVID-19 pandemic on cardiology services globally has been variable, with a paucity of contemporary data comparing pre- and post-pandemic trends over a long period in a South Asian setting.
Objectives: We aimed to report annual trends of cardiovascular services delivery and procedure volumes from 2019 to 2022, to assess the impact of the COVID-19 pandemic, and recovery of services at a tertiary cardiac centre in Bangladesh.
Methods: Data on patient visits (outpatient and emergency), admissions, procedures and catheterization volumes were collected from January 2019 to February 2022 via hospital electronic records. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams.
Results: Following significant reductions of all cardiology services in 2020 (1), particularly ER visits (Δ–59.5%; p = 0.0), cardiology services delivery and procedure volumes had recovered, reaching almost pre-pandemic levels by Q1 of 2021 (Figure 1). A steep and significant decline of admissions and procedures was seen in March–April 2021 as compared with 2020, coinciding with the Delta variant surge (2). By Q4 of 2021, patient visits and procedures, both outpatient and catheterization volumes had once again reached near pre-pandemic levels (3). During the Omicron surge in early 2022, a small decline in outpatient visits (Δ–10.9%) and outpatient procedures (Δ–6.83%) was observed in January–February. However, in-patient admissions (Δ4.39%) and catheterization laboratory procedures (Δ5.7%) showed a rise in February 2022 as compared with the preceding month, with ER visits showing the steepest rise (Δ 41.9%). Notably, although ER visits remained relatively blunted post-pandemic (2020–2021), this trend was not reflected in outpatient visits/procedures, in-patient admissions and catheterization procedures, all of which increased to pre-pandemic levels by the end of 2021 (1–3). This may be explained either by patients presenting at index to the outpatient department, instead of the ER; or, a higher proportion of patients being directly referred to our centre for admission from the peripheries.
Conclusion: Two years on from the pandemic, cardiology services and cath lab volumes have reached almost pre-pandemic levels in 2022, except for ER visits which remain low, albeit gradually rising.
110840
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
LUIZ FERNANDO KUBRUSLY1, Douglas Mesadri Gewehr2, Taiane Belinati Loureiro Kubrusly3, Fernando Bermudez Kubrusly3, Luiz Fernando Kubrulsy1
(1) Mackenzie Evangelical School of Paraná, Curitiba, Paraná, Brazil; (2) Denton Cooley Institute of Research, Science and Technology, Curitiba, Paraná, Brazil; (3) Curitiba Heart Institute, Curitiba, Paraná, Brazil
Background: The practice of pretreatment with oral P2Y12 inhibitors in ST-elevation acute coronary syndrome (STEACS) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue.
Objective: We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEACS patients with cardiovascular and bleeding outcomes.
Methods: PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P2Y12 versus no pretreatment in STEACS, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogenicity was assessed with I2 statistics.
Results: A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged 7 days to 19 months. Medications included clopidogrel, prasugrel and ticagrelor. At 30 days, P2Y12 pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56–0.91; p = 0.006; I2 = 75%), stent thrombosis (RR, 0.33; 95% CI, 0.12–0.95; p = 0.04; I2 = 83%), 30-day major bleeding (RR, 0.81; 95% CI, 0.74–0.90; p < 0.0001; I2 = 0%). No difference in the incidence of 30-day myocardial infarction (MI), target vessel revascularization (TVR), MACE (death/MI/TVR), stroke, pre-PCI TIMI 0 and post-PCI TIMI 0–2 was observed. Subgroup analysis for 30-day mortality, including only randomized studies, indicated a trend in favor of no pretreatment, but without statistical significance (RR, 1.49; 95% CI, 0.89–2.52; p = 0.13; I2 = 38%).
Conclusion: In this study, pretreatment with oral P2Y12 inhibitors among patients with STEACS before cath lab, compared with treatment once coronary anatomy is known, was associated with decreased all-cause mortality and bleeding risk.
110852
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
CHRISTIANE DIAS MAUÉS1
(1) Smart Vascular Technologies EI; (2) Federal Government of Brazil ME/MCTI
In recent years, nanotechnology has been a strong ally to medical technology advances, and in this sense, one of the greatest applications concerns drug carrying and releasing systems. The use of nanostructured systems to carry out drug delivery allows the development of new systems for an efficient transport of these drugs, where a controlled release is achieved to the diseased tissues of living systems. These drugs are linked to nanostructures in a controlled way, commonly called functionalization, along with other attached molecules – biomarkers. Smart nanoparticles as liposomes could still be functionalized for a better targeting to the target tissue, preventing the side effects of the drug they carry. As a pioneer project, this privilege holds a non polymeric multidrug eluting coronary stent, which spatial structure is represented by six configurations, associated to a biological matrix (coating) in which nanoparticles, more precisely functionalized liposomes, are stored and grouped into sequential layers, each one differing the type of pharmacological agent to be applied, as well as increased coefficients of biodegrability applied to this support matrix, conferring continuously and selectively control of drug releasing pulse. In this sense, nanofunctionalized liposomes, in addition to being cell membranes models, act as excellent biocompatible systems for formulation, carrying and release of drugs to organic tissues.
110846
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
MICHAŁ LEWANDOWSKI1, Ilona Kowalik1
(1) National Institute of Cardiology, Warsaw, Poland
Background: Prediction of sudden cardiac death remains a significant challenge. There is some evidence that ventricular ectopic activity could be regarded as a predictive marker.
Objectives: We carried out an analysis to explore whether premature ventricular complexes (PVCs) are a risk factor in implantable cardioverter-defibrillator (ICD) interventions.
Materials and methods: The study method was a RR interval series analysis (n = 184) of arrhythmic events and controls from the ICD. Study group consisted of patients with a mean age of 55 ± 27 years; 74% of them were male, 85% were secondary prevention patients, 62% had coronary artery disease (CAD), 15% hypertropic cardiomyopathy (HCM), 15% dilated cardiomyopathy (DCM), and 8% diseases of other etiol¬ogy. The mean follow-up time was 64 months (range: 3–126 months). The study population was divide into patients with at least 1 appropriate intervention ventricular tachycardia/ventricular fibrillation (VT/VF) (group A, n = 101) and controls without interventions (group B, n = 83). The number of PVC/4000 RR cycles, the shortest coupling intervals between a PVC and preceding R as well as the number of PVCs of very short (180–220 ms), short (220–280 ms) and different cycle lengths (CL) as well as the incidence of short-long-short (SLS) sequences were compared.
Results: The number of PVCs/4000 RR cycles was significantly higher in group A (263 ± 32 compared to 43 ± 17, p < 0.0001). The mean shortest PVC CL was significantly shorter in group A (320 ± 13 compared to 400 ± 38, p = 0.029). The number of PVCs with a very short CL was 1 ± 0.4 compared to 0.1 ± 0.1 (p = 0.028). The number of PVCs with a short CL was 5 ± 1.2 compared to 0.6 ± 0.4 (p = 0.0007) in groups A and B, respectively. The incidence of SLS sequences was significantly higher in group A than in group B (67 (94% of patients) and 4 (33% of patients) respectively (p < 0.0001)).
Conclusions: Significant differences were found in the characteristics of PVCs and SLS sequences between patients with appropriate ICD interventions and controls. A newly developed basic computer program called PCRR was applied for RR interval analysis. This simple method could be a predictor of PVC burden, heart rhythm variability and life-threatening arrhythmias in different populations.
110878
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARIA JULIANA RODRIGUEZ GONZÁLEZ1, Andres Felipe Barragán Amado1, Maria Fernanda Tamayo Tamayo1, John Alexander Ramirez1, Julián Gelves1, Esther Campos1, claudia Patricia Jaimes Castellano1
(1) Lacardio
Introduction: In the setting of hypertrophic phenotype, the hypertrophic cardiomyopathy (HCM) is the most prevalent genetic disorder and responds to the 60% of the cases; with variable penetrance and expression. Genotyping is a step in its approach to defining prognosis and establishing phenocopies. Mutations in some genes encoding sarcomere proteins like cardiac myosin-binding protein C and β-myosin heavy chain are the most prevalent affected, representing 30–40% of all pathogenic or likely pathogenic variants.
Aim: Describe the genotyping of our first cohort of hypertrophic phenotypes in a reference heart failure clinic.
Method: Data was taken for in-Hospital patients irrespective of the cause of hospitalization or out of hospital who required a cardiovascular imagen test; the only requirement was to have a cardiac magnetic resonance or transthoracic echocardiography with a hypertrophic phenotype defined by any wall over 15 mm or 13 in patients with a family history of HCM between 01/01/2019–31/12/2021. Descriptive statistics are presented as median (range) or % of affected patients.
Results: Patients with hypertrophic phenotype were 45, the average age was 54 years (ds: 19,73), 52% were women, 37% had a previous diagnosis of hypertension, the MYH7 was detected in 36% of the overall patients, and the total gene mutations were 55 and the unknown significance variants represented the 69%. Nine of these patients had multiple mutations and only three patients had non-sarcomere genes mutation (they had late-onset Fabry disease, amyloidosis, and Noonan). On the imaging aspects, the average diameter was 17,86 mm (ds: 4,16), the most affected segment was anteroseptal basal with 45% and the average left ventricular ejected fraction was 59,3 (ds: 15,01).
Conclusion: These results provide important knowledge about genotyping patients with hypertrophic phenotype, to determine the possible diagnosis, the gene mutation, the type of variant, and the significance. This study shows that in our population, the pathogenic variants represent 27% of the total, similar data in comparison with the available publications. This is the first study in Colombia that reveals genotyping in hypertrophic phenotype could let us establish some mutations that carry a worse prognosis and establish family approaches.
111055
Modality: E-Poster Researcher – Non-case Report
Category: PSYCHOLOGY
MAKI KOMIYAMA1, Hajime Yamakage1, Noriko Satoh-Asahara1, Yuka Ozaki1, Tatsuya Morimoto2, Yuko Takahashi1, Koji Hasegawa1
(1) Clinical Research Institute, National Hospital Organization Kyoto Medical Center, Kyoto, Japan; (2) Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
Depressive tendency and nicotine dependency are factors related to the failure of smoking cessation. Women generally have a higher depressive tendency and difficulty in smoking cessation than men. However, the impact of sex differences on the relationship between nicotine dependency and depressive tendency remains unclear. We evaluated 727 patients (496 men and 231 women) who visited our outpatient clinic for smoking cessation therapy and compared various parameters measured between sexes during consultation. Age, duration of smoking, and daily cigarette consumption were significantly higher in men during the first visit. Women had significantly higher self-rating depression scale (SDS) scores and took significantly more antidepressant drugs than men. The SDS score significantly correlated with the Fagerström test for the nicotine dependence score and with daily cigarette consumption in women, but not in men. Thus, the present study demonstrates the differential relationship of depressive tendency with tobacco use or nicotine dependency in men and women, which might reflect sex differences in response to psychological stress. We previously reported that depressive tendencies of patients with neurosis improve even in the initial stages of the smoking cessation treatment (i.e., within two weeks after starting the treatment), but further studies are required for the sex difference for the improvement.
110894
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
CRISTIANE DA CRUZ LAMAS1, Giovanna Ianini Ferraiuoli Barbosa1, Rafael Quaresma Garrido1, Wilma Félix Golebiovski1, Clara Weksler1, Diego Santos2, Caio Sambo2, Vitor Milczwski2, Milena Paixão3, Flavio Tarasoutchi3, Tânia Mara Varejão Strabelli3, Rinaldo Focaccia Siciliano3
(1) Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil; (2) Department of Infectious Diseases, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; (3) Heart Institute (InCor), Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
Introduction: Prosthetic valve endocarditis (PVE) is found in 10 to 30% of contemporary series of infective endocarditis (IE) and has a high mortality rate. Our aim was to describe cases of late PVE and analyze mortality-related risk factors.
Methods: Two quaternary cardiac surgery institutes were the study scenarios. Data were collected from 2011–2021 in site 1, and 2006–2021 in site 2. Patients were prospectively identified using site-specific procedures to ensure consecutive enrollment. Only adult patients with definite IE according to the modified Duke criteria were included. Studied variables were those present in the International Collaboration in Endocarditis case report forms. Statistical analysis was performed with the SPSS v26 software. Variables with p values less than 0.1 were included in the model.
Results: There were 250/559 (44.7%) episodes of LPVE in site 1 and 77/438(17.6%) in site 2 during the study periods. Males accounted for 207/327 (63.3%) of patients, mean age ± SD was 55.5 ± 17.3 years. Rheumatic valve disease was present in 161/326 (49.4%) and congenital heart disease in 29/327(8.9%). Healthcare-associated IE was present in 83 (25.4%) and 132/326(49.4%) patients were in heart failure (NYHA class III/IV). Etiologic agents were defined in 275(84.1%) of cases, and oral streptococci were responsible for 107/327(32.7%). Death was the outcome for 101/327(30.9%). Risk factors for death were assessed by multivariate analysis and those found to be statistically associated were: age over 60 years (OR = 2.4; 95% confidence interval [95%CI]: 1.2–5; p = 0.014), heart failure (NYHA class III or IV) (OR = 4.1; 95%CI = 1.8–8.3; p < 0.0001), the presence of perivalvular abscess/fistula/perforation on admission echocardiography (OR = 2.8; 95%CI = 1.3–6.1; p = 0.009) and being referred from another hospital (OR = 2.6; 95%CI = 1.25–5.4;p = 0.011).
Conclusion: Previous series have described that late PVE is found in older patients, but our cohort shows younger patients and a high frequency of rheumatic valve disease. A quarter of patients acquired IE in a healthcare setting, highlighting the relevance of this mode of acquisition and the extra care needed in infection control in patients with prosthetic valves. Similarly to other studies, destructive disease and heart failure were associated with death, and mortality was higher than in native valve IE.
110902
Modality: E-Poster Researcher – Non-case Report
Category: DYSLIPIDEMIA
KU MING YING1, Shirley Tan Siang Ning1, Crystal Tan Sing Yee1, Tiong Lee Len1, Saiful Shakirin bin Rosli1, Hwang Siaw San2, Ong Tiong Kiam3, Alan Fong Yean Yip3
(1) Sarawak General Hospital; (2) Swinburne University of Technology Sarawak Campus; (3) Sarawak Heart Centre
Introduction: Lipoprotein(a) [Lp(a)] is known to have prothrombotic, proinflammatory and proatherogenic properties contributing to Atherosclerotic Cardiovascular Disease (ASCVD) development and progression. Previous studies have shown ethnic differences in plasma Lp(a) levels.
Objective: We aim to determine the plasma Lp(a) concentrations among Malaysians with Acute Myocardial Infarction (AMI).
Methods: This prospective study involved AMI patients admitted to a tertiary hospital in Sarawak between August 2018 and March 2019. Blood samples were collected during hospital admission and stored at –80°C. Plasma Lp(a) concentrations were determined by quantitative sandwich enzyme immunoassay technique (Elabscience, USA).
Results: A total of 240 AMI patients were recruited, with mean age of 56.4(±10.90) years and 88.8% males. Ethnic distributions were 42.9% Malay, 30.4% Chinese and 26.7% Iban/Bidayuh. The mean Lp(a) concentration and baseline LDL-C level were 5.3(±7.49) mg/dL and 3.2(±1.15) mmol/L respectively. Mean Lp(a) concentrations among Malay, Chinese and Iban/Bidayuh patients were similar [5.9(±6.69) vs 5.3(±10.46) vs 4.5(±3.80) mg/dL; p = 0.340]. Patients with or without prior statin therapy demonstrated no significant difference in Lp(a) concentration [5.7(±9.71) vs 5.1(±5.53) mg/dL; p = 0.521]. Only 1.7% of patients were found to have Lp(a) >30 mg/dL. Patients presenting with 1-year MACE (AMI, stroke or cardiovascular death) were found to have significantly higher Lp(a) compared to those who did not [7.9(±7.67) vs 4.96(±7.41) mg/dL; p = 0.042].
Conclusions: Our study showed that the mean Lp(a) concentration among our AMI patients were lower compared to other published studies. However, those who experienced 1-year MACE had significantly higher Lp(a) concentration compared to the rest of the study population.
110904
Modality: E-Poster Researcher – Non-case Report
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
SASHA KJAEVA ANASTASOVA1, Prof, d-r. Srbinovska-Kostovska1, d-r Pajloskovska-Jordanova1, d-r Shehu1, d-r Risteski1, d-r.Debreshlioska2, d-r Angelevska2, d-r.Nivicka-Kjaeva3
(1) University clinic of cardiology, Skopje, North Macedonia; (2) University clinic of pulmo-allerology, Skopje, North Macedonia; (3) University clinic of ophthalmology, Skopje, North Macedonia
Aim: The aim of the study was to evaluate chronic obstructive pulmonary diseases (COPD) in correlation with natriuretic peptide biomarker Nt-proBNP with special emphasys to the subgroup of acute exacerbation patients with COPD. All patients analysed were hospitalized.
Material and methods: We have analysed 94 patients with COPD devided in 4 groups according to Gold classification system. Gold class I (18 pat.), Group II (18 pat.), Gold class III and IV (28/30 patients). Additionally, all patients were divided into two subgroups: patients with acute exacerbation and chronically stable patients. From the whole group of 94 patients, 63 were patients with acute exacerbation while 31 was were classified as chronically stable patients.
Results: Natriuretic peptide was measured in all 94 patients with the average value above reverence ranges in all pts and it was 236.27 pg/ml. Gold class I/II included patients only with acute exacerbation. In both groups (Gold I/II), values od Nt-proBNP were at a higher level (159, 62 pg/ml). The average value of Nt-proBNP in Gold class III, in the group of acute exacerbation was 492,60 pg/ml versus 147,48 pg/ml in the group of chronic stable patients while in Gold class IV these values were 307,44 versus 151,74 pg/ml. The average values in acute patients are far higher then in the chronic group of stable COPD patients with in appropriate Gold class. Such a difference is almost 3,5 times higher in Gold class 3 and 2 times in Gold class 4.
Conclusion: According to the results here is a clear and statistically highly significant difference in the values of Nt-proBNP in relation to acute and chronic COPD patients, especially in Gold class III and IV. In the acute group, this is all due to rich inflammatory process and deterioration of the lung function which is replicated on the right heart cavities resulting in high release of Nt-proBNP. Deterioration of lung function leads to right heart strain and weakness and increased excretion of Nt-proBNP.
110924
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
CRISTIANE DA CRUZ LAMAS1, Nícolas de Albuquerque Pereira Feijóo2, Thatyane Veloso de Paula Amaral de Almeida2, Mariana Giorgi Barroso de Carvalho2, Gabriel Santiago Moreira1, Léo Rodrigo Abrahão dos Santos2, Rafael Quaresma Garrido1, Bruno Zappa1, Giovanna Ianini Ferraiuoli Barbosa1, Wilma Félix Golebiovski1, Marcelo Goulart Correia1, Clara Weksler1
(1) Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil; (2) Unigranrio-Afya
Introduction: Infective endocarditis is a severe disease, with high mortality. Its features in a developing country such as Brazil differ substantially. Our aim is to describe a series of adult patients with IE cared for in a cardiac surgery referral center, highlighting its specificities.
Methods: Adult patients with definite IE according to the modified Duke criteria were included from 2006–2021 using the International Collaboration in Endocarditis case report form. Patients were identified prospectively using site-specific procedures to ensure consecutive enrollment. Statistical analysis was performed using the Jamovi 1.6 and R 4.0.1 softwares.
Results: There were 435 episodes of IE in the study period, and mean age ± SD was 47.8 ± 17.3 years; 283(65.1%) were males. Community-acquired IE occurred in 284 (65.4%), hospital-acquired in 112 (25.8%). Early prosthetic valve IE (PVE) accounted for 47/435(10,8%) cases and late PVE for 77(17,7%). Previous 170 (39.3%) had previous cardiac surgery, congestive heart failure in 173 (40.0%), chronic renal failure in 91 (21.0%), coronary artery disease in 60 (14.0%), diabetes mellitus in 55 (12.6%). Main predispositions to IE were rheumatic valve disease (RVD) in 133 (31.5%), valvular prosthesis in 28.5%, congenital heart disease in 61 (14.0%), previous IE in 51 (11.8%) and intravenous drug use in 5 (1.2%). Vegetations were seen in the mitral valve in 214 (49.4%) and aortic valve in 180 (41.6%), in intracardiac devices, in 33 (7.6%). Fever was seen in 91.7%, new regurgitant murmurs in 54.4%, embolism in 48.3%, splenomegaly in 20.4%; Osler’s nodes, Janeway lesions, subconjunctival hemorrages and splinters were seen in less than 5% each. CRP levels were high in 82.3% and ESR in 58.9%. Blood cultures were taken in 98.6% of episodes, but were positive in only 67.1%. The most frequently isolated pathogens were viridans group streptococci, VGS(21%), S.aureus (11%), and enterococci(11%). Main complications were acute heart failure, in 263 (60.7%), acute renal failure (33.9%), myocardial abscess (22.6%). Surgery was indicated for 373 (86.1%) and effectively done for 316 (79.8%). Inhospital mortality was 109/425 (25.6%).
Conclusions: In our quaternary center in Rio, left-sided IE predominated, with negative blood cultures or VGS as main findings. RVD was the main predisposition. Surgical indication was frequent, due to referral bias, and mortality was overall similar to the literature.
110942
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
IWONA KORZENIOWSKA-KUBACKA1, Anna Mierzyn’ska PhD2, Ewa Rydzewska PhD1, Edyta Smolis-Bąk PhD1, Rafał Dąbrowski MD, PhD1
(1) National Institute of Cardiology, Warsaw, Poland Department of Coronary Artery Disease and Cardiac Rehabilitation; (2) Department of Rehabilitation. Medical Centre of Postgraduate Education Gruca Orthopaedic and Trauma Teaching Hospital, Otwock, Poland
Introduction: Hostility and its behavioral components, anger and aggression are psychosocial risk factors for coronary heart disease. The impact of exercise training on these negative emotions in patients after myocardial infarction (MI) without psychological support, has been poorly studied.
Objective: The purpose of the study was to evaluate the effectiveness of physical training on the level of negative emotions, the cognitive aspect of adaptation to disease, and physical capacity in patients after MI who participated in cardiac rehabilitation.
Methods: We enrolled 60 post-MI men and women in the study. All of them underwent an 8-week training program(TP) consisting of 24 interval trainings 3 times a week, started on average 40 days after MI. Before and after completion of TP, patients underwent a symptom-limited exercise test with analysis of maximal workload, duration, HR and BP at rest and during effort. The Buss-Perry Aggression Questionnaire assessing the level of negative emotions and the Brief Illness Perception Questionnaire were performed with results analysis in the entire group and subgroups of men, women, patients under 60 years of age (younger) and over 60 years of age (older).
Results: After TP a significant reduction in the general level of negative emotions was found only in the group of younger: 67.8 ± 4.6 vs 63.9 ± 3.7 points, P < 0.01. Furthermore, a significant reduction in the sense of the impact of the disease on life was found in younger 6.96 ± 0.5 vs 5.48 ± 0.5points, P < 0.01. Furthermore, there was a significant improvement in overall adaptation to the disease in the subgroup of women from 40.6 ± 2.2 to 35.7 ± 1.9 points, P < 0.05. Physical capacity increased significantly in all studied groups.
Conclusions: Participation in rehabilitation based on exercise trainings without psychological intervention not only improved physical capacity, but also beneficially contributed to a decrease in negative emotions and had a positive effect on disease adaptation especially in younger patients under 60 years of age after MI.
110949
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
SASHA KJAEVA ANASTASOVA1, Prof.D-r.Elizabeta Srbinovska-Kostovska1, D-r Elena Grueva-Nastevska1, D-r Savetka Paljovskovska-Jordanova1, D-r Dean Risteski1, D-r Danica Petkoska-Spirova1, D-r Enes Shehu1, D-r Irina Angelovska2, D-r Angela Debreshliovska2
(1) University clinic of cardiology, Skopje, North Macedonia; (2) University clinic of pulmo-allerology, Skopje, North Macedonia
Aim: The aim of the study was to evaluate the echocardiographic parameters used to assess right ventricular function and pulmonary hypertension in patients with chronic obstructive pulmonary disease (COPD) according to their specificity and sensitivity and disease progression.
Material and methods: We have analysed 94 patients with COPD (Gold class I–IV). The 13 echo-cardiography parameters important for assessment of right ventricular function and pulmonary hypertension due to their sensitivity and specificity and progression of the disease were evaluated: basal dimension of the right ventricle(DV bazal), right atrium(DA), right atrial area(DA area), S‘wave of the right ventricle of TDI, TAPSE, functional area change (FAC%), (SPAP), Vmax of tricuspid regurgitation, acceleration time of pulmonary artery (AT), pulmonary vascular resistance (PVR), myocardial performance index of the right venricle (MPI), global strain of the right ventricle(GL strain), collapsibility of vena.cava inferior >/<50%.
Results: Predictors of disease progression with high specifity and sensitivity are the parameters: MPI DV TDI, Global strain of DV and collapsibility of v.cava inferior less then 50%. Predictors of disease progression with high specifity and low sensitivity are: DV bazal, DA, DA area, S TDI, TAPSE, FAC, SPAP, V max TR. Predictors of disease progression with low specifity and high sensitivity are parameters: shortened acceleration time of the pulse Dopler of the pulmonary valve and the development of pulmonary vascular resistance.
Conclusion: Echocardiography is a non invasive and useful method for evaluation and follow up the patients with COPD. All this indicates that the values of certain echo parameters can help us detect disease progression with high sensitivity, specifity or both.
110955
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
MICHAŁ LEWANDOWSKI1, Rafał Waligóra1, Paweł Syska1, Ilona kowalik1
(1) National Institute of Cardiology, Warsaw, Poland
Background: The condition for SICD therapy is passing an electrocardiographic screening test (ECG-s). A patient is considered suitable for implant if at least one surface ECG lead (sense vector) is acceptable for all tested postures.
Objective: Identifying the rate of failure, the predicting factors and clinical importance of extended ECG-s with right sided lead position and lying on the left and right side of the body.
Methods: ECG-s is based on a manufacturer-specific measurement tool. We performed this test in 50 consecutive pts with indication for SICD using standard protocol(lead at the left sternum border: sitting, standing and lying) and extended for right parasternal lead location and 2 additional position: lying on the left and right side. We analyzed age, gender, BMI, heart rate, rhythm(sinus/atrial fibrillation), QRS duration, PR interval, corrected QT interval(QTc), echocardiography parameters, etiology.
Results: ECG-s failure occurred in 4/50(8%) of patients. Screening results: 1 vector failure rate with the standard device and electrode positions: primary(P) 12%,seconadary(S) 17%, alternative(A) 40%, P vs. A and S vs. A p < 0,001. Testing with an electrode positioned on the right sternum border- 1 vector failure: (P) 10%,seconadary(S) 17%, alternative(A) 48%, P vs. A and S vs. A p < 0,001. In case of failure on left side 50,14 and 6% of pts passed the test with the right sided lead position for P, S and A vector respectively, p < 0.001. Identified factors predicting ESG-s passing vs. failure included: QTc interval 445,32 ± 35,4 vs. 480,6 ± 37,6 ms for any vector(p = 0,034), BMI:26,7 ± 4,7 vs. 29,9 ± 4,7 for vector A(p = 0,008), EF: 43,3 ± 20,1 vs. 34,0 ± 16,2 for vector A(p = 0,027). Sense vector failure rate with the left parasternal lead location lying on the left and right side of the body was concordant with lying on the back, p = 0,65. For the right parasternal lead location the rate failure was lower lying on the right side for all sense vectors: P, S and A(p = 0,045; 0,083 and 0,020) respectively.
Conclusions: ECG screening failure rate for SICD is comparable with previous reports. The right parasternal lead location screening enables important clinical findings before implantation and in case of lead reposition during procedure, thus we recommend to screen routinely on both sternum borders. Some additional body position testing: lying on the left and right side of the body, mimicking sleeping/rest could be an important element to determine eligibility for SICD.
110961
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
MICHAŁ LEWANDOWSKI1, Paweł Syska1
(1) National Institute of Cardiology, Warsaw, Poland
Background: Young implantable cardioverter-defibrillator (ICD) recipients present high rate of inappropriate shocks(IS) and complications. Some of them seem to be underestimated. The subcutaneous ICD system was developed to eliminate lead-related complications and was proved to be effective. S-ICD appears to be a good therapy option and an alternative to transvenous implantable cardioverter-defibrillator (TV-ICD) in pediatric and young patients population. Aims To report on our clinical experience with TV-ICD and S-ICD therapy in patients under thirty years of age.
Methods: We reviewed database of ICD recipients in our institution between 1996 and 2021(25 years) and have chosen 115 pts consecutively implanted up to and including the age of 30 years. We retrospectively analyzed the rate of appropriate and inappropriate interventions, lead complications rate, infection rate, mortality and treatment options.
Results: The study group: 84 TV-ICD(age: 6–30, BMI: 16,3–22,2) and 31 S-ICD (age: 15–30, BMI; 15,6–31,1) patients. The mean follow-up in analyzed groups was 159 ± 48 and 36 ± 2 months respectively. Abnormal ventricular function: EF < 30 occurred in compared groups: 12/84(14%) and 5/31(16%) respectively, p = 0,3. 24/84pts(28%) received ≥1 appropriate therapy(AT) for VT/VF(ATP or shock) in TV-ICD and 3/31pts(10%) in S-ICD groups. 25/84 pts(30%) had one or multiple (IS) and 0% in compared groups respectively, p = 0,02. There were 18/84 (21.5%) ventricular lead dysfunctions(reimplantation of a new system) in TV-ICD and 0% in S-ICD groups, p = 0,025. An infection rate (endocarditis or device pocket) was 6/84 (7%) in TV-ICD group with complete system removal and 1 pts (3%) wound infection in S-ICD group successfully treated with antibiotics. Mortality rate was 6/84 pts (7%), caused by ventricular lead dysfunction, end stage heart failure or heat transplantation fatal result in TV-ICD group. There was no death in S-ICD group.
Conclusions: Endocardial ICD implantation in children and young adults is a feasible and effective procedure in a 25-year follow-up but the rate of complications is high in this population. S-ICD recipients did not experienced lead failures, systematic infections or inappropriate shocks. S-ICD appears to be a good therapy option in life-threatening arrhythmias, preventing from some serious T-ICD complications in young patients. The method and follow-up period effect is present between the TV-ICD and S-ICD in analyzed groups.
110968
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
PRANAS SERPYTIS1, Egle Majauskiene1, Pranas Serpytis1
(1) Vilnius University, Faculty of Medicine, Lithuania; (2) Vilnius University, Clinic of Cardiac and Vascular Diseases, Centre of Cardiology and Angiology, Lithuania
Introduction: Physical activity is associated with improved health outcomes for adolescents. Many of the benefits are observed with an average of at least 60 min of moderate-to-vigorous intensity physical activity daily (1). Unfortunately, more than 80% of school-going adolescents did not meet current recommendations for daily physical activity (2).
Objective: We aim to analyze physical activity trends and their association with stress, weight, screen time, and other factors in Lithuania adolescents.
Methods: A prospective observational cross-sectional study enrolled students from High Schools in Lithuania’s capital city. A survey was administered to a cohort of students aged 13–18 years. Data from a questionnaire about behavioral risk factors, academic performance, stress level at school, and physical activity were collected. Stress levels were measured by 10 points system. Data were analyzed using SPSS v28 statistical package.
Results: The study population consisted of 589 adolescents (61.4% female and 38.5% male participants). The mean age was 15.79 ± 2.81 years. Adolescents engage in physical activity for 3.30 ± 1.91 days a week. Only 18.34% of adolescents’ (12.98% female vs 26.87% male; p < 0.001) physical activity lasts more than 420 min a week (60 min daily). Adolescents who exercise more, experience less stress at school (p < 0.001). Whereas screen time lasts 6.80 ± 3.23 hours daily and is associated with higher stress levels at school (p < 0.001). Smoking and alcohol consumption were significantly more common among girls (smoking: 22,37% vs 22,70%; p = 0,632; alcohol: 27.73% vs 21,15%; p < 0.001).
Conclusions: More than 80% of adolescents in Lithuania did not meet recommendations for daily physical activity. Girls are less active than boys and tend to have more addictions. To avoid health consequences, it is necessary to strengthen education about cardiovascular risk factors and a healthy lifestyle benefits.
110978
Modality: E-Poster Researcher – Non-case Report
Category: CARDIO-ONCOLOGY
LOURENÇO SAMPAIO DE MARA1, Mariana Kleis Pinto da Luz Lodi3, Suellen Cristina Roussenq3, Magnus Benetti2
(1) Curso de Pós Graduação em Cardio-Oncologia SBC/INC/INCA, Rio de Janeiro, RJ, Brasil; (2) Universidade do Estado de Santa Catarina-UDESC Centro de Ciências da Saúde e do Esporte – CEFID, Núcleo de Cardioncologia e Medicina do Exercício Santa Catarina, SC, Brasil,; (3) Centro de Pesquisas Oncológicas – CEPON, Santa Catarina, SC, Brasil
Introduction: Bone marrow transplantation (BMT) remains the best clinical alternative for the treatment of leukemias and chemotherapy-refractory lymphoid cancers. There is an increase in the survival of these patients, but with cardiovascular sequelae, which can be minimized by the effects of exercise.
Objective: To analyze the effect of exercise on the gain of cardiovascular capacity in patients undergoing allogeneic BMT.
Methods: Pilot study of a randomized controlled clinical trial with the Brazilian Registry of Clinical Trials, registry RBR-887gqvs. Fifteen patients with leukemia and lymphoma who were eligible for BMT participated, nine were randomized to the exercise intervention group (EIG), and six to the control group (CG). The EIG performed aerobic and resistance exercise during hospitalization, followed by a cycle ergometer protocol at Day Hospital, three times a week until the 100th day after BMT, with assessments of cardiovascular capacity by the six-minute walk test, which occurred before BMT or time 1 (T1), at hospital discharge or time 2 (T2) and 100 days post BMT or time 3 (T3). Data were evaluated using the SSPS software version 20.0.
Results: The mean age of patients in the EIG was 38.7 (±8.7) years with 78% men and for the CG, 41.7 (±15.4) years with 50% men, with no difference between the groups (p = 0.860). In the comparison between EIG and CG regarding cardiorespiratory functional capacity, there was no difference in T1 (727.5 ± 160 × 640 ± 209; p 0.232) and in T3 (885 ± 379.1 × 790 ± 162.8; p 0.794) and an increase in functional capacity in favor of the EIG in T2(813.7 ± 192 × 530 ± 209.3; p 0.009). Comparing the distances covered with the predicted value within the groups, it was observed that the EIG covered distances significantly greater than the predicted in the three different times: T1 (598.9 ± 39.7 × 727.5 ± 164.9; p = 0.038); T2 (598.9 ± 39.7 × 813.7 ± 192.7; p = 0.011); T3(598.9 ± 39.7 × 885 ± 379.1; p = 0.039). The CG covered a greater distance than predicted only in T3 (578.5 ± 21.9 × 790 ± 162.8; p = 0.046). There was no significant difference between the average distance covered predicted for the EIG and the CG (598.9 ± 39.7 × 578.5 ± 21.9; p = 0.131).
Conclusion: Patients who perform an exercise program during and after hospitalization for allogeneic BMT benefit from a gain in cardiorespiratory capacity.
110982
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARCELO WESTERLUND MONTERA1, Louise Freire1, Fabiola Traverso1, Beatriz Robert1, Isaura Rocha1, Daniele Cordeiro1, Ana Maria Medeiros1, Ana Amaral Dutra1
(1) Hospital Procardiaco
Introduction and/or Fundamentals: The treatment of acute decompensated heart failure (ADHF) in clinical practice is usually carried out by a cardiologist not specialized in heart failure (HF). The implementation of specialized HF protocols (HFP) in the treatment of ADHF has shown benefits in improving the outcomes and quality of care.
Objectives: To assess the benefits of HFP versus usual care(UC) in patients with ADHF in terms of clinical outcomes in in-hospital mortality(IHM), length of stay(LS), and readmission at 30 days(R30d), and the quality of care through the analysis of the medication prescription rate at hospital admission and discharge.
Materials and methods: Retrospective non-randomized study of a cohort of 834 pts with ADHF and HFrEF(LVEF < 50%) admitted to a private hospital in Rio de Janeiro, between 01/2015 and 12/2021 381 pts were submitted to HFP and 453 pts to the UC defined by the attending physician. All pts were evaluated for their clinical characteristics, LVEF by echocardiogram, natriuretic peptide levels. The outcomes evaluated were:LS, IHM and R30d. The rate of prescription of beta-blockers (BB) and converting enzyme inhibitors or angiotensin II receptor blockers (ACEI/ARB) and spironolactone(spiron.) were also evaluated at hospital admission and discharge.
Results: There was no significant difference between the groups in terms of age, sex, ADHF etiology, systolic blood pressure at admission, BNP and NT-proBNP levels and LVEF. HFP pts had a lower rate of IHM(11% vs 20%;p < 0.0001), and LS(7.4 ± 6.9 vs 10.5 ± 12.8 days;p < 0.001), and with no significant difference regarding R30d (4.3% vs 7.2%; p = 0.2). At admission the HFP pts showed a higher rate of ACEI/ARB prescription (45% vs 36%; p < 0.006) and higher dosage of intravenous furosemide (120 ± 60 mg vs 60 ± 30 mg, p < 0.01) and no difference in BB prescription rate(75% vs 70%; p < 0, 15). At discharge, the HFP pts had a higher rate of prescription of ACEI/ARB (89% vs 43%; p < 0.0001) and spiron. (50% vs 27%; p < 0.0001) and furosemide(72% vs 62% p = 0.05) and no difference in BB prescription rate(87% vs 84%; p = 0.2).
Conclusions: The treatment of pts with ADHF with HFP compared to UC, had an impact on improving in-hospital clinical outcomes with lower IHM and LS and they also had a better quality of care with a higher rate of prescription of ACEI/ARB and higher dosage of intravenous furosemide at admission, and a higher rate of prescription of ACEI/ARB, spiron. and furosemide at hospital discharge.
110986
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARCELO WESTERLUND MONTERA1, Louise Freire1, Arnaldo Rabischoffsky1, Amarino de Oliveira1, Luiz Antonio Carvalho1, Ana Amaral Dutra1
(1) Hospital Procardiaco
Objectives: Identify the clinical characteristics and complementary tests that allow the differentiation of Takotsubo from Acute Myocardial Infarction (AMI) with ventricular dysfunction, at hospital admission.
Materials and methods: Retrospective study of a cohort of patients admitted to a private hospital in Rio de Janeiro, from 2010 to 2020, with a diagnosis of Takotsubo and AMI with ventricular dysfunction (LVEF < 40%). The variables evaluated were: 1) clinical characteristics: age, gender, clinical presentation, presence of decompensating factor (DF), systolic blood pressure (SBP) and heart rate (HR). 2) ECG changes: T wave inversion, ST segment changes, pathological Q wave; 3) changes in the echocardiogram (ECO) regarding the location and type of segmental contraction 4) Levels of TpI, BNP, NT-proBNP, leukocytes and CRP. All patients initially underwent coronary angiography. The t test for independent samples, chi-square and logistic regression were used.
Results: 65 pts were evaluated with Takotsubo and 75 pts with AMI. There were no differences between the groups regarding age, clinical presentation, SBP and HR. There were also no differences regarding the levels of BNP and NT-proBNP, TpI, leukocytes and CRP at admission. Pts with Takotsubo had a higher prevalence of females (84.6% vs 13.8%, P < 0.0001) and identification of a DF in 78% of Takotsubo pts. The ECG in the pts with Takotsubo showed a higher prevalence of T wave inversion (38% vs 12.5%; p = 0.0005) with no differences in the other ECG alterations compared to the pts with AMI; The ECHO of the pts with Takotsubo showed a higher prevalence of akinesia in Apical (69% vs 32%; P < 0.001), anterior (23% vs 5.5%; P < 0.003) and Lateral (32% vs 2.7%, P < 0.0001)walls. In the logistic regression, the variables that showed high significance and predict the diagnosis of Takotsubo were:female (OR:9.8;CI:3.1–30.8); T wave inversion on ECG(OR: 5.8; CI: 1.45 to 23.71); Apical (OR:36.12;CI:4.8–271.7) and Anterior akinesia (OR:17.3;CI:2.8–109.8) on ECHO.
Conclusões: In the differential diagnosis of Takotsubo from AMI on hospital admission, the presence of female Pts, with DF, T-wave inversion on ECG, anterior or apical akinesia on ECHO, strongly suggest the diagnosis of Takotsubo in the face of AMI with ventricular dysfunction.
110998
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ANDREA VIRGINIA FERREIRA CHAVES1, Débora Nascimento da Nóbrega3, Marcelo Santos Veloso4, Eveline Barros Calado5, Manuel Markman2, Anabel Lima Vieira2, Milca Dantas da Silva1, Brivaldo Markman Filho5, Luydson Richardson Silva Vasconcelos3, Dinaldo Cavalcanti de Oliveira5
(1) Rarus – Serviço de Doenças Raras de Recife; (2) Hospital Agamenon Magalhães, Recife, PE; (3) Instituto Aggeu Magalhães; (4) Hospital Alfa, Recife; (5) Universidade Federal de Pernambuco – UFPE
Introduction: Molecular investigation of hypertrophic cardiomyopathy (HCM) through genetic panels makes it possible to identify phenocopies with left ventricular hypertrophy (LVH), as Fabry disease (FD). New biomarkers are being studied, including microRNAs (miRNAs).
Objective: To investigate miRNAs as pathogenicity markers in the cardiac variant of FD.
Methods: A total of 131 patients (pts) with HCM who underwent genetic investigation for FD were included, of which 76 were through GLA sequencing gene and 55 by the genetic panel for HCM.
Results: In 7 pts (5.34%) mutations were found in the GLA gene and the following variants were identified: 1 c.967C>A(p.Pro323Thr), 4 c.352C>T(p.Arg118Cys) and 2 c.937G>T(p.Asp313Tyr). Pts with mutations in the GLA gene were submitted to the panel for HCM: 3 pts (p.Arg118Cys) had mutations in other genes and in 4, there were no other detecting variants. The family screening revealed 17 individuals with mutations in the GLA gene, and 2 siblings were identified with LVH with the c.937G>T(p.Asp313Tyr) variant. The pts and the carriers of variants in the GLA gene were submitted to the determination of lyso-Gb3 and the analysis of the following miRNAs: miR-1291, miR-214, and miR-505. In the comparison between individuals with and without LVH, there was no significant difference for miRNAs, however, there was a tendency for overexpression in individuals with LVH, especially for miR-1291. The expression of miR-214 in subjects with LVH was significantly lower than in subjects without LVH (p = 0.0416). There was a significantly higher expression for miR-505, both in carriers of variants in the GLA gene without LVH and in those with LVH (p = 0.0195). The miR-505 and miR-214 showed a significant and directly proportional correlation with lyso-Gb3 in pooled pts (with and without LVH). All subjects had normal lyso-Gb3 levels.
Conclusion: In this study, provides evidence that increased miR-505 and miR-1291 expression and miR-214 under-expression in those with LVH may be pathogenic markers in FD. Further investigations of these microRNAs with a larger number of individuals are necessary.
111032
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
INGRID LOUREIRO DE QUEIROZ LIMA1, RICARDO ZAUTIH SILVA1, FABIO AUGUSTO PINTON2, JOSE MARIANI JUNIOR3
(1) HOSPITAL IRMANDADE SANTA CASA DE SAO PAULO; (2) HOSPITAL SIRIO LIBANES; (3) HOSPITAL ISRAELITA ALBERT EINSTEIN
Objective: To evaluate whether puncture guided by fluoroscopy was more effective for accessing the common femoral artery (CFA) than puncture guided by anatomical parameters alone.
Background: Although radial vascular access is becoming the preferred route of access for most procedures in interventional cardiology, CFA remains the major vascular access used in practice. Properly accessing the femoral artery reduces the incidence of vascular complications; however, in some cases, the anatomical parameters may not adequately guide the appropriate route of access to the CFA.
Methods: Single-center, prospective, controlled, randomized study, performed between June and December of 2015, evaluated 158 patients subjected to elective coronary angiography guided by fluoroscopy or angiography guided by classical anatomical parameters alone. In all patients, angiography was performed at the site of vascular access and was considered appropriate if the access route to the CFA was above the bifurcation of the CFA and below the inferior epigastric artery.
Results: Seventy-nine patients underwent puncture guided by anatomical parameters alone, and 79 underwent puncture guided by fluoroscopy. Puncture guided by fluoroscopy achieved greater success rates than did the use of anatomical parameters alone (92.4% vs. 64.6%; p < 0.001). In all groups analyzed, the one guided by fluoroscopy had more appropriate punctures than did the group using anatomical parameters alone. The independent predictors of inadequate puncture were age > 65 years and puncture guided by anatomical parameters alone.
Conclusions: Puncture guided by fluoroscopy increased the likelihood of adequate access to the CFA compared with puncture guided by anatomical parameters alone.
111048
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
PALJOSKOVSKA JORDANOVA SAVETKA1, D-r Danica Petkoska Spirova1, D-r. Sasha Kjaeva Anastasova1, D-r Dejan Risteski1, D-r Emilija Lazarova Trajkovska1, D-r Enes Shehu1, D-r Aleksandra Eftimova1, Prof. D-r Marijan Bosevski1
(1) University Clinic of Cardiology
Introduction: Peripheral arterial disease (PAD) is a condition in which the arteries are narrowed and they can’t carry as much blood to the outer parts of the body. Carotid artery disease (CAD) causes a narrowing of the major blood vessels that supply the brain. Both are known to be specific manifestations of atherosclerosis. We aimed to evaluate patients with documented CAD who also have PAD and investigate the risk factors that should be considered when talking about these vascular diseases.
Material and methods: This study included a population of 1031 patients with documented carotid artery disease is defined as a presence of plaque or stenosis confirmed with B-mode ultrasonography. 66,6% were men and 33,5% were women. The average age was 64.44 years. We investigate how many patents with CAD have PAD and evaluate the potential risk factors.
Results: This analysis reveals that 1030 out of 1031 patient (99,9%) have CAD and 1023 out of 1031 patient (99.2%) also has PAD. The most common risk factor is HTA in 1026 patients or 99.5% followed by diabetes mellitus in 1025 patients or 99.4%, tobacco smoking in 958 patients or 92.9%, HLP in 958 patients or 86.8% and also obesity found in 351 patients or 34%.
Conclusion: PAD is strongly associated with carotid artery disease. According to our study, these diseases seem to occur more commonly in men that women. We can conclude that the most prevalent factors that can influence the risk of developing an outcome are hypertension and diabetes mellitus. In accordance with this, these patients need more intensive medical management to prevent complications.
111244
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
CONRADO ROBERTO HOFFMANN FILHO1, Conrado Roberto Hoffmann Filho1, Benjamin Massao Harada1, João Paulo Souza Brighenti1, Michele Mendonça1, Beatriz Roca1, Gilmar Sidnei Erzinger2, Esther Botelho1, Gabriel Erzinger2, Jaqueline Barp1, João P.P. Ribeiro2
(1) Hospital Regional Hans Dieter Schmidt; (2) Univille Universidade da Região de Joinville
Introduction: Acute myocardial infarction remains the leading cause of death in Brazil and worldwide with high mortality rates, especially when adequate treatment is not performed. During the period of the COVID-19 pandemic, the demand for care services caused by acute coronary syndromes (ACS) was reduced by several factors.
Objetives: The present study was carried out to evaluate the management of our institution in the treatment of ACS during the COVID-19 pandemic.
Methods: Retrospective cohort study of patients treated at a tertiary center from 01/01/21 to 01/31/21, through the analysis of hospital’s electronic medical records. 582 patients were selected. SPPS software was used. Student’s T test to compare numerical variables. Categorical variables were expressed as frequencies and percentages and compared using the chi-square test. Pearson’s correlation used as needed. Quantitative variables were expressed as mean and standard deviation.
Results: Mean age did not differ between men and women 62.1% and 62.8% respectively. The ACS were divided in unstable angina (UA) in 30.6% and 32.1%, Non ST Elevation Myocardial Infarction (NSTEMI) 36.5% and 31.5% and ST elevation myocardial infarction (STEMI) 32.3% and 36.2%. Among coronary lesions >70%, Left anterior descending 61.4% and 64.1%, right coronary 45.6% and 49.3%, circumflex 28.9% and 35.8%, left main >50% 1.1% and 6.3%. The presence of left main lesion was higher in men. Significant positive correlation was observed between age and left descending lesion p = 0.04. In-hospital death was greater among older (67.7 and 61.9 years respectively) p = 0.003. Despite the number of deaths being significantly higher (p = 0.001) in STEMI (4.6%) compared to NSTEMI (2.4%) and UA (0.5%), the mean age was significantly lower in the first p = 0.03. Angioplasty was the most used treatment with 68.2% of cases and myocardial revascularization in 5%, p = 0.0005. Regarding treatment, about 87% used ASA, 80% antiplatelet drugs, statins 88%, ACEI/ARB 88.9% beta-blockers 85.6%, spironolactone 16.5% and insulin 8.6%. Comparing our data with literature, we found that the in-hospital mortality rate is similar (7.6%), the mean age is lower (62% and 68% respectively). The number of coronary angioplasty is higher (68.2% and 38.5%). And the number of revascularizations is lower (5% and 7.8% respectively).
Conclusions: The pandemic reduced the number of patients who went to the hospital, however the standard treatment of ACS was maintained.
111065
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
RICARDO MOURILHE-ROCHA1, Daniel Xavier de Britto Setta1, Marcelo Luiz da Silva Bandeira1, Thiago Matos Barcellos1, Flávia Prado Fialho Santos1, Eric Costa de Almeida1, Julia Paulo Mourilhe Rocha1, Bruno Reznik Wajsbrot1, Roberta Siuffo Schneider1, Ricardo Mendes Carneiro1, Vitor Hugo Mussi Campos1, Fernando Oswaldo Dias Rangel1
(1) HOSPITAL PRÓ-CARDÍACO
Background: Acute myocardial infarction is a prevalent disease with high morbidity and mortality. The recognition of mortality predictors allows the identification of patients at higher risk of death.
Objective: To identify the risk predictors of in-hospital mortality.
Materials and Methods: Observational, retrospective, cohort study of 398 patients admitted with a confirmed diagnosis of AMI, with and without ST-segment elevation (STEMI and NSTEMI) between January 2018 and January 2022. Data were subsequently analyzed by SPSS software.
Results: Among the comorbidities analyzed, mortality in the presence of previous diseases was heart failure (HF) occurred in 20.6% and 6.3% in those without HF (p = 0.03); previous stroke (stroke) in 21.4% and without stroke of 6.5% (p = 0.04); with atrial fibrillation (AF) 22% and without AF in 5.9% (p < 0.01). The mortality found in patients with different characteristics was: Killip I was 2.5% and in Killip >= 2 was 31.7% (p < 0.001); EF > 50% was 1.2% and EF <= 50% was 14% (p < 0.001); STEMI was 13.7% and NSTEMI was 4.7% (p = 0.02); without angioplasty was 13.3% and with angioplasty was 6.1% (p = 0.027). Binary logistic regressions were performed to check if such factors are independent predictors of risk, being statistically significant: ejection fraction <50%, OR 6.2 95% CI (1.6–23.6), p = 0.007; and Killip classification >= 2, 95% CI (3.0–25.7), p < 0.001.
Conclusions: The predictors of mortality were the presence of EF <= 50% and Killip >= 2. Such factors are related to the extent of myocardial injury caused by AMI and the presence of previous heart disease. Early recognition of these circumstances may allow the development of care aimed at reducing this outcome.
111071
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
ANA INÊS GONZÁLES1, Ana Inês Gonzáles1, Amanda da Silva1, Gabriella Lavarda do Nascimento1, Mario Bernardo-Filho2, Danúbia da Cunha de Sá-Caputo2, Anelise Sonza1
(1) Universidade do Estado de Santa Catarina (UDESC) – Centro de Ciências da Saúde e do Esporte (CEFID); (2) Universidade do Estado do Rio de Janeiro
Introduction: In the management of cardiovascular diseases (CVD), the adequate exercise prescription is an essential condition. In this scenario, the whole body vibration exercises (WBV) appear as a promising therapeutic resource.
Objective: To investigate the effects of WBV alone or associated with other types of exercises in the management of CVD.
Methods: This study is a systematic review following the PRISMA guidelines and registered PROSPERO under number CRD42021230663. The databases used were PubMed, Cochrane, PEDro, Lilacs, and Science Direct, from the beginning of the databases until January 2021. The descriptors related to WBV and CVD used were: [(Hypertension OR Heart Diseases OR Heart Failure OR Coronary Artery Disease OR Myocardial Infarction) AND (Whole Body Vibration OR Whole-Body Vibration)]. The following inclusion criteria were determined:studies such as controlled and randomized clinical trials, quasi-randomized controlled trials, comparative studies with or without simultaneous controls, case studies, case series with ten or more consecutive cases, cross-sectional studies, and pilot studies. The population was composed by adults (≥18 years), of both sexes, with a clinical diagnosis of CVD, submitted to intervention with the exercise of WBV. Studies in Portuguese, English, and Spanish were included. The selected studies were assessed for quality, risk of bias, and level of evidence.
Results: Three studies were included, with CVD submitted to WBV as an isolated intervention (35 females/12 males). There was variation in the parameters applied in the WBV. There were no abnormal cardiovascular responses in the three studies, and no adverse events were reported. The reactive hyperemia index (RHI) showed a significant increase after WBV in several subgroups and the muscle strength measure showed a significant increase in muscle strength when compared to the control group in the two studies. There were improvements in the parameters of systolic and diastolic blood pressure, pulse pressure, augmented pressure, augmentation index, AIx adjusted to 75 beats per minute, first systolic and second systolic peak and mean arterial pressure.
Conclusion: The use of different IVC protocols, alone, to improve hemodynamic, cardiovascular, vascular/arterial and muscular parameters in individuals with CVD is plausible and can be considered a safe and effective training resource.
111077
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
ANA INÊS GONZÁLES1, Ana Inês Gonzáles1, Yolanda Gonçalves da Silva Fontes1, Daiane Pereira de Lima1, Tatiane Boff Centenaro1, Tales de Carvalho1
(1) Universidade do Estado de Santa Catarina (UDESC) – Centro de Ciências da Saúde e do Esporte (CEFID)
Introduction: Cardiac Rehabilitation is considered an effective strategy in the treatment of individuals with Cardiovascular Diseases and has substantive evidence base on its benefits. However, in Brazil there is a predominance of programs based on rehabilitation centers that provide access to a minority of patients, providing low adherence to rehabilitation. Given this situation, alternative models are plausible to be tested, with home-based CR being a possibility to expand access and adherence of individuals.
Objective: To compare adherence, quality of life (QoL), functional capacity and perception of barriers in patients undergoing center-based (CB) and home-based (HB) CR.
Methods: Individuals with Coronary Artery Disease, randomized into two groups (CB and HB), were submmited to a 12 week of aerobic aerobic training with walking and patient education. Exercise prescription was individualized, based on heart rate (HR) determined by the ventilatory thresholds of the cardiopulmonary exercise test. In all, 36 physical exercise sessions were proposed. The sessions in the CB group were all supervised and monitored in person and in the HB only 3 supervised (one per month) and 33 at home (streets, squares, parks), with remote monitoring and monitoring (asynchronous). Adherence to sessions was evaluated by the average percentage of sessions performed. QOL and functional capacity were measured before and after 3 months using Short Form 36 and peak oxygen consumption, respectively. Barriers were verified after 3 months by the Scale of Barriers for CR (EBRC).
Results: 21 (32.3%) individuals participated in the study, distributed in CB (N = 11) and HB (N = 10). HB showed higher adherence in the number of prescribed sessions (p < 0.001) and extra sessions (p = 0.001). Regarding QoL, only a significant intergroup difference was observed. In the HB group, in the domains of functional capacity (p = 0.04), limitations due to physical aspects (p = 0.04) and emotional aspects (p = 0.04). In the CB group, regarding the functional capacity domains (p = 0.01) and limitations due to physical aspects (p = 0.01). There was no difference between groups and between groups for peak VO2 values. Regarding the perception of barriers, the CB group had the highest total score (p < 0.01).
Conclusions: HB adherence was higher, with better results in the emotional aspect of QoL and lower perception of barriers.
111076
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
DANIEL XAVIER DE BRITTO SETTA1, Marcelo Luiz da Silva Bandeira1, Bruno Reznik Wajsbrot1, Julia Paulo Mourilhe Rocha1, Thiago Matos Barcellos1, Flávia Prado Fialho Santos1, Claudia Lanzillotti Weksler1, Roberta Siuffo Schneider1, Ricardo Mendes Carneiro1, Vitor Hugo Mussi Campos1, Fernando Oswaldo Dias Rangel1, Ricardo Mourilhe-Rocha1
(1) HOSPITAL PRÓ-CARDÍACO
Background: Acute myocardial infarction (AMI) is a prevalent disease with high morbidity and mortality. The measurement of quality indicators in health care enables the recognition of weaknesses and the construction of action plans to improve care. One of the main indicators is the utilization rate of survival modifying medications at the time of hospital discharge, whose internationally recommended goal is at least a 90% utilization rate.
Objectives: To evaluate the rate of use of survival modifying drugs in AMI care [ASA, P2Y12 inhibitors, beta-blockers, statins and iECA or ARB (the latter in the presence of ventricular dysfunction) at hospital discharge].
Methods: This is an observational, retrospective, cohort study of 398 patients admitted with a confirmed diagnosis of AMI with and without ST-segment elevation between January/2018 and January/2022. Data were collected by a trained healthcare professional team and subsequently analyzed by SPSS software.
Results: The diagnosis of STEMI (68.8%) was predominant. Drug utilization rates at discharge in the general population and subgroups were: AAS = 96.9% (97.6% in NSTEMI and 95.2% in STEMI; p = 0.23), P2Y12 inhibitors = 93.5% (93.9% in NSTEMI and 92.5% in STEMI; p = 0.59), beta-blockers = 86.9% (81.3% in NSTEMI and 83.8% in STEMI; p = 0.4), iECA or ARB = 82.9% (71.0% in NSTEMI and 60.0% in STEMI; p = 0.23), statins = 93.8% (93.5% in NSTEMI and 94.3% in STEMI; p = 0.79).
Conclusions: The ASA, P2Y12 inhibitor, and statin utilization rates were within the recommended target. However, the usage rates of beta-blockers and ACEI or ARB were lower. The recognition of these indicators allows the initiation of strategies to expand the use of these drugs and improve outcomes in the medium and long term.
111102
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
ADELLE CRISTINE LIMA CARDOZO1, José Icaro Nunes Cruz1, Giulia Vieira Santos1, Jade Soares Dória1, Camille Marques Aquino1, Juliana Maria Chianca Lira1, Philipi Santos Soares1, Diego Maldini Borba de Lima1, Mariano César de Souza Reis1, Antônio Carlos Sobral Sousa2, Enaldo Vieira de Melo1, Joselina Luzia Menezes Oliveira2
(1) Federal University of Sergipe; (2) Rede D’Or São Luiz – São Lucas Hospital; (3) Primavera Hospital
Introduction: Several studies analyze the influence of Spirituality/Religiosity (S/R) on cardiovascular diseases, considered the leading causes of global morbidity and mortality. The brazilian Updated Cardiovascular Prevention Guideline (2019) shows the importance of S/R in healthcare and recommends its approach in clinical practice.
Objectives: To describe the clinical profile and S/R in cardiology patients and to evaluate the acceptance of the S/R approach during the medical consultation.
Methods: Cross-sectional, descriptive study. The sample included patients from cardiology outpatient clinics of three hospitals in Sergipe (Brazil). A questionnaire of self elaboration and two scales were applied: Duke Religiosity Index (DUREL) and Brief Multidimensional Measure of Religiosity/Spirituality (BMMRS). The values obtained in the constructs and domains of the scales were entered into the database so that they scored directly proportional to the level of S/R.
Results: 130 patients were included in the study (mean age 60.6 ± 11.2 years). 62.3% were female. The prevalences of hypertension, dyslipidemia, coronary artery disease, and diabetes mellitus were 73.8%, 59.2%, 40.8%, and 35.4%, respectively. 97.6% of the patients believe in God and 79.8% believe that S/R helps to cope with the diseases. 96.9% would like to have S/R addressed in a doctor’s appointment, however 78.1% stated that this topic was never addressed by their doctors. 96.9% said they were Christian (76.2% Catholic, 19.8% Evangelical, and 2.4% Spiritualist), 3.8% said they had no religion, and 0.8% were Umbanda believers. The domains with the highest mean scores on the BMMRS were “Values and Beliefs” (7.1 ± 1.2; scale maximum: 8.0) and “Religious and Spiritual Overcoming” (25.0 ± 2.9; scale maximum: 28.0). The means of the constructs organizational religiosity, non-organizational religiosity, and intrinsic religiosity (DUREL) were 4.1 ± 1.5, 4.6 ± 0.8, 13.8 ± 2.1, respectively, all of them considered high.
Conclusions: Cardiology patients had a high level of religiousness in this study. Almost the totality of the sample believed that S/R should be addressed during medical consultations. Despite this, most stated that their physicians never addressed these topics during consultations, denoting a mismatch between clinical practice and the recommendation of the Guideline.
111090
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
RICARDO MOURILHE-ROCHA1, Bruno Reznik Wajsbrot1, Ricardo Mendes Carneiro1, Eric Costa de Almeida1, Julia Paulo Mourilhe Rocha1, Thiago Matos Barcellos1, Flávia Prado Fialho Santos1, Claudia Lanzillotti Weksler1, Ana Amaral Ferreira Dutra1, Tiago Azevedo Costa Mattos1, Fernando Oswaldo Dias Range1, Daniel Xavier de Britto Setta1
(1) HOSPITAL PRÓ-CARDÍACO
Introduction: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice. Epidemiological data have shown that AF is a huge public health problem due to its association with a high risk of death and functional loss. Characterizing mortality predictors allows identifying patients at higher risk for evolution to death.
Objective: To identify risk predictors for in-hospital mortality in patients with atrial fibrillation.
Methods: Retrospective and consecutive cohort of patients hospitalized for acute atrial fibrillation between January 2018 and December 2021 at a tertiary hospital in Rio de Janeiro. Demographic, clinical, laboratory and mortality data were analyzed, obtained from a database collected by reviewing electronic medical records and subsequently performing univariate and multivariate statistical analysis using SPSS 20.0.
Results: There were 819 patients, with a male predominance (57.6%), mean age of 71 +– 14.4, 72.6% aged >65 years, 66.4% hypertensive, 21.7% diabetic, 12% with HF, 8.2% with stroke or previous TIA, 21.6% with previous coronary artery disease and 8.6% with CABG surgery. The median of CHA2DS2-VASc was 3 and the median of HASBLED was 2. There was reversion to sinus rhythm in 69.9% of the patients. The general mortality of the population was 0.9%. Mortality in patients with CHA2DS2-VASc >= 3 was 1.2% vs 0 in those with CHA2DS2-VASc <3 (p = 0.02). In patients with CHA2DS2-VASc >= 2 or +, 0.9% died vs no death in patients with CHA2DS2-VASc <2 (p = 0.092). Analyzing the VASc variables (from CHA2DS2-VASc), if variables are present it increases mortality by more than 3 times (0.5% vs 1.8%; p = 0.071). Another important parameter was age >= 75 years, which almost triples mortality (0.5% aged < 75 years vs 1.3% aged >= 75 years (p = 0.193). All other variables showed no relationship to the mortality.
Conclusion: The only predictor of mortality in this population was CHA2DS2-VASc >= 3. Early recognition of higher-risk patients can provide a more targeted care plan aimed at early discharge without increasing negative outcomes.
111113
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
ADELLE CRISTINE LIMA CARDOZO1, José Icaro Nunes Cruz1, Jade Soares Dória1, Camille Marques Aquino1, Gabriela de Oliveira Salazar1, Bruna Souza Matos de Oliveira1, Diego Maldini Borba de Lima1, Giulia Vieira Santos1, Juliana Maria Chianca Lira1, Antônio Carlos Sobral Sousa1, Enaldo Vieira de Melo1, Joselina Luzia Menezes Oliveira2
(1) Federal University of Sergipe; (2) Rede D’Or São Luiz – São Lucas Hospital; (3) Primavera Hospital
Introduction: Despite advances in treatment, chronic coronary syndrome (CCS) persists as an important cause of global morbidity and mortality worldwide. Spirituality/Religiosity (S/R) has been pointed out as an important dimension in health care, including cardiovascular diseases.
Objectives: To evaluate S/R in patients with CCS and its association with Resilience.
Methods: This is an observational, cross-sectional, analytical study. The sample included patients from cardiology outpatient clinics of three hospitals in Sergipe. The patients included were divided into two groups: I) CCS; II) Control. Three questionnaires were applied: Duke Religiosity Index (DUREL); Brief Multidimensional Measure of Religiosity/Spirituality (BMMRS), and Connor-Davidson Resilience Scale for Brazil-10. The scales were quantified ordinally according to the progression of the degree of S/R, so that the higher the average on the scale, the higher the level of S/R. Mean scores on the scales were compared using Student’s t-test. Demographic characteristics and comorbidity profile were described in terms of means and frequencies and compared between groups using the Chi-square or Fisher’s exact test.
Results: Were included 130 patients, of whom 53 (40.8%) belonged to the CCS group and 77 (59.2%) to the Control group. Ages were not different between the CCS and Control groups (62.2 vs. 59.4 years; p > 0.05). There was also no difference between the groups for the following variables: marital status, work status, diabetes mellitus, hypertension, sedentary lifestyle, and obesity (p > 0.05), however, dyslipidemia was more prevalent in the CCS group (80.0% vs. 50.7%; p < 0.001). According to the BMMRS, patients in the CCS group believe that “God punishes them” more than control patients (3.1 vs. 3.5; p < 0.05). In addition, the CCS group believed that “people in their religious communities would offer them less comfort in difficult times” than patients in the Control group (2.8 vs. 3.2; p < 0.05). There were no differences between the groups for the DUREL or the Resilience Scale.
Conclusions: The results suggest that patients with CCS are more likely to believe that “God punishes them” and that “people from their religious communities would offer them less comfort in difficult times”. There was no correlation between S/R and Resilience. Studies with larger sample sizes are needed to better understand this last association.
111123
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARTA AMORIM1, Diana Ferrão1, Marta Carreira1, Fernando Nogueira1, Pedro Ribeirinho Soares1, Sergio Madureira1, Rita Gouveia1, Catarina Elias1, Ana Neves1, Joana Pereira2, Patrícia Lourenço3
(1) Heart failure clinic of the Internal Medicine Department of Centro Hospiralar e Universitário São João; Faculdade de Medicina da Universidade do Porto; (2) Heart failure clinic of the Internal Medicine Department of Centro Hospiralar e Universitário São João; (3) Heart failure clinic of the Internal Medicine Department of Centro Hospiralar e Universitário São João; Cardiovascular Research and Development Unit of Faculty of Medicine of Porto University
Introduction: Low Chloride (Cl) has been associated with worse prognosis in heart failure (HF). Still, results are controverse and mainly based in old Randomized controlled trials.
Objectives: To assess determinants of Cl levels and to study the prognostic role of Cl in a contemporary real-world chronic HF population.
Methods: Retrospective analysis of chronic ambulatory HF patients followed in a HF clinic. Adult patients with history of HF with left ventricular systolic dysfunction (LVSD) attending the clinic between January 2012 and May 2018 were included. Patients with no Cl measurement were excluded. Follow-up: until February 2022. Primary endpoint: all-cause mortality. Multivariate linear regression analysis to assess independent determinants of Cl level. The prognostic impact of Cl was evaluated by Cox-regression analysis. Cl was assessed both as a categorical (cut-off 101 mmol/L – percentile 33.3) and as a continuous variable. Multivariate adjustment was performed accounting for: age, gender, LVSD, NYHA class, arterial hypertension, diabetes, atrial fibrillation, ischaemic aetiology, BNP, renal function, serum sodium, loop and thiazide diuretics and evidence-based therapy.
Results: We studied 859 patients. Mean age 70 years, 66.3% male, 44.9% had ischaemic HF and 46.7% had severe LVSD; 84.3% were on renin-angiotensin system inhibitors (RASi), 92.8% on beta blockers and 29.1% on mineralocorticoid receptor antagonists. Cl ranged from 85 to 116 mmol/L. Independent determinants of decreased Cl levels were Diabetes, severe LVSD, higher NYHA class and lower natremia. RASi medication associated with higher Cl and loop and thiazide diuretics predicted lower serum Cl. During a median follow-up of 56 (29–90) months 464 (53.4%) patients died: 45.9% in those with Cl > 101 mmol/L and 66.6% in the remaining, p < 0.001. Patients with Cl ≤ 101 mmol/L) had a multivariate adjusted HR of death of 1.27 (95% CI 1.02–1.57), p = 0.03 compared to those with higher Cl. Per each 2 mmol/L increase in Cl levels the all-cause death HR was 0.94 (95% CI: 0.89–1.00), p = 0.048.
Conclusions: Low Cl is an independent predictor of all-cause mortality in HF with LVSD. Patients with Cl ≤ 101 mmol/L have a 27% increased risk of death and per each 2 mmol/L Cl increase there is a 6% decrease in the death risk. Main determinants of lower Cl are diuretic use, concomitant diabetes, worse LVSD and higher NYHA class; use of RASi and higher sodium levels are independently associated with higher Cl levels.
111134
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARCUS VINICIUS SIMÕES1, Káryta Suely Macedo Martins1, Antonio Carlos Barros-Filho1, Minna Moreira Dias Romano1, Denise Mayumi Tanaka1, Paulo Louzada-Junior1, Edecio Cunha-Neto2, José Antonio Marin-Neto1
(1) Faculdade de Medicina de Ribeirão Preto – USP, Ribeirão Preto, SP, Brasil; (2) Incor – Instituto do Coração – FMUSP
Background: The essential histopathologic lesion in chronic Chagas’ cardiomyopathy (CCC) is a relentless low grade myocarditis with increased production of cytokines. Recent experimental studies have suggested that pentoxifylline, an immunomodulator that reduces the production of TNF-alfa, may be associated to a better evolution of CCC.
Purpose: We tested the effect of pentoxifylline in cytokines profile and cardiac function in patients with CCC.
Methods: This is a prospective double-blind clinical study, enrolling 38 CCC patients (age: 60 +/– 13 y.o., 66% male, LVEF = 48 +/– 7%), randomized to pentoxifylline (PTX, n = 19), 400 mg 3x/day for 6 months or placebo (PLC, n = 19). At baseline and post-treatment, patients underwent assessment of serum cytokines (IL6, IL10, TNF-alfa) and 2D-Echo with measurement of LVEF, indexed LV end diastolic volume (LVEDVi), LV wall motion score index (WMSi), tricuspid annulus systolic excursion (TAPSE). Mixed effects ANOVA for repeated measures was used to test the treatment effect between groups.
Results: The table summarizes the results. We observed a strong trend toward reduction of TNF-alfa and increase of IL10 values in the PTX group, but no significant effect in cardiac function variables.
Conclusion: Despite its immunomodulator effect, pentoxifylline was not associated to significant improvement in cardiac function in patients with CCC.
111145
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
JULIANA RIBEIRO GOUVEIA REIS1, Laissa de Cássia Alves2, Karine Siqueira Cabral Rocha2, Alessandro Reis3, Juliana Ribeiro Gouveia Reis1
(1) Instituto Pró-Vida; (2) Centro Universitário de Patos de Minas; (3) Hospital Santa Casa de Misericórdia de Patos de Minas
Metabolic syndrome is characterized by a set of cardiovascular risk factors such as arterial hypertension, insulin resistance, hyperinsulinemia, glucose intolerance/type 2 diabetes, central obesity and dyslipidemia. People with this condition have low functional capacity. The cardiopulmonary stress test is considered the gold standard in the assessment of physical capacity, however, it requires specific equipment and a specialized team. Therefore, the Shuttle walking test becomes a more practical option to estimate VO2 max in this population. The purpose of this study was evaluate the measurement of indirect VO2 in people with metabolic syndrome and compare it with predicted values for normality. This is a cross-sectional study with a quantitative approach. The inclusion criteria for the study were patients with metabolic syndrome who were being treated at the State Center for Specialized Care in Minas Gerais/Brazil, aged between 18 and 59 years. Patients with SatO2 < 88%, severe arterial hypertension, aortic coarctation, and decompensated heart failure were excluded. Patients underwent anthropometric assessment and then the Body Mass Index was calculated. The test was started after analyzing the contraindications and the VO2 obtained and the maximum expected VO2 were recorded. The results were analyzed using descriptive statistics, mean and standard deviation using the Wilcoxon test. The significance level was set at 0.05. The project received approval from the Research Ethics Committee under opinion number 3,153,984. Thirty patients participated in this research, 15 men and 15 women. The mean age of the male group was 55 years (±3.6) and the mean age of the female group was 49 years (±3.6). The mean BMI of the male group was 32.45 (±3.44). The female group had a mean BMI of 33.77 (±4.31). Regarding the VO2 of male patients, an average VO2 value of 12.84 (±2.20) was observed, while the average VO2 maximum was 72.90 (±2.12), with p value <0.05. In female patients, there was a lower value compared to males, with an average VO2 obtained of 12.52 (±2.20), and VO2 max with an average of 36.31 (±4.49), with a value of p < 0.05, also with mean values below the male participants. It is concluded that individuals with metabolic syndrome have low VO2 max values when compared to the expected values for this population and women have lower rates.
111149
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
VIVIANE PAIVA DE CAMPOS1, Ana Carolina Krauspenhar Gluszczuk2, Nathalia Jacques Pereira2, Francisca Moura Strebel3, Fernanda Lucchese-Lobato4
(1) Instituto de Cardiologia/Fundação Universitária de Cardiologia Programa de Pós-graduação em Ciências da Saúde: Cardiologia; (2) Universidade Federal do Rio Grande do Sul; (3) Universidade Federal de Ciências da Saúde de Porto Alegre; (4) Irmandade Santa Casa de Misericórdia de Porto Alegre
Background: About 320,000 preterm (PT) infants are born in Brazil annually. Of these, it is estimated that 10–15% have congenital heart disease (CHD). Infants with CHD are born with normal body weight and lose it substantially after birth. The stunted growth and low weight characteristic of CHD infants are associated with poor developmental and surgical outcomes. Due to the challenges that infants with CHD face they are less likely to breastfeed, which leaves them more vulnerable to a diminished immune system, incidence and severity of diseases, mortality, prolonged hospital stay, and developmental delays.
Objective: To verify the prevalence of breastfeeding in PT infants with CHD admitted to a reference children’s hospital in Southern Brazil between 2019–2022.
Methods: This is a descriptive cross-sectional retrospective study. Data from medical records of PT infants (<37 weeks gestational age) with CHD, ages 0–12 months submitted to surgical procedures between 01/19 to 03/22, were analyzed. Infants with genetic syndromes were excluded from the analyses. Demographic, anthropometric, and clinical data were collected from electronic charts and entered into the REDCap data platform. Statistical analyses were performed using the SPSS v. 25 software.
Results: The 62 infants included in the study were mainly late PT (34–36 weeks and 6 days; 68%), female (53%), white (73%), acyanotic CHD (58%), and SUS users (77%). Seventy percent of all infants had appropriate weight for gestational age at birth. Most infants were formula fed (73%), while only 27% received breast milk, either exclusively (3%), complemented with solids (5%), or mixed breast milk and formula (19%). Fifty-two percent used tube feeding exclusively. Only 13% of tube-fed infants received breast milk. At the time of surgery, 65% were severely stunted, 56% severely underweight and 50% extremely thin/thin in BMI.
Conclusions: The findings suggest that premature infants with CHD in Southern Brazil are more likely to have an adequate nutritional profile at birth with increasing deficits and significant weight loss in the pre-surgical period. Due to the low prevalence of breastfeeding and high use of exclusive tube feeding, we conclude that it is of utmost importance to encourage breastfeeding and nutritional programs to promote weight gain and better immunity before surgery. Future multidisciplinary programs should focus on milk bank collection and inclusive breastfeeding pre-surgical protocols.
111197
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
RAMAKRISHNAN SIVASUBRAMANIAN1, Chandini Suvarna1, Praveen Aggarwal1, Sandeep Seth1, Neeraj Parekh1, Meenakshi Sharma2, Sheikh Vamik1, Ambuj Roy1, Ganesan Karthikeyan1, Sandeep Singh1, Rajiv Narang1, Balram Bhargava2
(1) All India Institute of Medical Sciences (AIIMS), New Delhi, India; (2) Indian Council of Medical Research (ICMR), New Delhi, India
Background: Outcomes of ST elevation myocardial infarction (STEMI) are suboptimal in India. Pre-hospital thrombolysis is an established practice in developed countries for timely reperfusion in STEMI. Mission DELHI (Delhi Emergency Life Heart Attack Initiative) is a pilot project for pre-hospital thrombolysis using motorbike ambulance service by trained paramedics at the patient’s doorstep in a selected geographical area of New Delhi. To the best of our knowledge, this is the first study of prehospital thrombolysis in India.
Objective: In this pilot phase, we report the safety and feasibility of prehospital delivery of care in STEMI. Methods We covered a geographical area of 5-km around our institution. A command center was set up and the patients were required to call a dedicated helpline number. Upon initial screening, a motorcycle ambulance was dispatched to the caller’s location. A brief history, physical examination and an ECG were obtained. ECG was electronically transmitted to the command center and thrombolysis with Tenecteplase was given at patient’s doorstep after evaluation of the ECG by a cardiologist.
Results: A total of 26 STEMI patients (mean age 56.2 years; 88.5% male) were treated either at home (46.2%), public places (23.1%), place of work (15.4%) or at small clinics (15.4%). Time taken to reach the patient location was 15.1 ± 6.1 min, and call to ECG time was 25.0 ± 6.8 min. Out of the 26 patients with STEMI, 15 patients were thrombolysed at a pre-hospital location with a door to needle time of 31 ± 11.1 min. Out of these, 13 patients had successful thrombolysis and had undergone further MI management. There was one death in a patient with cardiogenic shock. We also managed a total of 60 patients diagnosed with NSTEMI.
Conclusions: In this pilot study, we have demonstrated the feasibility and safety of a telemedicine supported pre-hospital thrombolysis by paramedics at the patient’s location. Such an approach is likely to significantly improve thrombolytic therapy usage and reduce ischemic times, and thereby could result in significant improvements in STEMI outcomes in a country like India.
111208
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
JOSÉ LUIZ BARROS PENA1, Isabel Cristina Gomes Moura1, Marcos Victor Prosdocimi Diniz1, Fabiano Maia Linhares1, Pedro Manuel Marques Cristóvão1, Eduardo Back Sternick1, Amanda Marcos de Oliveira2, Gabriela de Campos Viveiros2, Rafaela Santos Garcia2, Eduardo Felipe Souza de Deus2, Tatiane Pires da Silva2, Tarcila Paoli Marques Moreira2
(1) Faculdade Ciências Médicas de Minas Gerais; (2) Hospital Felício Rocho
Introduction: Due to its various clinical manifestations, Fabry disease (FD) is a commonly misdiagnosed rare condition. Treatment depends ideally on early disease detection and timely enzyme replacement therapy to improve prognosis. Echocardiography may be an efficient noninvasive technique to detect structural and functional heart consequences resulting from the disease. This study aimed to determine whether new echocardiographic modalities may contribute to more improved diagnoses.
Material and methods: Prospective and transversal study of 15 patients (Pts) with FD. During one examination, conventional transthoracic, bi-, and tridimensional echocardiography as well as strain/strain rate speckle tracking were measured. Specific echocardiographic data were obtained and exported to a workstation for subsequent evaluation. Statistical analyses were performed with 5% significance using the R program, version 3.1.3.
Results: Nine Pts (60%) were male, and the mean age was 39 ± 11.9 years. Pts presented increased left atrium volume index, mean left ventricle (LV) septum, and posterior wall thickness. LV hypertrophy was found in varying degrees in 8 (53%) FD Pts. Mean myocardial mass value measured by the 4D technique was 110.9 ± 8.1 grams. A binary appearance of LV endocardial border (“binary sign”) and hypertrophy of the anterolateral papillary muscle were detected in 9 (60%) of Pts. Mitral regurgitation was present in 4 (26.7%) Pts, mitral valve prolapse in 2 (13.3%), and aortic regurgitation in 1 (6.7%). Four (26.7%) Pts presented RV hypertrophy. Global mean longitudinal 2D strain measured –19.5 ± 3.4%, and 4D circumferential strain measured –17.7 ± 3.5%. We identified peak systolic strain reduction in basal and mid inferolateral segments in 10 (66.6%) Pts. By analyzing the bull‘s-eye plot.
Conclusion: Echocardiography is an accurate, robust tool in Fabry disease evaluation. Compared to conventional measurement techniques, advances in 3D and speckle tracking echocardiography have augmented and improved anatomical and functional data.
111251
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
FERNANDA SANCHES AGUERA GROCHOCKI1, LAÍS SANCHES AGUERA1, CRISTINA PELLEGRINO BAENA1, JOSE ROCHA FARIA NETO1
(1) PONTIFÍCIA UNIVERSIDADE CATÓLICA DO PARANÁ – PUCPR
Introduction: Cardiovascular diseases are the leading cause of mortality in the world. The identification and correction of modifiable risk factors are the cornerstone of cardiovascular prevention. However, this purpose in performing periodic health assessment (check-up) in asymptomatic individuals still has its effectiveness questioned.
Objective: To analyze whether the periodic health assessment can be a tool for the control and treatment of cardiometabolic risk factors and whether the impact of this assessment is different according to the presence of these factors.
Methods: A retrospective cohort was carried out, including data from patients seen consecutively in 2015 and 2016, at a check-up service in Curitiba, Paraná. The cardiometabolic profile of the patients was evaluated and a comparison was made between variables of interest obtained in 2015 and 2016. It was also evaluated whether the variation from one year to the other was different between patients who presented cardiometabolic alterations in the first year compared to those who presented variables without alterations. Microsoft Excel and SPSS Statistics programs were used for calculations, using Student’s T test for paired samples or Wilcoxon test, according to normality tests.
Results: A total of 478 patients were included, 80.3% of whom were male and with a mean age of 46.29 years (SD ± 8.06). The following altered variables showed improvement: triglycerides (p < 0.05), HDL (p < 0.001), LDL (p < 0.001), non-HDL (p < 0.001), fasting glucose (p < 0.001) and glycated hemoglobin (p < 0.001). Evaluating altered anthropometric data, there was an improvement in Body Mass Index(BMI) (p < 0.01), Systolic Blood Pressure (p < 0.001), Diastolic Blood Pressure (p < 0.001) and male waist circumference (p < 0.05). Analyzing the altered variables, there was a change to values within the normal range in 21% of cases of total cholesterol, 29% triglycerides, 26% HDL, 27% LDL, 32% non-HDL, 7% BMI, 87% systolic blood pressure, 84% Diastolic blood pressure, 10% waist circumference, 54% blood glucose, 43% glycated hemoglobin. (p < 0.001).
Conclusion: Periodic health assessment seems to have a positive impact on the control and treatment of cardiovascular risk factors. This effect was mainly observed in patients who already had altered laboratory and anthropometric variables in the first evaluation.
111254
Modality: E-Poster Researcher – Non-case Report
Category: CARDIO-ONCOLOGY
DANIANE RAFAEL1, Juliana Bueno Refundini1, Adriana A. da Silva1, Ana Cristina Camarozano1, Claudio Leinig Pereira da Cunha1, Sérgio Lunardon Padilha1, Admar Moraes de Souza1, Ana Karyn Ehrenfried de Freitas1
(1) Universidade Federal do Paraná – UFPR
Chemotherapeutics brought greater survival to breast cancer patients, however, they can generate cardiotoxicity with important dysfunction. The echocardiogram (Echo), has enabled early detection of myocardial dysfunction. Our purposes was to obtain, with Echo, the incidence of left ventricle dysfunction after chemotherapy, analyzing the Ejection Fraction (EF) in 2 dimensions-Simpson Method (2D) and in 3 dimensions (3D), and to identify early contractile changes using the Longitudinal Strain – Speckle-Tracking (ST). A prospective study studied 37 women, mean age 48 ± 11 years with breast cancer in the beginning of chemotherapy between 2013 and 2015. Echo was performed at baseline, after 3 and 6 months, evaluating 2D EF and 3D EF in addition to the contractile evaluation using the ST and peak systolic velocity at the base of the lateral wall (lateral S’) on tissue Doppler. The patients were also evaluated for signs, symptoms, possible risk and protective factors contributing to myocardial dysfunction overall. Dyspnea was the only symptom detected (23%). We observed that the altered ST in the 1st exam proved to be a predictor of 3D EF reduction in the 3rd exam (p = 0.049). The lateral S‘ reduced at 6 months, corroborating the change in systolic function. Both risk and protective factors did not affect the parameters evaluated. There was a progressive decrease in EF after exposure to cardiotoxic chemotherapeutic agents, which became more evident by 3D analysis. The evaluation of the ST showed significant changes associated with the period of administration of anthracycline, and an ST altered in the beginning of the treatment was a predictor of EF reduction at 6 months of treatment. These findings support the importance of these new Echo techniques in the follow up of these patients.
111263
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
AMBUJ ROY1, Ambuj Roy1, Nitish Naik1, Sharma Sanjiv1, Sandeep Singh1, Gautam Sharma1, Ramakrishnan Lakshmy1, Rohit Bhatia1
(1) All India Institute of Medical Sciences (AIIMS)
Background: Rheumatic mitral stenosis (MS) is associated with significant morbidity, especially ischemic stroke(IS) and continues to be very prevalent in developing countries. Clinical predictors of IS are poor and is common even among those not in atrial fibrillation (AF). Silent brain infarct (SBI) is an important predictor and surrogate of future ischemic stroke. In this study, we assessed the prevalence of SBI in patients with MS in normal sinus rhythm (NSR) and AF.
Methods: Consecutive patients with more than moderate mitral stenosis underwent non-contrast MRI. Standard MRI sequences and definitions for infarct were used. Patients with prior intervention and surgery for MS were excluded as were those with prior clinical IS or transient ischemic attack (TIA), left atrial clot, and severe concomitant other valval lesions.
Results: Of 211 patients who underwent MRI, 140 were in NSR and 71 in AF. 59% were females, 88% had severe MS, 23%, 24% and 53% were in NYHA Class I, II and III respectively. A total of 44 (21%) patients had SBI. The baseline variables in those with normal MRI scans and with SBI were as in Table 1. Only NYHA functional class and not AF was significantly different in patients with SBI.
Conclusions: SBI is common among patients with MS including those in NSR. Only NYHA class was different in the two groups. Better predictors of IS beyond rhythm are needed in patients with MS to decide on IS preventive strategies.
111280
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
ABISAI DOS SANTOS SANTANA1, Giovana Côrte Real Ruffier2, Mauro Felippe Felix Mediano1, Daniel Arthur Barata Kasal1
(1) Instituto Nacional de Cardiologia; (2) Universidade do Estado do Rio de Janeiro
Introduction: The assessment of physical performance in the preoperative evaluation of open-chest heart surgery (OHS) can help to establish the most appropriate moment for the intervention. There are noninvasive and simple methods that can be used at the bedside, in order to evaluate physical performance in these patients.
Objective: To evaluate physical performance in the preoperatory period of elective OHS and establish associations with surgical recovery outcomes.
Methods: Adult patients subjected to elective OHS, either coronary artery bypass grafting (CABG) or valvular replacement (VR) surgery, at a quaternary hospital were recruited for the study. Physical performance was measured with 30-s chair-stand-test (30sCST), timed up and go test (TUGT) and hand grip, performed during surgical admission, before the intervention. Surgical risk was estimated with the Euroscore II risk score. Clinical data were obtained using medical records. The outcomes evaluated were mechanical ventilation time (MVT), admission time (AT), and in-hospital death (IHD), and their associations with the physical tests were evaluated with either logistic (IHD) or linear (MVT, AT) regressions (p < 0.05).
Results: One hundred sixty-six individuals were evaluated, most patients were male (65%), aged 58.3 ± 11.3 years, and with body mass index of 27 ± 4.4 kg/m2. Left ventricular ejection fraction (Teicholz) was 59.4 ± 15.5%, and New York Heart Association functional classes I, II, III and IV were 8, 70, 53, and 3%, respectively. Euroscore II was 3.1 ± 2.1, 98% of surgeries employed extracorporeal circulation, and IHD was 7.2%. In the unadjusted analysis, the hand grip was associated with IHD (OR 0.90; p = 0.007), but the association was not significant after adjustments for age and sex, or Euroscore II (OR 1.00 p = 0.93 and OR 0.92 p = 0.06, respectively). None of the physical tests were associated with either AT or VMT.
Conclusions: The present results suggest a lack of association between the 30sCST and TUGT physical tests and the recovery variables after OHS studied. Preoperatory hand grip offered an association with mortality after surgery, but significance was borderline after adjustment for Euroscore II. The contribution of physical fitness before OHS to surgery outcomes may be evaluated with additional methods and in particular groups such as the elderly in future studies, in order to explore this important association.
111769
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
LUCAS CARVALHO DIAS1, Luiz Eduardo Montengro Camanho2, Eduardo Benchimol Saad2, Charles Slater1, Luiz Antonio Oliveira Inacio Junior2, Gustavo Vignoli Santos2, Ricardo Mourilhe Rocha1
(1) Hospital Universitario Pedro Ernesto; (2) Hospital Pró-Cardíaco
Introduction: The hypertrophic cardiomyopathy (HCM) is an autosomal dominant genetic disease, strongly related to the occurrence of malignant ventricular arrhythmias and sudden death.
Objective: Describe the clinical data and the occurrence of appropriate and inappropriate therapy in a subgroup of HCM patients with implantable cardioverter-defibrillators.
Methods and results: In a cohort of 720 consecutive and retrospective patients, monitored from March 2006 to December 2021, with 57 of this total being diagnosed with HCM. The male sex was found in 42 (74%), and the average age was 54.6 years. ICD implantation by primary prophylaxis occurred in 49 (86%) patients and in 8 (14%) by secondary prophylaxis. The report of unexplained syncope was observed in 50 (88%) patients. At the time of ICD implantation, the records showed that 51 (89%) patients were in NYHA functional class 1 and the average LVEF was 59,4%. The electrocardiographic analysis showed that the mean QRS was 118 ms and that 25 (44%) had an LBBB pattern. During the ICD monitoring period, 11 patients (19%) were observed with a record of VF/VT and appropriate therapy. Inappropriate therapy was observed in 7 patients (12%), all in the AF group, which occurred in 25 (44%) patients throughout the record.
Conclusion: Despite the not insignificant number of inappropriate therapies, the ICD has been shown to be an effective therapy in preventing sudden cardiac death and in the clinical management.
111563
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
CAMILA MACIEL DE OLIVEIRA1, Roberto Luis Zagury3, Luiza Borcony Bolognese4, Davi Casale Aragon5, Livia Mandina da Graça Couto2, Marcela Carvalho2, Thaíza dos Anjos2, Mercedes Balcells6, Clemente Nobrega2, Chunyu Liu7
(1) Universidade Federal do Parana (UFPR); (2) Klivo LLC; (3) Instituto Estadual de Diabetes e Endocrinologia Luiz Capriglione (IEDE); (4) Pontificia Universidade Catolica de Minas Gerais (PUC-Poços); (5) Universidade de São Paulo (USP-RP); (6) Massachusetts Institute of Technology; (7) Boston University
Digital therapeutics, an emerging type of medical approach, is defined as evidence-based interventions through qualified software programs that help prevent, manage, or treat chronic diseases. We aim to describe the clinical impact of a digital therapeutic product of a Brazilian startup company that focuses on individual needs as an essential shift for the ongoing management of patients with chronic conditions such as diabetes, hypertension, and dyslipidemia. This program is a model of behavior change based on an intensive lifestyle intervention method and seeks to manage cardiovascular risk factors in adults aged ≥ 18 years. It was sponsored by health plans and healthcare provider organizations and was free for patients. During the management process, patients were remotely supervised by nurses on a weekly basis via phone calls intended at health education and assessment of laboratorial outcomes. An app was developed to improve the communication between patients and nurses, but e-mails and text messages were also used. To improve control of glycemic events in patients with diabetes, a glucometer was sent to the patient’s home and was connected to the app. When abnormal glucose parameters were detected, the patient was contacted according to an established protocol. Outcomes of interest were evaluated at baseline and after 3 months. For a total of 2544 patients (53.35 ± 13.45 years; 50% male) distributed in 21 Brazilian states (40% in São Paulo), it was possible to verify significantly improved glycemic and lipid profile (total cholesterol and LDL-cholesterol) after follow-up for 3 months. A1c decreased (9.13 ± 2.10 versus 7.14 ± 1.69; p < 0.01), and so did fasting glucose (127.19 ± 51.96 versus 122.51 ± 42.40; p = 0.03), total cholesterol (176.66 ± 50.11 versus 161.36 ± 45.72; p = 0.01), and LDL-cholesterol (100.42 ± 40.11 versus 89.87 ± 33.82; p = 0.03). No difference was observed for HDL-cholesterol or triglycerides in this sample. This program has shown promising findings related to glycemic and lipid profiles, providing insights into the management of cardiovascular risk factors, which will allow us to reshape this unique therapeutic approach for the Brazilian population continuously.
111319
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
PEDRO GABRIEL MELO DE BARROS E SILVA1, Denilson Campos Albuquerque3, Marcus Vinícius Simões5, Renato Delascio Lopes6, Conrado Hoffmann7, Paulo Roberto Nogueira8, Helder Reis9, Fabio Akio Nishijuka10, Lidia Zyntynski Moura11, Fernando Bacal3, Evandro Tinoco Mesquita3, Múcio Tavares de Oliveira Junior3
(1) IP-Hcor; (2) Hospital Samaritano Paulista; (3) Sociedade Brasileira de Cardiologia; (4) Hospital Copa D’Or; (5) Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo; (6) Brazilian Clinical Research Institute; (7) Hospital Regional Hans Dieter Schmidt; (8) Fundação Faculdade Regional de Medicina de São José do Rio Preto; (9) Hospital de Clínicas Gaspar Viana; (10) Hospital Naval Marcílio Dias; (11) Irmandade Santa Casa de Misericórdia de Curitiba; (12) Instituto do Coração (INCOR HC FMUSP)
Background: Heart failure with preserved ejection fraction (HFpEF) accounts for almost half of the HF cases. However, little is known about the characteristics, medical therapies, and long-term prognosis of patients hospitalized with HFpEF in Latin America.
Methods: BREATHE was a nation-wide prospective registry that included patients hospitalized due to acute heart failure (AHF) in Brazil. In-hospital management as well as 12-month clinical outcomes were assessed. In the current analysis, patients were classified according to left ventricular ejection fraction (LVEF) in 3 groups: <40% (HFrEF), 40 to 49% (HFmrEF) and ≥50% (HFpEF).
Results: A total of 3,013 patients were included with a median follow-up of 346 days. In 1,204 patients, the LVEF was assessed during the first 24 hours of hospitalization with 28.1% of patients classified as HFpEF. The patients with HFpEF were older (70.5 ± 16.4 vs 63 ± 15.9; P < 0.01) had more female patients than HFrEF ones (57.5% vs 30.4%; P < 0.01). Among comorbidities, hypertension (81.4% vs 70.5%) and atrial fibrillation (40.5% vs 27.2%) were more common in patients with HFpEF (both P < 0.01), while history of myocardial infarction was more common in HFrEF (18.9% vs 29.4%; P < 0.01). The creatinine was 1.5 ± 1.0 mg/dL and similar among the 3 groups but the level of BNP/NT-ProBNP was >2 times lower in the HFpEF population. The wet-cold profile occurred in 5.9% of the patients with HFpEF and in 12.6% of patients admitted with HFrEF (P = 0.04). The main cause of decompensation was poor adherence in the HFrEF patients, and infection in HFpEF. At hospital admission, almost 54% of HFpEF patients were using renin-angiotensin-aldosterone inhibitors or beta-blockers, and 19.5% were using spironolactone. There was no enhancement in the use of these medications during the 12 months follow-up. Intra-hospital mortality was similar among the 3 groups of LVEF (average 10.5%). After discharge, the mortality and hospital readmission rates at 365 days were not statistically different in all groups (23.3 deaths for 100 patient years with 51% readmission rate at 12 months in the HFpEF group).
Conclusions: In this large multicentre nationwide Brazilian prospective registry of AHF, patients with HFpEF presented different clinical characteristics but similar prognosis compared to patients with lower ejection fraction during one year of follow-up. Improvement in the medical care is necessary to minimize complications in this high-risk population.
111345
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
BRUNO RAMOS NASCIMENTO1, Washington Luis S. Ramos2, Gisele Lobo Pappa2, Edson Roteia Araújo Júnior2, João Francisco Barreto da Silva Martins2, Wagner Meira Júnior2, Sander Luis Gomes Pimentel1, Juliane Franco1, Kaciane Krauss Bruno Oliveira1, Maria Carmo Pereira Nunes1, Antonio Luiz Pinho Ribeiro1, Erickson Rangel do Nascimento2
(1) Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte – MG, Brazil; (2) Departamento de Ciência da Computação da Universidade Federal de Minas Gerais, Belo Horizonte – MG, Brazil
Introduction: Cardiac involvement seems to impact prognosis of COVID-19. Bedside echocardiography (echo) holds promise for early prediction of unfavorable outcomes, and artificial intelligence may be an additional tool to overcome personnel limitations. We propose a spatial-temporal deep learning-based approach for automatic prediction of mortality of inpatients with COVID-19 with echo images.
Methods: Patients admitted in 2 reference hospitals in Brazil in 90 days with confirmed moderate and severe COVID-19, based on the Berlin criteria, underwent clinical and laboratory evaluation, and focused bedside echo (GE Vivid IQ), following admission, with remote interpretation by telemedicine in Brazil and the US. Independent echo predictors of all-cause mortality were assessed, after adjustment for clinical variables. Our image dataset consists of 737 videos (Mpeg) collected from included patients in 3 different probe positions: apical 4-chamber and parasternal long and short axis. It was used to predict the patients’ outcome (discharge or death) in a 10-fold cross-validation procedure manner. We used a 2-stream deep neural network composed of two identical ResNet-18 Convolutional Neural Networks (CNN) – originally developed for Rheumatic Heart Disease diagnosis – followed by attention units to extract relevant spatial and temporal features from RGB and Optical Flow frames. A final softmax layer is used for classification, and accuracy measures are presented with 95% confidence intervals (CI).
Results: Total 163 patients were enrolled, mean age was 64 ± 16 years, 107 (66%) were admitted to intensive care and in-hospital mortality was 34% (N = 56). Independent predictors of mortality, after adjustment for clinical and demographic variables, were age ≥ 63 years (OR = 5.53, 95%CI 1.52–20.17), LVEF < 64% (OR = 7.37, 95%CI 2.10–25.94) and TAPSE < 18.5 mm (OR = 9.43, 95% CI 2.57–35.03), C-statistic = 0.83. During training, we rescaled videos to 224 × 224 pixels and used temporal jittering to select a final clip with 32 frames per video in random batches of size 6. Our proposed method achieved an exam-wise accuracy of 61.21% (95%CI 50.87–71,55), sensitivity of 59.31% (95%CI 36.12–82.5) and specificity of 65.18% (95%CI 45.08–85.28) for mortality.
Conclusion: Automatic detection of high-risk echo findings in COVID-19 inpatients at bedside seems feasible and, with more research, can improve mortality prediction at the point-of-care, especially in low-income settings.
111379
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
EZEQUIEL J ZAIDEL1, Lara Gheco1, Luis Guillermo García Chamorro1, Erna Florencia Segovia1, Diego Carvallo Claros1, Elena Vargas Parra1, Agustín Monzón1, Brian Perotti1, María Inés Sosa Liprandi1, Álvaro Sosa Liprandi1
(1) Sanatorio Güemes, Buenos Aires, Argentina
Introduction: Migratory movements have led to Chagas disease (CD) being diagnosed in non-endemic areas. There are few epidemiological studies on the prevalence and behavior of the disease in urban areas.
Aim: To describe the clinical profile of patients with CD evaluated in an urban area and to identify the frequency of high risk cases.
Methods: Retrospective cohort study of patients who were hospitalized or evaluated in outpatient clinics, in a third level center from Buenos Aires. Patients over 18 years of age with a diagnosis confirmed by serology were selected. The patients were evaluated by clinical examination and complementary studies in accordance with current standards. A descriptive analysis was performed and the risk scores of Viotti, Rassi, Pinho Ribeiro, and Sousa were analyzed.
Results: Data from 46 patients were analyzed, with a mean age of 61 ± 11 years, and 41% female. Main origin of patiets was nothern provincies from Argentina, as well as Bolivia and Paraguay. The diagnosis was made mainly by medical check-up due to risk factors for ECH (30%) or by finding in blood banks (10.8%). The median time of evolution from the date of diagnosis of the disease to the cutoff made for this analysis was 6 years (IQR 1–12). Only one case in this cohort had received trypanocidal treatment. The prevalence of cardiomegaly was 51% by radiography, but the diastolic diameter by echocardiogram was 51 mm ± 7 mm with a mean ejection fraction of 58%. 21% presented right bundle branch block, 4% left anterior hemiblock, 18% atrial fibrillation, and 6% low voltage and ventricular extrasystoles. Fifty percent had symptomatic heart failure, 23% had implanted cardiac devices, and 17% had cerebrovascular accident (CVA). No cases of digestive or neurological pathology were found. By Viotti score, 41% had a high risk of progression. Using Rassi score, 10% had a high risk of mortality, but by the Pinho Ribeiro score, only 1 patient had a high risk. When analyzing the risk of stroke, 16% of the cohort presented high risk by Sousa score, however, anticoagulation in this cohort was prescribed only to subjects with atrial fibrillation or those who had already had a stroke.
Conclusions: The evaluation of patients with urban CD is a growing challenge for cardiologists from urban settings: Using current scores, the proportion of high risk cases was variabe, highlighting the need of better stratification tools.
111386
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
IEDA PRATA COSTA1, Eduardo Arrais Rocha1, Almino Cavalcante Rocha Neto1, Roberto Lima Farias1, Daniele Melo Leopoldino1, Cristiane Liberato1, Ronaldo Vacsoncelos Távora2
(1) Hospital Universitário Walter Cantidio – universidade Federal Ceara; (2) Hospital de Messejana _ SESA/CE
Introduction: Cardiovascular death is the main cause of death in chronic Chagas‘ heart disease (CCC). Syncope in CCC can be caused by bradyarrthymias (sick sinus syndrome-SSS and conduction disorders) or ventricular arrhythmias.
Objectives: To evaluate the association of syncope and pre-syncope with important unfavorable outcomes (SSS, severe conduction system disorders – HV >70 ms and VT/VF) in the electrophysiological study (EPS) in patients with CCC.
Methods: This is a prospective cohort study, including 52 patients with CCC from the postgraduate’s research project, 48 of whom underwent an EPS with or without previous use of antiarrhythmic drugs; with a mean age of 57 + 10.2 years; 62.5% male. PTs were classified into two groups: I- With syncope/pre-syncope and II- Without syncope. The chi-square test and Fisher’s exact test were used for statistical analysis.
Results: The clinical characteristics were the mean: Rassi score was 8.43 + 4.8 points (39.5% low risk); 43.7% used antiarrhythmics; 8.3% had Functional Class III/IV and 79.1% (38pt) had syncope/pre-syncope. In group I, we observed that 31.2% (10pt) were at low risk of Rassi and 71.8% (23pt) had altered EPS (1 by SSS, 1 by prolonged HV and 21 by VT). In group II, we found 56.2% (9pt) low risk and 25% (4pt) had altered EPS. Unfavorable outcomes in the EEF were greater in group I than in group II (p = 0.002). Comparing the risk of Rassi and the presence of altered EPS, in the groups we have: Group I- Low risk- 60%, Intermediate- 71.4% and high- 80% altered EPS (p = 0.83). Group II – Low risk – 11%, Intermediate 42.8% altered EPS(p = 0.57).
Conclusions: Syncope/pre-syncope was a predictor of unfavorable outcomes in the EPS. The presence of altered EPS was similar in the different Rassi risk scores in both groups.
111401
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
ÉRICA SOBRAL GONDIM1, Antonia Elizangela Alves Moreira1, Ana Camila Gonçalves Leonel1, Amanda da Costa Sousa1, Emiliana Bezerra Gomes1
(1) Universidade Regional do Cariri – URCA
Introduction: The electrocardiogram (ECG) subsidizes an assertive nursing care plan aimed at cardiac conduction abnormalities. But there are difficulties in performing and interpreting the test, which demonstrates the need for teaching strategies for its understanding and skills development.
Objective: To report a teaching strategy on ECG shared between a professor, a student in teaching internship and an undergraduate teaching assistant.
Method: Experience report of theoretical and practical teaching about ECG, carried out in October 2021 with 36 undergraduate nursing students, in a public university in Northeast, completed in two phases: theoretical, (skills training) and practical (simulation and case studies).
Results: The implementation of the strategy used theoretical-practical association in a transversal way, which stimulated the development of knowledge, skills and attitudes, emphasizing the creativity and improvisation demonstrated due to the scarcity of materials at the public university. Finally, the promoters of the teaching strategy shared the potentialities and difficulties perceived in the process. The main potentiality was the motivation demonstrated by the students as a result of the interactivity and dynamics of the class, which stimulated their interest and active participation in both moments of the strategy. The biggest obstacle was the scarcity of resources, making it necessary to use low-fidelity simulation to replace the equipment and electrodes themselves. The heterogeneity of the learning process was also mentioned as a difficulty, since there are different ways to build knowledge aimed at different audiences, but it was evident from the students‘ reports that the strategy guided the necessary aspects of the teaching theme.
Conclusion: Reporting the experience of teaching with simulation allowed the promoters to improve their strategies based on the students‘ feedback and the development of the activity. We suggest studies that enable the development of skills with the use of dynamic and participatory strategies.
111415
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
SEBASTIÁN DARÍO PERALTA1, Marcelo Omar Bettinotti1, Carlos Maximiliano Giuliani1, Guillermo Jubany1, Luis Murillo1, Juan Grieve Bruno1, Ezequiel José Zaidel1, Luis Carlos Sztejfman2, Matías Sztejfman2
(1) Sanatorio Güemes, Buenos Aires, Argentina; (2) Sanatorio Finochietto, Buenos Aires, Argentina
Introduction: Current transcatheter aortic valve replacement (TAVR) procedures may be performed with an ultra-minimalistic approach which improves hospital resources. Aims The aim was to describe in hospital length of stay (LOS) and vascular events of TAVR procedures using ultra minimalisitc approach prior and during the COVID-19 pandemic.
Methods: Consecutive TAVR cases from two centres between Jan 2019 and June 2021 were analyzed. Ultra-minimalistic approach included: all in one (AIO) femoral single puncture, conscious sedation, self-expanding valves, and femoral closure devices. Intra-pandemic cases were considered since March 2020 according to country’s COVID 19 uptake. Conventional descriptive and comparative statisitics were performed with Epi Info V7.
Results: 37 cases were included, 21 (56%) before the pandemic and 16 intra-pandemic. Mean age was 82 (6) years and 59% were female. 73% had no prior conduction abnormalities, 35% had concomitant peripheral artery disease, 8% porcelain aorta. Median EuroScore was 5.8 (IQR 4.2–8), STS 5.4 (IQR 3.6–7.2), mean ejection fraction 56% (SD 11%) and mean gradient at baseline 45 mmHg (SD 12). A self-expandable valve was used in all cases. A predilatation was used for all cases. There were no deaths, no bleeding events, no strokes nor infections, 1 case of vascular complication (iliac dissection, resolved during the same procedure) and 1 case of permanent pacemaker implantation (2.7%). The rate of mild paravalvular leak was 43% and moderate leak 5.4%. Median length of stay was 2 days (IQR 2–3). 16 cases (43%) were performed intra-pandemic, without differences in procedural duration (58 minutes vs 56 pre-pandemic, p = 0.56), nor in LOS (median = 2 days in both groups, p = 0.24). 16% of the cases were discharged at day 1.
Conclusion: Ultra-minimalisitc TAVR was safe and associated with short LOS prior and during COVID-19 pandemic. Physicians and patients must consider these findings in the context of the pandemic with risk of in-hospital infections and low healthcare capacity. These results must be considered also for TAVR cost-effectiveness analysis.
112184
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
SERGIO RODRIGO BERALDO1, Sergio Rodrigo Beraldo1, Tiago Augusto Magalhaes1, Augusto Hiroshi Uchida2, Rafael Willain Lopes3, Douglas Carli Silva4, Erico Luiz Camacho5, Gabriel Nunes Rodrigues5, Paulo Roberto Maia6, Ana Clara Beraldo Muniz6, Carlos Eduardo Rochitte1
(1) Computed Tomography and Cardiovascular Magnetic Resonance Sector from Heart Institute (InCor), University of Sao Paulo Medical School.; (2) Hospital Israelita Albert Einstein; (3) Nuclear Medicine Sector of Hospital do Coração -HCOR; (4) Siemens Healthineers; (5) Corpus Computed Tomography and Magsul MND Nuclear Medicine; (6) Sapucai Valley University School of Medicine
Background: Patients with low to intermediate probability of CAD presenting exercise treadmill test (ETT) consistent with myocardial ischemia is a common scenario and may lead to other complementary tests, frequently myocardial scintigraphy (SPECT).
Purpose: We sought to evaluate the diagnostic performance of myocardial perfusion (CTP), and Fractional Flow Reserve Derived from Computed Tomography – (cFFR) compared to SPECT in a population of patients with inducible ischemia on exercise treadmill tests (ET), using coronary computed tomography angiography (CTA) as the reference method.
Methods: Sixty patients (58.4 ± 9.2, 37 men (61.7%), underwent clinical evaluation and two non-invasive imaging exams: SPECT and CTA with CTP during stress with dipyridamole.
Results: SPECT showed significantly lower diagnostic accuracy than CTP (AUC 0.62 vs. 0.72, p < 0.001). The cFFR and minimal luminal area showed higher diagnostic accuracy than perfusional methods (AUC = 0.86 and 0.90). Coronary calcium score (CAC) showed AUC of 0.72 for the detection of obstructive CAD by CTA. In a per-patient analysis, CAC score and CTA were the strongest predictor of revascularization (AUC 0.87 and 0.94 p < 0,001).
Conclusions: CTP alone presented higher accuracy than SPECT in patients with positive ETT with low or intermediate probability of CAD. Adding the cFFR and CAC data increases the diagnostic accuracy by computed tomography. These results suggest the use of CTP, cFFR or CAC in clinical practice might be adequate alternatives to SPECT in this scenario.
111437
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
GABRIEL ASSIS LOPES DO CARMO1, Bárbara Carolina Silva Almeida1, Gabriela Zamunaro Lopes Ruiz1, Renato Braulio1, Ana Cristina Carioca1, Fábio Morato Castilho1, Cláudio Leo Gelape1, Bruno Rodrigues Pereira1, Luiza Moreira Gomes1, Ana Carolina Sudário Leite1
(1) Universidade Federal de Minas Gerais (UFMG)
Introduction: Vasoplegia after cardiac surgery is a well described complication, closely related to increased mortality. It is associated with use of angiotensin converting enzyme inhibitor or angiotensin receptor blocker. Therefore, we routinely discontinue these medications before elective surgeries. However, we still face several cases of vasoplegia.
Objective: Describe clinical characteristics associated with vasoplegic syndrome after elective cardiac surgery.
Methodology: Prospective cohort analysis of cardiac surgery patients in a public hospital in Brazil between 2016 and 2021, excluding heart transplant.
Results: We enrolled 406 patients, median age 57 (46;66) and 214 (52,7%) females. 287 (70,7%) had valve surgery, 99 (24,4%) coronary artery bypass graft, 29 (7,1%) congenital heart correction, 17 (4,2) aorta procedures and 33 (8,1%) other cardiac surgeries. Univariate analysis showed that age, 64 (57;73) vs 55 (44;65), p < 0,001, chronic obstructive pulmonary disease, 47,1% vs 16,5%, OR = 4,51 (1,68–12,15), p0,004, renal replacement therapy (RRT), 57,1% vs 17%, OR = 6,49 (1,42–29,66), p = 0,021, and aortic surgery, 41,2% vs 16,7%, OR = 3,49 (1,28–9,50), p = 0,018, were associated with vasoplegia. After multivariate analysis, age, OR = 1,068 (1,041–1,095), p = 0,005, RRT, OR = 5,77 (1,12–29,69), p < 0,001, and aorta procedures, OR = 3,45 (1,17–10,17), p = 0,025, remained statistically significant.
Conclusion: Our study shows that older age, RRT and aortic procedures are associated with higher incidence of vasoplegia in elective cardiac surgeries. All these factors are non-modifiable, but could add some information in the decision to perform a surgery in selected patients, as well as planning best intra and post operative monitorization strategies. Therefore, the diagnosis of vasoplegia could be made as soon as possible and appropriate therapy could be started earlier.
111439
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
BRUNA AFFONSO MADALOSO1, Nelson Samesima1, Nancy Maria Martins de Oliveira Tobias1, Caio de Assis Moura Tavares1, Horacio Gomes Pereira Filho1, Mirella Espanhoto Facin1, Carlos Alberto Pastore1
(1) Clinical Unit of Electrocardiography – Instituto do Coração (INCOR), Hospital das Clínicas FMUSP
Background: The electrocardiogram (ECG) is a powerful tool for differential diagnosis among a group of pathologies called J-wave syndrome. The vectorcardiogram (VCG) can be used as a complementary method to the ECG in several dubious alterations.
Purpose: We carried out a VCG analysis; after conceiving a novel parameter (JT-distance), that quantified the visual VCG change observed, in most Brugada type-1 patients and that allows diagnosis of the Brugada ECG pattern.
Methods: We selected ninety-six ECGs (test cohort) with J-point elevation in V1/V2, ECG superior leads and VCGs, all performed on the same day. The VCG measurement by Frank method (JT-distance) was designed in transverse and right sagittal planes by three lines drawn 1) at the final third of the QRS loop, comprehending J-point; 2) at the initial portion of the T loop; 3) a parallel of the J-point line at the beginning of T loop. JT measure was determined by the distance between parallels. A validation cohort of thirty-five patients was also established.
Results: JT-distance ≥1.5 mm (transverse plane) and JT-distance >1.25 mm (right sagittal plane), differentiated Brugada type-1 from type-2, early repolarization and others, with 95% sensitivity,68% specificity (p < 0.05). JT-distance <1.5 mm (transverse plane) and JT >1.25 mm (right sagittal plane) had 100% sensitivity, 85% specificity (p < 0.05) for Brugada type-1 diagnosis (Figure 1). Validation cohort showed JT distance ≥1.5 mm (transverse plane) could differentiate both Brugada types from others with sensitivity of 61%, specificity of 94%, (p = 0.0009). When JT distance (transverse plane) was <1.5 mm and in right sagittal plane was >1.25 mm, we found sensitivity of 83%,specificity of 94%, for Brugada type-1 diagnosis. (p = 0.001). Both cohorts showed very similar Cohen’s kappa levels (0.65 vs 0.77, test and validation cohorts, respectively).
Conclusions: The novel vectorcardiogram measurement (JT-distance) presented a new diagnostic criterion to identify Brugada pattern with a practical and possible reproducible method. Nevertheless, prospective studies should also be performed to confirm these findings.
111440
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ARCHNA SINGH1, Sakshi Shukla1, Sandeep Aggarwal1
(1) All India Institute of Medical Sciences, New Delhi
Aim: Adiponectin is a cytokine produced by adipocytes that act on specific receptors of several tissues through autocrine, paracrine, and endocrine signaling mechanisms. Adiponectin circulates in different oligomeric isoforms, with different biological effects. Circulating levels of adiponectin decline under conditions of metabolic stress, including obesity and metabolic syndrome, and are associated with decreased adiponectin signaling. Adiponectin has insulin-sensitizing effects and antiatherogenic properties. Higher adiponectin has been associated with decreased CVD risk.
Methods: We divided female participants into 3 categories based on their BMI: normal weight control (C) = 24.28, overweight (OW) = 26.28, and non-diabetic obese (NDO) = 39.40. We estimated adiponectin mRNA expression (n = C: 31, OW: 21, and NDO: 67), serum levels (n = C: 44, OW: 29, and NDO:75) and fasting lipid profile. The Kruskal-Wallis and one-way ANOVA tests were applied for between-group analysis.
Results: Overall group analysis for adiponectin mRNA levels and serum levels showed no significant differences; however, a significant difference was noted between C and NDO groups at both mRNA (0.0000) and serum (p-value: 0.0032) levels. A significant difference was seen between groups for all lipid profile parameters i.e., HDL (mean: C: 54.67, OW: 47.79, NDO: 42.28), LDL (mean: C: 96.54, OW: 97.73, NDO: 113.17), TC (mean: C: 165.82, OW: 154.92, NDO: 184.84), TG (mean: C: 114.56, OW: 107.40, NDO: 151.78) and VLDL (mean: C: 22.92, OW: 21.47, NDO: 32.73). Adiponectin gene expression correlated negatively with serum adiponectin levels and with HDL and ApoA1 levels.
Conclusion: Lower adiponectin levels could contribute to an increased CVD risk in obesity, an effect that could be mediated via changes in HDL.
111474
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
CARLOS HENRIQUE DEL CARLO1, Antonio Carlos Pereira Barretto1, Mucio Tavares de Oliveira Junior1, Alfredo José Mansur1, Antonio de Padua Mansur1, Sergio Jallad1, Juliano Novaes Cardoso1, André Barbosa de Abreu1, José Antonio Ramos Neto1, Roberto Kalil Filho1
(1) Heart Institute (InCor) University of Sao Paulo Medical School
Background: Heart failure (HF) is a clinical syndrome with high morbidity and mortality. Optimal treatment can lead to improvement in ventricular remodeling in HF with reduced ejection fraction (HFrEF).
Objective: To analyze the characteristics and prognosis of patients (pts) with HFrEF who evolved with HF with recovery ejection fraction (HFrecEF): left ventricular ejection fraction (LVEF) >40%. We also analyzed the outcomes of pts with any degree of LVEF improvement.
Methods: We analyzed the electronic medical records of outpatients treated at a tertiary medical center in São Paulo-SP (Brazil) diagnosed with heart failure (ICD-10: I50) in 2017 and followed up until December 31st, 2020. There were included 4068 pts with an initial echocardiogram (ECHO1) presenting LVEF ≤40% (HFrEF). Data from a second evolutionary echocardiogram (ECHO2) were analyzed and pts were reclassified into HFrEF, HFrecEF, or any LVEF improvement (LVEF in ECHO2 > ECHO1). The clinical characteristics and prognosis of pts with respect to HFrecEF and those with any degree of LVEF improvement were analyzed.
Statistical methods: Mann-Whitney U test, chi-square test or Fisher’s exact test, univariate and multivariate logistic regression analysis, and survival using the Kaplan-Meier method (p = Log-Rank).
Results: Of the 4068 pts studied, age 61.3 ± 13.4 years, 65% male, with regard to etiology: idiopathic cardiomyopathy (46.6%), ischemic (27.5%), hypertensive (14.2%), Chagas disease (7.6%), valvular (4.2%); the mean initial LVEF: 30.0 ± 6.7%. Comparing LVEF in ECHO1 and ECHO2, 2594 pts (63.8%) showed any degree of LVEF improvement and 1250 (30.7%) evolved with total or partial LVEF recovery. Pts with HFrecEF had a higher initial mean LVEF: 32.2 ± 6.6% vs 29.0 ± 7.5% (p < 0.001). The ECHO2 showed an important improvement in the LVEF among pts with HFrecEF (50.9 ± 7.5% vs 29.4 ± 6.4%, p < 0.001). Female gender, hypertensive and valvular etiologies were associated with HFrecEF, while male gender, chagasic etiology, and history of stroke were independently associated with non-recovery of LVEF. Pts with HFrecEF had lower mortality (16.5% vs 30.1%, p < 0.001). The reduction in mortality was also observed in pts with any LVEF improvement (21.9% vs 33.0%, p < 0.001).
Conclusion: HFrecEF was observed in 30.7% of pts with HFrEF and was accompanied by an improvement in prognosis. A reduction in mortality was also observed in pts with any degree of LVEF improvement.
111477
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
ANA CAROLINE DARIVA CHULA1, Ana Caroline Dariva Chula1, Márcia Olandoski1, Elias Teixeira Krainski2, Lucas Henrique Olandoski Erbano1, Bruna Olandoski Erbano1, Raisa Natalia Dotto1, Lucas Baena Carstens1, Nicolle Amboni Schio1, Amanda Zanlorenzi1, Rafaela Lima Camargo1, José Rocha Faria-Neto1
(1) Pontificia Universidade Catolica do Parana – PUC PR; (2) Universidade Federal do Parana – UFPR
Background: Many countries have reported an increase in the number of out-of-hospital deaths from cardiovascular diseases during the COVID-19 pandemic, which may be due to factors intrinsic to the disease or social conditions arising from the pandemic.
Objective: To analyze possible differences in the temporal trend of out-of-hospital cardiovascular deaths during the COVID-19 pandemic in the year 2020 in Brazilian capitals.
Method: This is a time series, whose data were collected on the websites https://transparencia.registrocivil.org.br/especial-covid, based on the Civil Registry Information Center, and https://opendatasus.saude.gov.br/dataset/bd-srag-2020, from the Influenza Epidemiological Surveillance Information System. On the first website, the numbers of deaths from COVID-19 and deaths from out-of-hospital cardiovascular causes were collected, week by week, from the 2nd to the 35th epidemiological week of 2019 and 2020, in Brazilian capitals. On the second website, data on hospitalizations for COVID-19 in the capitals were collected daily between March and October 2020, by date of first symptoms and by date of hospitalization itself, and tabulated weekly for combination by epidemiological week. The 2020 time series of total out-of-hospital cardiovascular deaths (TMCV-EH) was considered as the outcome. The time series effect of COVID-19 data was tested to explain the variation across the studied weeks of 2020. COVID-19 hospitalization data were tested as potential predictors of MCV-EH, as were death data from COVID-19. The TMCV-EH in the corresponding period of 2019 was used for comparison.
Results: There was an increase in the TMCV-EH in 2020 compared to the non-pandemic year of 2019 and a correlation in the variation of these deaths with the COVID-19 data, with a peak in late April and early May when the relative risk, in the sum of the data, reached twice. There was also heterogeneity in the distribution of MCV-EH when analyzing each capital, with a predominance in the north and northeast regions. The highest relative risks stand out, compared to 2019, in peak periods in some capitals such as Salvador with 3.8, Recife with 3.6, São Luis with 5.6, Belém with 7.5 and Manaus with 9. 5 times. Rio de Janeiro presented a relative risk in the peak period of 2.2 times and São Paulo of 1.6 times.
Conclusion: There was an increase in the number of out-of-hospital cardiovascular deaths during the COVID-19 pandemic, in Brazilian capitals.
111486
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
MARIANE VENTUROLI FERREIRA BENAVENTE1, Márcia Olandoski1, José Rocha Faria Neto1
(1) Pontifícia Universidade Católica do Paraná – Escola de Medicina
Introduction: During COVID-19 pandemic, several countries reported reduction in hospital admissions for cardiovascular diseases (CVD), including acute coronary syndromes (ACS), in addition to excess cardiovascular mortality due to direct and indirect effects of the pandemic. In Brazil, there are studies demonstrating reduction in hospitalizations, increase in in-hospital lethality and excess deaths from CVD. There are no studies evaluating the impact of the pandemic on hospitalizations and mortality from CVD in the state of São Paulo, the country’s most populous state, which concentrates the largest number of COVID-19 cases and deaths. Understanding this impact is essential for the implementation of public health strategies to reduce morbidity and mortality from these conditions.
Purpose: The aim of this study was to assess the impact of the pandemic on ACS admissions and mortality from CVD in the state of São Paulo.
Methods: We performed a retrospective observational study by analyzing the number of ACS hospital admissions – angina pectoris (AP) and acute myocardial infarction (MI) and the number of deaths from CVD – MI and unspecific cardiovascular causes (UCVC), in-hospital and at home, between January 1st, 2020, and December 31st, 2021. Data from 2018 and 2019 were used for comparison.
Results: In 2020, there was a 10% decrease in hospitalizations for ACS (18% for AP and 4% for MI) compared to 2019. In 2021 reduction was of 12% (27% for AP and 2% for MI). In 2020, there was a 10% decrease in deaths from MI (11% in-hospitals and 7% at home) compared to 2019, while in 2021 there was a 12% increase in the number of MI deaths compared to 2020, 11% in-hospitals and 15% at home, reaching pre-pandemic levels. In 2020, there was a 50% increase in deaths from UCVC (33% in-hospitals and 127% at home) and in 2021 there was an increase of 11% in the number of these deaths, 11% in-hospitals and 10% at home. The decrease in ACS hospitalizations was followed by increase in deaths from MI and UCVC causes in both 2020 and 2021.
Conclusion: In the state of São Paulo the pandemic had impact reducing ACS hospitalizations and increasing deaths from CVD, specially UCVC and at home, which remained above baseline levels throughout the analyzed period.
111495
Modality: E-Poster Researcher – Non-case Report
Category: PSYCHOLOGY
MARCIA MOURA SCHMIDT1, Filipa Waihrich de Oliveira1, Camila de Matos Ávila1, Brenda Pereira Nunes2, Fernanda Lucchese-Lobato3
(1) Instituto de Cardiologia/Fundação Universitária de Cardiologia; (2) Hospital Geral de Caxias do Sul; (3) Hospital da Criança Santo Antônio, Irmandade Santa Casa de Misericórdia
Background: Heart failure (HF) is a systemic disease characterized by deterioration of the heart. There are high rates of morbidity, mortality, and re-hospitalization. Cardiology Societies recommend the inclusion of self-care in the treatment.
Objective: This study aimed to verify whether a psychoeducation intervention can reduce hospital readmissions, improve quality of life, and promote post-traumatic growth in patients with HF at 1-yr follow-up.
Methods: Parallel randomized clinical trial study with HF patients from a regional hospital in Southern Brazil. Patients were invited to join the study at their first outpatient appointment after hospital discharge. All participants completed the WHO quality of life (WHOQOL-BREF) and the post-traumatic growth inventory (PGI) questionnaires at both pre- (T1) and 6 months post-(T2) intervention assessments. Randomization envelopes were opened after the first interview. The patients in the control group (CG) continued to carry out their regular outpatient consultations per medical instructions. Patients in the intervention group (IG), in addition to the regular visits, had two additional individual follow-ups, of 1 hour each, with an interval of 7 days in between, to promote health and psychological education. About one year later, hospital readmission was assessed through medical records and phone call patient report. Statistical analyses were performed using SPSS software v. 24.0.
Results: A sample of 142 patients was recruited at T1 (72 in the CG and 70 in the IG). While at T2, 19 dropped out, and 123 patients (63 in the CG and 60 in the IG) were reassessed after 315 ± 198 days. The participants were 65% male, with 64 ± 11 years old, 58% had low income and 67% had less than high school. The risk of readmission was reduced by 54% (p = 0.050). There was an improvement in the total quality of life (p = <0.05) and positive psychological growth (p < 0.001) in the IG at T2.
Conclusions: The intervention proved to be protective for patients with HF in a regional hospital in Southern Brazil. A 2-session psychoeducational intervention was effective in reducing readmission rates by half compared to the CG, as well as improving quality of life and promoting positive psychological growth. Future brief culturally sensitive psychoeducation programs should be implemented in Brazilian hospitals to improve knowledge about HF and patient self-care, reducing the burden that HF creates to our health system. NCT 04870918.
111496
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
DR. CHANDINI SUVARNA1, Praveen Aggarwal1, Ramakrishnan Sivasubramanian1, Sandeep Seth1, Neeraj Parekh1, Sheikh Vamik1, Ambuj Roy1, Ganesan Karthikeyan1, Sandeep Singh1, Rajiv Narang1, Balram Bhargava2, Meenakshi Sharma2
(1) Chandini Suvarna; (2) Praveen Aggarwal; (3) Ramakrishnan Sivasubramanian; (4) Sandeep Seth; (5) Neeraj Parekh; (6) Sheikh Vamik; (7) Ambuj Roy; (8) Ganesan Karthikeyan; (9) Sandeep Singh; (10) Rajiv Narang; (11) Balram Bhargava; (12) Meenakshi Sharma
Background: Non–ST-segment elevation myocardial infarction (NSTEMI) are common manifestations of coronary artery disease (CAD) which is the leading cause of death in India. Despite advances in the treatment of ACS, pharmacologic therapy remains underused and is often delayed. Mission DELHI (Delhi Emergency Life Heart Attack Initiative) is a pilot project for pre-hospital thrombolysis using motorbike ambulance service by trained paramedics at the patient’s doorstep in a selected geographical area of New Delhi.
Objective: We sought to determine the feasibility and safety of prehospital care and risk stratification of NSTEMI.
Method: We covered a geographical area of 10-km around our institution. A command center was set up and the patients were required to call a dedicated helpline number. Upon initial screening, a motorcycle ambulance was dispatched to the caller’s location. A 12 lead ECG was obtained as soon as possible after first medical contact by paramedic and electronically transmitted to a dedicated command center. Evaluation of the ECG was done by cardiologist. Patients with suspected NSTEACS, administration of platelet aggregation inhibitors, anti-cholesterol drugs and transferred to the emergency department for further diagnostic assessment and therapeutic decision. On site troponin testing was done when needed. Patients with persistent symptoms despite initial therapy may be transferred directly to a catheterization laboratory.
Result: A total of 60 NSTACS patients (mean age 57.7 years; 68.3% male) were treated either at home (66.7%), public places (15%), place of work (11.7%) or at small clinics (6.7%). Time taken to reach the patient location and take an ECG was 27.9 ± 8.2 min. Nearly 56.7% of patients received a loading dose of aspirin, clopidogrel and atorvastatin pre-hospital. Nearly two third of patients (46.7%) received medication for HTN, followed by 66.7% of patients given cardiac medications and 60% patients given other medications including antacid/antiemetic.
Conclusions: In this study, we have demonstrated the prehospital acquisition and transmission of ECG by paramedics was feasible. An early diagnosis of the majority of cases with NSTEMI and initiation of basic pharmacotherapy was possible prehospitally. Such an early diagnosis and risk stratification could improve outcome, which needs to be assessed in larger studies.
111914
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
ILIANA REGINA RIBEIRO MENEZES1, Giovanni Possamai Dutra1, Letícia de Sousa Peres1, Nathalia Duarte Camisão1, Mariana Moreno Canário da Silva1, Renata Mexias Abdala Felix1, Thiago Moreira Bastos da silva2, Anna Butter1, Henrique Custódio Goudar1, Bruno Ferraz de Oliveira Gomes1, João Luiz Fernandes Petriz1, Gláucia Maria Moraes de Oliveira2
(1) HOSPITAL BARRA D’OR; (2) UNIVERSIDADE FEDERAL DO RIO DE JANEIRO
Introduction: There is evidence that the clinical outcomes of COVID-19 vary according to its variants. Given the high risk of infection-related mortality, recognizing the outcomes in each variant may contribute to understanding the severity of the disease.
Objective: To evaluate the association of mortality, myocardial injury, lung parenchyma involvement and use of mechanical ventilation, and length of hospital stay with the most prevalent variants of COVID 19 in Brazil.
Methods: Patients admitted to an intensive care unit during the COVID-19 pandemic, with an RT-PCR confirmed diagnosis of COVID-19 were included. The following outcomes and clinical features were analyzed in each period: mortality, length of hospital stay, myocardial injury, lung parenchyma involvement, and use of mechanical ventilation (MV). We divided our sample according to periods where some variants were more prevalent: March to October/2020 (beta); November/2020 to July/2021 (P.1); August to December/2021 (delta) and January to April/2022 (omicron). The variables were analyzed using the chi-square test (categorical) and ANOVA (continuous).
Results: 1454 patients were included, mean age = 59.8 ± 17.0 years, 62.6% men. Occurred 269 deaths (18.5%) during the study period (mean follow-up = 338 ± 209 days). We observed a greater association with mortality in the beta variant: beta (23%), P.1 (16.6%), delta (16.6%), and omicron (12.1%) with p = 0.015. Myocardial injury was more prevalent with the omicron variant: beta (32.7%), P.1 (49.2%), delta (53.5%), and omicron (60.6%) with p < 0.001. Lung involvement >50% was more common in omicron: beta (13.0%), P.1 (14.3%), delta (13.6%) and omicron (27.6%) with p < 0.001. No difference was observed in MV need. The average length of hospital stay was higher in beta: beta (20.6 days), P.1 (14.3 days), delta (13.5 days), and omicron (9.6 days), p < 0.001. Finally, the Average time of MV use was higher in beta and P.1: beta (21.4 days), P.1 (21.1 days), delta (14 days), and omicron (9 days).
Conclusion: The beta variant was associated with greater mortality and length of hospital stay, while the omicron variant was associated with myocardial injury and shorter mechanical ventilation time in patients hospitalized in intensive care for COVID 19.
111523
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
DIEGO LOPEZ OTERO1, Alberto Otero Cacho2, Brais Diaz Fernandez1, Maria Bastos Fernandez1, Xoan Sanmartin Pena1, Vicente Perez Munuzuri2, Alberto Perez Munuzuri2, Jose Ramon Gonzalez Juantey1
(1) Universitary Clinical Hospital of Santiago de Compostela, Cardiology. CIBERCV, Santiago De Compostela, Spain; (2) FlowReserve Labs S.L. Santiago de Compostela
Purpouse: To validate a new model of Fractional Flow Reserve obtained from a coronary computed tomography angiography (CCTA) (FFRct) (figure 1A), as well as obtaining new emerging parameters, less studied, such as ΔFFRct (Figure 1B), wall share stress (WWS) (figure 1C) and stenosis resistance (SR).
Methods: We included patients referred by the chest pain unit for ischemic heart disease screening, selecting for invasive study those with at least one coronary lesion >50% in the CCTA. Patients with unadequate CCTA interpretation were excluded. To eliminate possible biases, the results of the invasive FFR were unknown at the time of applying this new model to obtain the FFRct value.
Results: 26 patients (32 lesions) were included. 86.6% were males and a mean age 57.4 ± SD 11.7 years. In most cases, as these were low-risk patients, and critical disease was excluded, a FFR value >0.80 was obtained. To study the correlation between invasive FFR values and those obtained by the computational model, Spearman’s ρ coefficient and R2 were calculated. There were no false negative or positive cases. The correlation was high in all the parameters studied (>0.6), being positive for the FFRct and negative for ΔFFRct, WWS and SR. The plot in Figure 1D compares the FFRct under steady hyperaemic conditions as a function of the invasive FFR, note the good agreement between the numerical and invasive methods.
Conclusions: Our new model was shown to have a good correlation with the invasively measured FFR in this serie of low-medium risk patients. The clinical usefulness of the new parameters in isolation is yet to be determined, but they could be helpful in cases where the FFRct value is in the gray area (0.75 ≤ FFRct ≤ 0.8), specially the ΔFFRct.
111547
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
EZEQUIEL J ZAIDEL1, Álvaro Sosa Liprandi1, Joaquin Perea1, Matías Ariel Oliva1, Pablo Perel2, Kavita Singh2, Dorairaj Prabhakaran2, Lana Raspail2, Karen Sliwa Hahnle2
(1) Sanatorio Güemes, Buenos Aires, Argentina; (2) World Heart Federation
Introduction and aims: Vulnerable patients with chronic Chagas Disease (CD) may have worse outcomes if hospitalized due to COVID-19. As CD is a neglected tropical disease, it is under-represented in international COVID-19 studies. Current data is scarse and with diverse results. The aim of the present analysis was to describe the clinical profile of patients with known chronic CD during COVID-19 hoapitalization and to analyze if CD patients had different clinical outcomes.
Methods: WHF Covid-19 and cardiovascular (CV) Disease registry is a unique COVID-19 prospective registry, as it included cases from different continents and economic strata. CD was a specific subgroup of analysis, and different centres mainly from latin america included CD cases in the registry. A conventional descriptive and comparative analysis was performed.
Results: A total of 5313 Covid-19 patients were enrolled in 40 hospitals from 23 countries. Among them, 36 were reported as chronic CD cases. The mean age of CD was similar to non-CD patients (56.4 ± 15 vs 57 ± 16 years, p = NS) but the proportion of women was higher (61.1% vs 40.4%, p = 0.011), and had higher rate of baseline heart failure (16.6% vs 5.4%, p < 0.01), prior pacemaker (3.5% vs 1.1%, p < 0.01) and use of CV drugs (75% vs 46.1%, p < 0.01). During hospitalization, the rate of invasive ventilation was higher in CD (8.3% vs 7.5%, p < 0.01), as well as inotropes requirement (8.3% vs 6.8%, p < 0.01), and ventricular arrhythmias (11.4% vs 1.09%, p < 0.01) or heart blocks (11.4% vs 1.4%, p < 0.01). Regarding outcomes, in-hospital death was 5.7% in CD patients and 13.2% in non CD patients (P = 0.38), and no additional deaths occurred at 30 days (0% vs 2.6% in non CD cases, p = 0.054).
Conclusions: Altough a limited number of Chagas disease patients were included, they seem to have more CV disease at baseline than non-CD patients, more CV events during COVID-19 hospitalization but similar short term outcomes.
111530
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
ANDREA ROCHA DE LORENZO1, Ivanete Costa2, Augusto Santos Tavares3, Gabriel Grossman2, Rafael Lopes3, Ronaldo SL Lima1
(1) Clinica de Diagnóstico por Imagem; (2) Hospital Moinhos de Vento; (3) Hospital do Coração-HCOR
Background: The COVID-19 pandemic- and more specifically, the lockdown period- caused unquestionable effects on non-COVID healthcare, with reductions in the access to exams and treatments. As myocardial perfusion imaging (MPI) has a well-established role in the evaluation of coronary artery disease (CAD), the diagnosis of CAD might have been affected, with possible long-term adverse consequences. Understanding of the temporal trend of MPI utilization is central in this context.
Objective: This study aimed to evaluate the impact of the COVID-19 pandemic on MPI performance and results in 3 Brazilian, Nuclear Cardiology laboratories.
Methods: Consecutive patients, with or without known CAD (prior myocardial infarction or revascularization), who underwent stress/rest MPI at 3 Brazilian private Nuclear Cardiology laboratories were studied. The number of tests, indication (diagnostic vs known CAD), frequency of abnormal tests, and frequency of ischemic MPI (those with reversible perfusion defects) were registered in three 30-day time intervals: immediately pre-pandemic, lockdown, and post-lockdown. Variables were compared using Fisher’s exact test; p < 0.05 was considered statistically significant.
Results: From a total of 1027 MPI studies, 443 were pre-pandemic, 127 were during lockdown (a 71% reduction), and 457 were post-lockdown. Diagnostic tests were 70% of the total before, 61% during lockdown, and 67% after (p = 0.05). The frequency of abnormal MPI tests increased in patients without known CAD in the lockdown period, returning to prior levels after lockdown (11%, 19%, and 11%, p = 0.05), although ischemic tests remained stable (7%, 9%, and 8%).
Conclusions: A large reduction of MPI performance occurred during lockdown, with less diagnostic tests. There was no significant difference in the frequency of myocardial ischemia among the 3 intervals, although abnormal MPI tests increased during lockdown in patients undergoing MPI for diagnostic reasons. The altered pattern of MPI utilization caused by the pandemic might have future effects on CAD diagnoses, and therefore should be further and continuously assessed.
111536
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
SORAYA ARAÚJO1, Patrícia Vieira2, Andrea Bento3, Carolina Cohen3, Regina Próspero4, Amira Awada4, Sônia de Castilho5, Vanessa Pirolo Vivancos6
(1) Cardiovascular Advocacy Group; (2) Brazilian Association of Family Hypercholesterolemia; (3) Collaborate with the Future; (4) Rare Lives Institute; (5) ADJ Diabetes Brazil; (6) Botucatuense Association of Diabetic Care
The Cardiovascular Disease Advocacy Group (GAC) promoted a campaign of Cardiovascular risk awareness named “Faça de Coração – Teste seu Risco Cardiovascular”, as a part of the campaign for World Heart Day. Our group applied a poll to stakeholders at the Legislative Assembly of the State of São Paulo- Brazil to mobilize one of the critical stakeholders to this day. This type of approach provides quick evidence of knowledge from the people who are responding and, at the same time, provokes reflections on the subject. The aim of this study was to verify the perception of parliamentarians about cardiovascular diseases (CVD) and their impact on public health in Brazil. Method: A poll conducted by the GAC in the Legislative Assembly of São Paulo, from 06/09 to 30/08 of 2021 was applied. The poll consisted of eleven multiple-choice questions (five questions about their health status; two questions about public policies; four questions about specific knowledge of CVD) available on the Googles Forms platform. The questions were presented to the 94 parliamentarians who compose the Legislative Assembly of São Paulo (LASP) in virtual visits, witnessed and sent by WhatsApp and e-mail. A descriptive analysis was performed. Results and conclusions: Of the 94 members within a current mandate in the Legislative Assembly, 70 responded to the poll. 84,3% were male; 62,9% aged 36 to 59y; 18,6%, 18 to 35y; and 18,6% aged >60y. In the self-report health status, all are non-smokers, 74% practice physical activity; 52,9% made health check-up; 80% know about their cardiovascular risk; 14,3% has hypertension; 4,3% High Cholesterol, 2,9% Diabetes and 1,4% Obesity. 42% be a part of any collegiate of parliamentarians at LASP to find the best strategies to promote health. Most respondents demonstrate a good knowledge of cardiovascular disease. It is very worrying to note that 91,4% do not believe that the current public policies are effective in the management and control of CVD. However, this is the first step to changing this scenario.
111548
Modality: E-Poster Researcher – Non-case Report
Category: HYPERTENSION/RENAL DENERVATION
MARIANO DUARTE1, Mariano Duarte2, Analia Aquieri1, Javier Coyle1, Claudio Yaryour3, Carlos Reyes Toso2
(1) Laboratorio Hipertensión Arterial, Hospital de Clínicas Facultad de Medicina UBA; (2) Laboratorio de Fisiopatología Cardiovascular UA 2 Facultad de Medicina UBA; (3) División Urgencias Hospital de Clínicas Facultad de Medicina UBA
Introduction: The rapid regulation of blood pressure allows the continuous adaptation of the cardiovascular system. This function is carried out by baroreflex (BR). Despite the hypertensive (HT) damage to the arterial wall and BR structures are located within it, the impact of hypertension (HYP) on the BR function has not been fully studied. We hypothesized that HYP has decreased BR function caused by increased arterial stiffness (AS).
Materials and methods: In prospective study, 101 patients over 65 years of age were included; G1: HT G2: Normotensive (NT). BR function: A continuous rhythm strip in lead DII of electrocardiogram and the Valsalva maneuver was performed. Chronotropic response at the end of the test was established by the lowest R-R recorded up to 5 beats post-Valsalva. According with AHA, BR function was established by the greatest variation in heart rate (smallest R-R) within 5 immediate beats over Valsalva. Results 2 populations: A-BR Nomofunction: increase 10 and 30 beats. B-BR hypofunction, increase <10 beats. Assessment of AS by means of pulse wave velocity (PWV): It is performed by Complior System device, the “gold standard” for the non-invasive measurement.
Results: 101 patients (43 men) were studied, 76 of them were HT (147.2 ± 15.7 mmHg) and the rest NT (130.2 ± 10.8 mmHg) p < 0.05. BR hypofunction was observed in 60 of the 76 HT and only in 3 of the 25 NT. PWV was higher in the HT vs. NT (10.54 vs 8.58 m/s) p < 0.001.
Conclusions: As hypothesized, 8/10 in G1 had decreased BR function and only 1/10 in G2. Best predictors of BR hypofunction were sought by multivariate analysis were HYP and AS. So, AS could be one of the causal links between HYP and BR hypofunction and would explain the HT baroreceptor desensitization.
111558
Modality: E-Poster Researcher – Non-case Report
Category: ANTICOAGULATION
CHRISTIAN HENGSTENBERG1, Nicolas M. Van Mieghem2, Rosa Wang3, Xiaomei Ye4, Ling Shi4, Shien Guo4, Cathy Chen3, James Jin3, Xin Ye3, Martin Unverdorben3, George Dangas5
(1) Department of Internal Medicine II, Division of Cardiology, Vienna General Hospital, Medical University, Vienna, Austria; (2) Department of Cardiology, Erasmus University Medical Centre, Thoraxcenter, Rotterdam, the Netherlands; (3) Daiichi Sankyo, Inc., Basking Ridge, NJ, USA; (4) Evidera PPD, LLC, Bethesda, MD, USA; (5) Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, NY, USA
Introduction: ENVISAGE-TAVI AF (NCT02943785; N = 1426) was a randomized, open-label trial that compared edoxaban vs VKAs in patients with atrial fibrillation (AF) after transcatheter aortic valve replacement (TAVR). Noninferiority was shown with edoxaban vs VKAs for the primary endpoint, net adverse clinical events. The effect of edoxaban or VKA-based therapy on patient-reported treatment satisfaction remains unknown.
Objective: To assess patient-reported treatment satisfaction and convenience with edoxaban vs VKAs in patients with AF after TAVR.
Methods: The Perception of Anticoagulation Treatment Questionnaire 2 (PACT-Q2) is a validated patient-reported outcome instrument that was used to assess patients’ satisfaction and convenience with their anticoagulant treatment. A mixed-effect model for repeated measures assessed the least squares mean difference (LSMD) in PACT-Q2 scores between edoxaban- and VKA-treated patients. Cohen’s effect size (ES) evaluated clinical meaningfulness of the differences, defined as ES ≥ 0.2.
Results: A total of 1107/1426 (77.6%) patients (edoxaban, n = 585; VKA, n = 522) had evaluable PACT-Q2 data and were included in this analysis. Edoxaban- vs VKA-treated patients had similar baseline characteristics. Edoxaban-treated patients reported significantly higher overall PACT-Q2 scores for treatment satisfaction than VKA-treated patients (LSMD [95% confidence interval], 6.1 [4.5–7.7], P < 0.05), with a clinically meaningful difference (ES, 0.4 [0.3–0.5]). Results were similar in the convenience dimension (Figure).
Conclusions: ENVISAGE-TAVI AF patients found edoxaban to be more convenient and had greater treatment satisfaction than those who received VKAs. For patients with AF after TAVR, edoxaban may elicit an improved patient experience compared with VKAs.
111569
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
FATHIMA AAYSHA AAYSHA CADER1, Ishmum Zia Chowdhury2, Syeda Rifat Mahmud1, Isha Abdullah Ali1, Saidur Rahman Khan1
(1) Ibrahim Cardiac Hospital & Research Institute; (2) BIRDEM General Hospital
Introduction: There is little data from South Asia on the impact of the COVID-19 pandemic on acute myocardial infarctions (AMI) admissions and outcomes, particularly in the two years following the onset of the pandemic.
Objective: We aimed to compare AMI admissions and outcomes over two time periods since the onset of the pandemic at a tertiary cardiac care centre with catheterization laboratory facilities and referrals from across the country.
Methods: In this cohort study conducted at our tertiary cardiac centre, we collected and compared data of all patients diagnosed and admitted with AMI over two time periods: between March–August 2020 and March–August 2021. Patient demographics, diagnostic and therapeutic strategies and in-hospital outcomes were statistically analysed and compared by the student’s t test and chi-square tests, as appropriate.
Results: A total of 380 AMI admissions were included, 82 (21.6%) in 2020 and 298 (78.4%) in 2021 over the same time periods. Significantly more men presented in both years (69.5% and 83.2% in 2020 and 2021 respectively; p = 0.005). No significant differences in cardiovascular risk factors or type of AMI were seen across both time periods (49.7% vs 52.4% STEMI in 2020 vs 2021). Late presentation of STEMI was 30.5% vs 23.2% in 2020 and 2021 respectively (p = 0.13). 35.9% were vaccinated against COVID19 in 2021 (p < 0.001). Significantly more patients developed cardiogenic shock (40.2% vs 23.8% (Odds Ratio [OR] & 95% confidence interval [CI] 2.15 (1.29–3.61); p = 0.003); heart failure (76.8% vs 57.4%; OR 2.46 (1.40–4.32); p = 0.001), cardiac arrest (19.5% vs 9.7%; OR 2.25 (1.15–4.38); p = 0.015) and required ventilation (19.5% vs 9.1%; OR 2.43 (1.24–4.78); p = 0.008) in 2020, as compared with 2021. In-hospital mortality was numerically higher in 2020 (17.1% vs 9.7%; OR 1.91 (0.96–3.81); p = 0.063). AMI patients were significantly less likely to undergo coronary angiography (54.9% vs 71.1% for 2020 vs 2021; p = 0.005) and percutaneous coronary intervention (35.4% vs 44%; p = 0.001) during index admission in 2020. 45% of STEMI patients were given fibrinolysis overall, with fewer in 2020 as compared with 2021 (20.9% vs 47.2%).
Conclusion: In the immediate aftermath of the pandemic, fewer patients presented with AMI in 2020, as compared with similar time periods the next year, in 2021. Significantly fewer patients underwent angiography and PCI in 2020. AMI patients had improved outcomes in 2021, as compared to 2020.
111588
Modality: E-Poster Researcher – Non-case Report
Category: HYPERTENSION/RENAL DENERVATION
TATIANE DE AZEVEDO RUBIO1, Bruno Rodrigues1, Silvia Elaine Ferreira-Melo1, Lucia Helena Bonalume Tacito2, José Fernando Vilela-Martin2, Moacir Fernandes de Godoy2, Heitor Moreno-Junior1, Juan Carlos Yugar-Toledo2
(1) University of Campinas – UNICAMP; (2) Faculty of Medicine of Sao Jose do Rio Preto -FAMERP
Among the blood pressure (BP) regulation mechanisms in RHTN, the expression of autonomic modulation plays an important role. Linear and non-linear analyzes of heart rate variability (HRV) assess the autonomic modulation of the cardiovascular system. Resistant hypertensive patients may present with autonomic dysfunction with different degrees of impairment. The objective of the present study was to evaluate the impairment of the autonomic function of controlled and uncontrolled resistant hypertensive patients, as well as those using beta-blockers. Assessments of autonomic function were performed in 49 resistant hypertensive patients aged between 53 and 82 years.
Results: Uncontrolled RHTN patients (U-RHT) present a reduction in HRV and greater expression of sympathetic activity in relation to parasympathetic activity, demonstrated through a statistically significant reduction of the variables SDNN, RMSSD, SD1 and SD2 when compared to the group (C-RHT). In addition, despite the use of beta-blockers, both in RHTN + beta-blockers (RHT+BB) and U-RHT patients, the autonomic balance shows negative changes, that is, lower HRV, compared to the controlled RH group.
Conclusion: RHTN patients present a reduction in HRV due to the occurrence of a reduction in parasympathetic activity and a relative increase in the sympathetic component. These results corroborate the importance of interventions on the autonomic nervous system.
112313
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
NATHALIA DUARTE CAMISÃO1, BRUNO FERRAZ DE OLIVEIRA GOMES1, JOÃO LUIZ FERNANDES PETRIZ1, GLAUCIA MARIA MORAES DE OLIVEIRA2, ANNA BUTTER1, HENRIQUE CUSTÓDIO GOUDAR1, RENATA MEXIAS ABDALA FELIX1, THIAGO MOREIRA BASTOS DA SILVA2, MARIANA MORENO CANÁRIO DA SILVA1, LETÍCIA DE SOUSA PERES1, ILIANA REGINA RIBEIRO MENEZES1, GIOVANNI POSSAMAI DUTRA1
(1) Hospital Barra D’or; (2) UNIVERSIDADE FEDERAL DO RIO DE JANEIRO (UFRJ)
Introduction: The pandemic caused by the SARS-Cov-2 virus brought the need for and importance of identifying biomarkers that may indicate a worse prognosis and an increase in the long-term mortality of these patients.
Objective: Identify biomarkers associated with long-term death in patients hospitalized by COVID-19.
Methods: Retrospective study with hospitalized patients with a confirmed diagnosis of COVID-19. The following biomarkers, collected during hospitalization, were analyzed: d-dimer (admission, peak, and discharge), ultrasensitive troponin (admission and peak), C-reactive protein (admission and peak), and platelet count (admission and peak). We used the ROC curve and the area under the curve (AUC) analysis to determine the biomarkers with the best association with all-cause mortality.
Results: A total of 1454 patients were included, mean age of 59.8 ± 17.0, 62.6% were men. There were 269 deaths (18.5%) during the study period (mean follow-up = 338 ± 209 days), and 44.7% of patients had myocardial injury. We observed that the highest AUC was obtained with the discharge d-dimer (AUC = 0.900) and the peak d-dimer (AUC = 0.870). The cutoff point proposed by the Youden index was, respectively: 1945 ng/dL (sensitivity 89%/specificity 73%) and 1987 ng/dL (sensitivity 81%/specificity 88%).
Conclusions: We observed a high association of mortality (in and out of hospital) with the peak d-dimer obtained before hospital discharge. This data highlights the need for attention to patients who present high levels of this biomarker at the hospital discharge and may indicate the need for preventive therapies for thromboembolic events.
111595
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARLUS KARSTEN1, Gustavo dos Santos Ribeiro2, Luís Fernando Deresz3, Elisabetta Salvioni4, Dominique Hansen5, Piergiuseppe Agostoni6
(1) Universidade do Estado de Santa Catarina (UDESC); (2) Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); (3) Universidade Federal de Juiz de Fora (UFJF); (4) Centro Cardiologico Monzino (CCM); (5) Hasselt University (UHASSELT); (6) University of Milan (UNIMI)
Background: Exercise oscillatory ventilation (EOV) is an abnormal phenomenon observed in chronic heart failure (HF) patients and is associated with a greater risk of adverse cardiovascular events.
Purpose: To compare the EOV prevalence of 3 EOV definitions and to predict 2-year all-cause mortality in HF patients.
Methods: Cardiopulmonary exercise test data from 233 HF patients were analyzed. Two blinded reviewers identified EOV according to the definitions of Ben-Dov, Corrà, and Leite. Prevalence data were compared by the Cochran’s Q test and McNemar post hoc test. The relative risk of death and Kaplan-Meier survival analysis were applied in a 2-year follow-up. Sensitivity and specificity to predict 2-year mortality were determined by the receiver-operating characteristic curve.
Results: EOV prevalence was 16.7, 17.5, and 8.4% by Ben-Dov, Corrà, and Leite’s definitions. There was no difference in EOV prevalence between Ben-Dov and Corrà. Both were different from Leite (p < 0.01). The 2-year death risk was 1.9 (1.0–3.7), 2.8 (1.6–5.2), and 2.0 (0.9–4.3) applying Ben-Dov, Corrà, and Leite’s definitions. Table 1 shows the sensitivity and specificity to predict 2-year mortality.
Conclusion: EOV definition’s choice directly affects the number of EOV cases. Ben-Dov and Corrà definitions seem to have similar predictive power. Corrà definition shows better sensitivity to predict 2-year mortality.
111589
Modality: E-Poster Researcher – Non-case Report
Category: PSYCHOLOGY
SIRLEI PEREIRA NUNES1, Sirlei Pereira Nunes1, Bellkiss Wilma Romano1, Flávio Tarasoutchi1, Danielle Misumi Watanabe1
(1) InCor – Instituto do Coração do Hospital das Clínicas da FMUSP
Introduction: The high mortality from cardiovascular diseases compromises significantly the Quality of Life (QoL) of patients (pacs) in all aspects, especially physical, psychosocial and mental health, making it necessary to rethink care in this population, implementing care, carried out and shared by a team of multidisciplinary.
Objective: Verify the surgical influence the valve on the improvement of QoL at perspective of pacs.
Method: Retrospective randomized observational longitudinal study of pacs surgical valve disease from a public health institution in the State of São Paulo, by a multidisciplinary team: clinical and surgical cardiologists, nurses, psychologists and others. Psychology assessment occurred in three moments: preoperative(preop), postoperative (posop) in the nursery ward and postoperatively (posop B), six months after the procedure from hospital discharge. 995 pacs were evaluated in preop, 517 posop in nurse and 144 pacs in posop B, March/2018 to February/2020, using semistructured interview technique and the SF 36 instrument that measures QoL from the individual’s perception of their general health status- score from 0 to 100.
Results: The results showed an improvement in QoL the SF 36, emphasizing physical, social, emotional and mental health aspects, see table 1(one).
Conclusion: Value-based care through the surgical valve disease line of care was effective in providing pacs with na improvement in their QoL.
111644
Modality: E-Poster Researcher – Non-case Report
Category: NURSING
FERNANDA CARNEIRO MUSSI1, Flávia Silva Ferreira1, Maria Cecilia Gallani4, Jules Ramon Brito Teixeira2, Thiago Ferreira Sousa3, Francisco José Gondim Pitanga5, Fernanda Michelle Santos Silva1, Brenda Silva Cunha1
(1) Escola de enfermagem, Universidade Federal da Bahia, Salvador, Bahia, Brazil.; (2) Escola de Enfermagem, Universidade Estadual de Feira de Santana, Feira de Santana, Bahia, Brazil.; (3) Centro de Formação de Professores, Universidade Federal do Recôncavo Baiano, Amargosa, Bahia, Brazil; (4) Faculté des sciences infirmières, Université Laval, Québec, Québec, Canada.; (5) Escola de Educação Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Introduction: Sedentary behavior (SB) has been associated with chronic disease and all-cause mortality even in sufficiently active people. College students are referred to as a group exposed to SB, but little is known about this behavior in nursing students.
Objective: To estimate the amount of time nursing students, spend in sedentary behavior in their daily lives and to examine the association between time in sedentary behavior and sociodemographic, academic, and behavioral variables.
Method: Cross-sectional study, with 286 university students. Pearson’s Chi-square or Fisher’s Exact test and Multiple Logistic Regression were used. Sedentary behavior ≥8 hours per day (h/day) was common and risks were corrected by the Delta estimation method, obtaining the prevalence ratio and 95% confidence interval. A statistical significance of 5% was adopted.
Results: Sedentary behavior ≥8h/day was identified for 53.5%. Older college students were 33.0% less in sedentary behavior ≥8h/day compared to younger students; with ≥3 hours of the out-of-class study showed 1.23 times more sedentary behavior ≥8h/day compared to those with <3 hours; with ≥4 subjects showed 1.58 times more sedentary behavior ≥8h/day compared to those with ≤3; insufficiently active showed 1.25 times more sedentary behavior ≥8hr/day compared to those who met the recommendation and who used sleep medications showed 1.46 times more sedentary behavior ≥8h/day compared to those who did not.
Conclusion: It is necessary to combat sedentary behavior especially in younger college students, with accumulation of subjects, sleeping drugs, and insufficiently active.
111660
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
JOSÉ RAMÓN LANZ-LUCES1, Fernando Augusto Alves da Costa11, Luís Fernando Escobar Guzman2
(1) Instituto Paulista de Doenças Cardiovasculares (IDPC); (2) Hospital Beneficência Portuguesa de São Paulo (BP)
Introduction: Dilated aortic root (DAo) is a risk for cardiovascular events besides left ventricular hypertrophy (LVH). There is a lack of a useful index pondering both scenarios.
Objective: To evaluate an electrocardiographic index in DAo and LVH comparing echocardiographic consensus values and those derived using the wall chest thickness (CT).
Methodology: 631 patients, 236 hypertensive (HT) and 395 non-hypertensives (nHT), the diameter of the aortic root was based on the golden number (Phi) and the derived formula CT × 1.33 = Ao, using a cut-off >15% for enlargement. The index stemmed from the R + S amplitude sum in leads D1 + D2 + D3 and for values <23 mm. The index was also compared with Cornell and Sokolow-Lyon-Rappaport indexes and stablished criteria for Dao and LVH using T-test and CH2 test as appropriate.
Results: The index prevalence was similar between groups (HT:42.7 vs. nHT: 37%, p = 0.15). There were differences in echocardiographic measurements (aorta, septum, posterior wall, and ventricular mass, p < 0.05). The index failed to be related to LVH, on the contrary it was associated to DAo derived from CT in the general population (OR: 2.189 CI95%: 1.546–3.100, p < 0.001) and in NTH (OR:3.010 CI95%: 1,869–4.847). Similar results for actual Dao criteria in the NTH (OR:3.078 CI95%:1.224–7.738, p = 0.012). Cornell index showed similar odds however, the test-sensibility was far less than the novel index, 8.4% vs 71.2%.
Conclusion: This novel index was advantageous separating those with a DAo based CT measure along with literature consensus criteria for non-hypertensive patients.
111670
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
LUIZ SÉRGIO FERNANDES DE CARVALHO1, Alice Pacheco Santos4, Ana Carolina Machado Rodrigues da Cunha4, Guilherme Albuquerque Gruber4, Ana Claudia Cavalcante Nogueira2, Alexandre Anderson de Souza Munhoz Soares2, Gustavo Alexim3
(1) Clarity Healthcare Intelligence; (2) Instituto Aramari Apo; (3) HRS-DF – Hospital Regional de Sobradinho do Distrito Federal; (4) UCB – Universidade Católica de Brasília
Introduction: The epidemiology of acute coronary syndromes (ACS) has gone through dramatic changes in recent decades, with an increase in its incidence in young individuals (under 55 years, ACSy) and a relative decrease in older individuals (ACSo). The management of ACS in young patients with moderate to high atherosclerotic load after the primary event still needs elucidation, since these individuals retain a long life expectancy.
Objective: To compare clinical outcomes and cost of care in individuals with premature CAD and moderate to high atherosclerotic load undergoing Coronary Artery Bypass Graft (CABG) or percutaneous coronary intervention (PCI).
Method: The study population consisted of the retrospective B-CaRe:QCO assortment, which includes all patients admitted with ACS in public hospitals in Federal District between 2013 and 2015 and who underwent cardiac catheterization with SYNTAX score >28. Outcomes were adjudicated with death certificates and medical record data. The primary clinical outcome was composite by CV death and recurrent ACS (MACE), followed by secondary endpoints: all-cause death and AMI. To assess indirect and direct costs, we evaluated, in international dollars (Int$) per year, the cost of lost productivity due to illness and death, ambulatory costs, and costs of new hospitalizations. Multivariate and propensity score paired (PEP) analyses were performed.
Results: Among 1088 subjects (111 treated by CABG and 977 with PCI) aged <55 years accompanied for 6.2 (IQR 1.1) years, 304 primary events were observed. MACE was observed in 20.7% of the CABG group and 28.8% of the PCI group (p = 0.037). All-cause deaths were seen in 8.1% of the CABG group and 6.6% (p = 0.450) of the PCI group. AMI was seen in 6.3% of the CABG group and 15% of the PCI group (p = 0.014). On multivariate analysis, PCI was associated with higher hazard ratio (HR) for MACE, 1.227(95% CI 1.004–1.499; p = 0.04577), and in PEP HR = 1.268 (95% CI 1.048–1.548; p = 0.0271) compared to the CABG group. Although we observed no statistical differences in direct costs, the cost of lost productivity was higher in the PCI group (Int$4,511 (IQR 18062)/year vs Int$3,578 (IQR 13198)/year; p = 0.049] compared to CABG.
Conclusion: In younger, high-atherostatic load ACS patients, the surgical approach is associated to lower occurrence of major long-term adverse cardiovascular effects, besides being associated to lower indirect costs.
111703
Modality: E-Poster Researcher – Non-case Report
Category: PERIOPERATIVE EVALUATION
BRUNO FERRAZ DE OLIVEIRA GOMES1, Thiago Moreira Bastos da Silva2, Leticia de Sousa Peres1, Iliana Regina Ribeiro Menezes1, Nathalia Duarte Camisão1, Mariana Moreno Canário da Silva1, Renata Mexias Abdala Felix1, Giovanni Possamai Dutra1, Anna Butter1, Henrique Custódio Goudar1, João Luiz Fernandes Petriz1, Gláucia Maria Moraes de Oliveira2
(1) Hospital Barra D’Or; (2) Universidade Federal do Rio de Janeiro
Background: Myocardial injury in non-cardiac surgery (MINS) occurs in 10–25% and increases mortality in 30 days. Prediction tools can help in the creation of preventive strategies.
Methods: Retrospective cohort study including all non-cardiac surgery patients admitted to a postoperative care unit who stayed at least one night in this unit and had at least one measurement of high-sensitive cardiac troponin. Clinical characteristics and the occurrence of MINS were assessed. All variables were included in the classification tree statistical model, a machine learning method, where variables with p < 0.05 were included in the analysis.
Results: 2230 patients were included, mean age = 63.7 ± 16.2 years, and 55.6% women. The prevalence of MINS was 9.4%. The classification tree is available in Figure 1. The variables selected by the model were: age, RCRI score, high-risk surgery, previous myocardial infarction, and creatinine. This model has an accuracy of 90.6%.
Conclusion: Age, RCRI score, high-risk surgery, previous myocardial infarction, and creatinine were predictors of MINS and were included in the classification tree. This model exhibited high accuracy and may be useful in the early identification of these patients.
111681
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
MARIA TERESA CABRERA CASTILLO1, MILENA DAVI NARCHI1, FLAVIA CUNACIA D‘EVA1, ROBERT TANAKA1, ADRIANA FUCCI1, DEBORA CLOTILDE CAROLLA1, LUISA MURAKAMI1, FARID SAMAAN1, RUI FERNADO RAMOS1, GUSTAVO BERNARDES DE FIGUEIRDO OLIVEIRA1, ARI TIMERMAN1
(1) INSTITUTO DANTE PAZZANESE DE CARDIOLOGIA
Introduction: Cardiovascular disease (CVD) is the leading cause of death in Western countries, with heart failure being the final pathway of heart disease. Despite this, few patients are referred for Palliative Approach (PA). There is no consensus about the indication or the right time to refer patients to PA, whose main objective is to improve the patient’s quality of life.
Objective: Characterize the epidemiological profile of patients with heart diseases with indication for PA in a hospital specialized in cardiology.
Methods: This is a cross-sectional study with analysis of 554 patients included for PA from Feb 2018 to Feb 2022. Frequency, median, percentage, mean, maximum and minimum value were used for statistical analysis.
Results: The sample comprised of 554 patients (P), for PA 270(57%) were male, mean age 71 ± 14 years, 179(37%) Catholic, 91(20%) Evangelical, With most frequent medical history of arrhythmia 242(51%), ventricular dysfunction 297(62%), Coronary artery bypass graft surgery 109 (23%) and stroke 175(15%). The most frequent clinical complains were: Dyspnea 329(59.30%), Lower limb edema 96(17.39%), diagnosis at the time of PA was renal failure 351 P (74.4%) and of these 148 (31%) needed hemodialysis, Heart failure 177(31.9%) (HF), Sepsis/Septic shock 146(26,3), stroke 113(20%). The mean ejection fraction was 40%. As for performance in activities of daily living we used the Palliative performance Scale (PPS) where 282 (71,1%) needed life support. We evaluated the prognosis with the PPI scale, 345(56.8%) with high short-term mortality. Regarding treatment, 277(58,7%) of patients with PA had CVC, 277(58.7%) received broad spectrum antibiotics, 196(41.5%) dobutamine, 138(30%) noradrenaline, 164 (34.7%) on mecanichl ventilation 130(27.5%) on hemodialysis 116(24.6%) sedated, 81 (8%) with IAP. Among these patients 295(52.9%) died during hospitalization and 126 (22%) were able to be discharged. Only 26(4.7%) did not accept the PA protocol, the most frequent site of the PA was 245(51.1%) in the ICU, followed by the ward with 227 (48%) P.
Conclusion: In our sample we identified that patients with heart disease in PA still receive futile interventions and therapies, and the most frequent site of palliation is the ICU. This shows a later indication for PC, in patients with advanced HF and at the end of life. Strategies and institutional protocols are needed for an earlier indication, in order to promote integral care and better qualy of life.
111684
Modality: E-Poster Researcher – Non-case Report
Category: CONGENITAL AND PEDIATRIC CARDIOLOGY
PAULO ZIELINSKY1, Paulo Zielinsky1, Júlia Foresti1, Débora Raupp1, Daniela Babinski Guimarães1, Kelly Zucatti1, Vitória Gomez1, Vitória Aragon1, Izabele Vian1, Eduarda Bonamigo1
(1) Institute of Cardiology of Rio Grande do Sul (IC/FUC)
Omega-3 (DHA) has been reccomended to adequate fetal development during gestation. Since it is a substance with intense anti-inflammatory action, such as dietary polyphenols, its effects upon the fetal heart and circulation are unknown and safety of its administration during gestation is not yet established. This study was designed with the purpose to investigate if maternal supplementation of omega-3 is followed by alterations of flow dynamics on fetal ductus arteriosus, at the final trimester of pregnancy, through a double blind, placebo-controlled, randomized clinical trial by groups. Pregnant women between gestational 27 and 28 weeks without cardiac alterations at fetal echocardiography were included, with exclusion of those taking nonsteroidal anti-inflammatory drugs or other substances with this effect, such as polyphenol-rich foods. The intervention group received supplementation of 450 mg of DHA/day in gastroresistent capsules and was compared to the placebo group, after 8 weeks. The participants in both groups were submitted to fetal Doppler echocardiography, assessment of dietary polyphenol and omega-3 consumption, as well as serum prostaglandin levels. Intergroup and intragroup data were evaluated. The study ended up with 24 participants in each group. After 8 weeks, Doppler echocardiographic parameters of ductal flow and serum prostaglandin levels in both groups did not show significant intergroup differences (systolic velocity: p = 0.59; diastolic velocity: p = 0.53; pulsatility index: p = 0.29; serum prostaglandin levels: p = 0.40) The expected intragroup differences as a result in increase in gestational ages were present. The results of this study suggest that omega-3 supplementation is safe at the final third of pregnancy, not causing alterations in the dynamics of the fetal ductus arteriosus flow, at the doses used, despite its potential anti-inflammatory action.
111685
Modality: E-Poster Researcher – Non-case Report
Category: CARDIORESPIRATORY PHYSIOLOGY/BASIC SCIENCE
TIAGO FERNANDES1, Fernanda Roberta Roque1, Vander José Neves2, João Lucas Penteado Gomes1, Andre Casanova Silveira1, Graziela Amaro Vicente Ferreira Saraiva4, Suliana Mesquita Paula3, Camila Paixão Jordão5, Rodrigo Souza4, Luciana Venturini Rossoni3, Maria Urbana Pinto Brandão Rondon4, Edilamar Menezes Oliveira1
(1) Laboratory of Biochemistry and Molecular Biology of Exercise, School of Physical Education and Sport, University of Sao Paulo; (2) President Tancredo de Almeida Neves University Center; (3) Department of Physiology and Biophysics, Institute of Biomedical Science, University of Sao Paulo; (4) School of Physical Education and Sport, University of Sao Paulo, Sao Paulo; (5) Heart Institute
Arterial hypertension (AH) is a multifactorial syndrome characterized by high levels of blood pressure. Aerobic exercise training (ET) has been used as an important non-pharmacological treatment of AH, since it mitigates cardiovascular remodelling and blood pressure; however, the mechanisms involved are poorly understood. Our analysis of the miRNA’s expression profile by microarray, we selected the miRNA-205 for being one of the most differentially expressed miRNAs in AH, being neutralized by ET, and for targeting many genes involved in the vascular process. Therefore, we aim to evaluate the therapeutic potential of ET and gene therapy with AAV9-miRNA-205 treatment in spontaneously hypertensive rats (SHR), and the circulating miRNA-205 expression in AH patients. SHR aged 6 months and the respective controls Wistar Kyoto (WKY) were divided into four experimental groups (n = 7/group): SHR, trained SHR (SHR -T), WKY and trained WKY (WKY-T). The swimming ET consisted of 10-week, 1 × day/5 × a week/10 weeks. ET promoted reduction in blood pressure in SHR and resting bradycardia in trained animals. We observed a reduction in VO2max accompanied by cardiac hypertrophy and skeletal muscle atrophy. Moreover, these animals showed an increase in wall:lumen ratio of the femoral artery and muscle arteriole. ET corrected these changes in the peripheral vessels. AH increased 300% miRNA-205 levels by real-time PCR paralleled with a decrease of target genes VEGF, Akt, Bcl-2, eNOS, Itga5, TGFα and p70S6K levels by western blot compared to WKY group in skeletal muscle. In contrast, ET counteracts miRNA-205 and target genes levels toward control. Also, we used an adeno-associated virus 9 (AAV9) delivery methods to inhibit miRNA-205 in cardiovascular and muscle systems. Interestingly, AAV9-mediated miRNA inhibition (single systemic injection of AAV: 2 × 1012 viral genome particles) reduced AH-induced high levels of blood pressure compared to AAV-9 control around 25 mmHg in SHR. Indeed, miRNA-205 inhibition attenuated cardiac remodelling in SHR. In AH patients, the circulating levels of miRNA-205 were higher when compared to the normotensive group. Together, these results support the hypothesis that the morphofunctional changes arising of AH may be regulated by miRNAs and target genes; and ET participates in restoring the cardiovascular system. Thus, AAV9-mediated miRNA-205 inhibition appears as perspectives for the potential therapeutic use of miRNAs in the treatment of AH.
111930
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
RAFAEL MODESTO FERNANDES3, Carolina Aslan Ribeiro Brito5, Carolina Costa da Silva Souza5, Vitor Queiroz de Castro Souza5, David Le Bihan4, Andrea A. Vilela1, Rodrigo B. M. Barretto2, Elizabete S. Santos1, Amanda G. M. R. Sousa1, Ari Timerman1
(1) Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; (2) Instituto do Coração (INCOR), University of São Paulo, Brazil; (3) D’Or Institute for Research and Education (IDOR), Hospital Aliança, Salvador, Brazil; (4) Grupo Fleury- São Paulo; (5) Bahiana School of Medicine and Public Health, Salvador, Brazil.
Background: Cardiovascular disease is the leading cause of death in Brazil and worldwide. In the context of diastolic dysfunction, echocardiography is the best non-invasive diagnostic method. However, the comparison of the two main guidelines for evaluate left ventricular diastolic function in acute coronary syndrome (ACS) is scarce.
Objective: To compare the prognostic value of both guidelines of American Society of Echocardiography, from 2009 and 2016, in patients with ACS.
Methods: This is a sub-analysis of a prospective cohort observational study with 109 patients admitted to the emergency with ACS. The follow up was performed within 1 year and combined outcome was cardiovascular death or new heart failure. We used the non-parametric Spearman method to assess the correlation between the categories of diastolic function according to the guideline used. The Cox model and the Log rank test with Kaplan-Meier curves were used to compare the prognostic value of categorizing patients according to the guideline used. The results were expressed as hazard ratio with a confidence interval of 95%.
Results: The mean age was 63 years ±11, most male patients (73.4%) and the predominant color of patients was white (60.4%). Among the main risk factors, the most frequent for coronary artery disease was dyslipidemia (78%), followed by systemic arterial hypertension (77.1%) and sedentary lifestyle (65.9%). The study identified a mean borderline ejection fraction, a high E/E’ ratio, and LV diastolic and systolic volumes presented means above normal. The most common electrocardiographic change on admission was T-wave inversion (45%), and NSTEMI was the main clinical diagnosis (74%). The categories in which there was a greater disagreement between the guidelines were grade II diastolic dysfunction and normal function. The correlation between the diagnosis of diastolic dysfunction when compared to the use of the 2009 and 2016 guidelines was weak (R = 0.56 by Spearman’s method; p < 0.001). By the Kaplan-Meier curves, dividing the groups into with or without LA pressure elevation, the distinction between the evolution of the two groups is significant when performed by the 2016 guideline (Log Rank = 8.17; p = 0.04).
Conclusion: The current guideline (2016) for the assessment of left ventricular diastolic dysfunction showed a higher prognostic value of combined outcome of cardiovascular death or new heart failure within one year, when compared to the guideline of 2009 in patients.
111722
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ALEXANDRA CORRÊA GERVAZONI BALBUENA DE LIMA1, Caroline Barreto Cavalcanti1, Paula Fernandes Freitas Lima1, Barbara Cunha Barreto2, Bruno Ramos Carneiro2, Gabriela de Oliveira Silva2, Maria Alice Ramalho Bragatto2, Ilan Sousa Figueirêdo3, Wenisten Jose Dantas da Silva3, Erick Giovani Sperandio Nascimento3, Luís Moreira da Silva de Azevedo Meireles4, Sergio Henrique Rodolpho Ramalho5
(1) North Wing Regional Hospital – Brasilia – Brazil; (2) School of Health Sciences – Brasília – Brazil; (3) Manufacturing and Technology Integrated – Campus SENAI CIMATEC, Salvador, Bahia, Brazil; (4) MDI Industrial, Salvador, Bahia – Brazil; (5) Coordinator of the Clinical Research Center of the Brasilia of the Dasa Hospitals Network – Brasilia – Brazil
Background: Dyspnea is challenge in hospitalized individuals. The reasons for dyspnea are often multifactorial and the evaluation may use different and expensive methods (ex.: arterial blood gas, natriuretic peptide measurement, echocardiogram, computed tomography). This objective of this study was to assess the accuracy of an artificial intelligence (AI) capnography waverform and the presence of heart or pulmonary disease using the AI technology.
Methods: In this prospective observational study, of patients admitted to a public hospital in Brasilia, Brazil, from September 2021 to February 2022, deep learning algorithms were developed and validated using capnography waveforms acquired from patient monitoring. The classification model was a binary classifier of individuals with healthy patients and sick patients (heart disease or pulmonary disease or heart and pulmonary disease) by analyzing biosignal waveforms. We assessed the model performance using area under the receiver operating characteristic curve (AUC-ROC), Accuracy, Sensitivity, Recall, F1-score, and Specificity.
Results: Among them, 286 cases were taken as the experimental group, 61 (21%) heart disease, 69 (24%) pulmonary disease, 85 (30%) heart and pulmonary disease and 71 (25%) without heart or pulmonary disease (healthy patients). The AI model revealed a true positive (sick patients) of 88% and a true negative (healthy patients) of 82%. Therefore, the AI capnography waveform algorithm showed an average performance of 86% of Accuracy, 85% of Specificity, 85% of Recall and 83% of Precision, 84% of F1-score, and 85% of AUC-ROC.
Conclusions: Capnography is a non-invasive, low-cost, and easy-to-use equipment. The capnography waveform could predict the presence or absence of heart or pulmonary disease based on biosignals acquired using noninvasive patient monitoring. The research showed that the design of AI information processing can assistant the clinical diagnostic and evaluation of patients.
111727
Modality: E-Poster Researcher – Non-case Report
Category: PERICARDIUM/ENDOCARDIUM/VALVOPATHIES
RAFAEL ALEXANDRE MENEGUZ MORENO1, Luiz Eugenio B. Prota-Filho1, Caio C.V. Queiroz1, Fabricio C. Wohnrath1, Felipe A.C. Carboni1, Gisele R.C. Silva1, Joselyn I.P. Castro1, Wandemberg S. Silva1, Auristela I.O. Ramos1, Nisia L. Gomes1, Sergio L.N. Braga1, J. Ribamar Costa Jr1
(1) Instituto Dante Pazzanese de Cardiologia
Background: Percutaneous mitral balloon commissurotomy (PMBC) remains the preferred treatment for patients with severe symptomatic rheumatic mitral stenosis (MS) and suitable anatomy. The objective of this study was to propose a new score for the prediction of immediate and late success.
Methods: This is a retrospective, single-center, single-arm registry encompassing all 1915 consecutive patients with rheumatic mitral stenosis recruited and referred to PMBC between August 3rd 1987 and July 19th 2010. All data were previously collected and recorded in a dataset. Clinical status was determined according to the New York Heart Association (NYHA) classification. Long-term outcome was a composite of incidence of major adverse cardiac events (cardiovascular death, new PMBC or mitral valve repair surgery) up to 24 years of clinical follow-up (from 1988 until December 3rd, 2011), including cardiovascular death, need for new PMBC, or mitral valve replacement surgery.
Results: Mean patient age was 36.8 ± 12.9 years, most (86.4%) were female, and Wilkins score was between 9–11 in 49.1% of patients. In the multivariate analysis, the predictors of immediate success were age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96–0.99; p = 0.01), left atrium size (OR, 0.96; 95% CI, 0.93–0.99; p = 0.01), mean pre-procedure mitral gradient (OR, 0.93; 95% CI, 0.89–0.96; p < 0.001), intermediate Wilkins score 9–11 (OR, 0.62; 95% CI, 0.40–0.94; p = 0.02), and high Wilkins score ≥12 (OR, 0.35; 95% CI, 0.16–0.76; p < 0.01). For prediction of late events, age (hazard ratio [HR], 0.98; 95% CI, 0.97–0.98; p < 0.001), New York Heart Association class III–IV (HR, 1.50; 95% CI, 1.18–1.92; p < 0.001), left atrium size (HR, 1.02; 95% CI, 1.02–0.04; p < 0.01), and high Wilkins score ≥12 (HR, 2.02; 95% CI, 1.30–3.15; p < 0.01) were significant. Two nomograms were developed using significant predictors from the model (one for immediate results and another for long-term results).
Conclusions: In this large population, not only the Wilkins score, but also clinical and hemodynamic features, seem to be relevant in predicting immediate and late success for patients with rheumatic MS who underwent PMBC.
111724
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
DOMINGOS SAVIO BARBOSA DE MELO2, Domingos Savio Barbosa de Melo2, Antonio Carlos Pereira Barreto1, Aristea Izabel de Oliveira2, Rodrigo Savio de Oliveira Melo2, Breno Domingos de Gusmao Melo2
(1) Heart Institute- InCor-FMUSP; (2) Ergocardio Medicina Diagnosis and Research
Background: Rapid up-titration of beta-blockers (BB) in the treatment of heart failure (HF) during hospitalization has yet to be tested.
Objectives: The purpose of this research was to evaluate the correlation between the rapid up-titration of beta-blockers and functional capacity in patients hospitalized for HF using the 6-minute walk test (6MWT) as a parameter.
Methods and Results: 92 patients with advanced HF (New York Heart Association [NYHA] IV) and left ventricle ejection fraction (LVEF) <45% were hospitalized for clinical compensation and followed-up for one year after discharge. The patients were distributed into two groups: 46 in the treatment group (TG) and 46 in the control group (CG). During hospitalization, they were divided randomly for BB rapid up-titration with an increase of dosage every two days (TG), or by the usual treatment regime (CG). Statistical analysis used: Student’s t-test, Mann-Whitney, Chi-square and Fisher’s exact test, Kaplan-Meier for survival, using the Log-rank test for comparison and the hazard ratio (HR) calculated with the Cox model. P < 0.05 was considered significant. The exercise tolerance analysis was performed at the entrance, three months and one-year intervals and the walking distance was stratified into four levels (NV): NV1 <300 meters (m), NV2 = 300–375 m, NV3 = 375–450 m and NV4 > 450 m. At the entrance moments, three months and one year the distance traveled for the TG/CG were, respectively, 206.62 ± 33.54/185.09 ± 32.32 meters, 384.55 ± 77.54/336.55 ± 65.23 meters, and 422.17 ± 98.57/387.41 ± 76.66 meters. It was verified that there was an increase in walking distance for the two groups studied (p = 0.002). However, the distance walked in the TG was significantly higher than in the CG (p < 0.001).
Conclusions: The rapid up-titration of beta blockers dosage during hospitalization of end-stage HF patients compared to the usual treatment regimen in advanced HF is safe, effective, and promotes increased functional capacity through 6MWT analysis.
111743
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
DOMINGOS SAVIO BARBOSA DE MELO2, Antonio Carlos Pereira Barretto1, Aristea Izabel de Oliveira2, Rodrigo Savio de Oliveira Melo2, Breno Domingos de Gusmao Melo2, Domingos Savio Barbosa de Melo2
(1) Heart Institute- InCor-FMUSP; (2) Ergocardio Medicina Diagnosis and Research
Background: Rapid up-titration of beta-blockers (BB) in the treatment of heart failure (HF) during hospitalization has yet to be tested.
Objectives: Our purpose for this research is a new model for administering beta-blockers in patients with end-stage HF in order to, after clinical compensation of the patient, promote more rapid dosage increments than the conventional method or usual care procedures. We also sought to ascertain whether or not this model for administering beta-blockers could modify the impact of HF in relation to the enhancement of the quality of life (QOL) as measured by the Minnesota Living with Heart Failure questionnaire.
Methods and Results: 92 patients with advanced HF (New York Heart Association [NYHA] IV) and left ventricle ejection fraction (LVEF) <45% were hospitalized for clinical compensation and followed-up for one year after discharge. The patients were distributed into two groups: 46 in the treatment group (TG) and 46 in the control group (CG). During hospitalization, they were divided randomly for BB rapid up-titration with an increase of dosage every two days (TG), or by the usual treatment regime (CG). Statistical analysis used: Student’s t-test, Mann-Whitney, Chi-square and Fisher’s exact test, Kaplan-Meier for survival, using the Log-rank test for comparison and the hazard ratio (HR) calculated with the Cox model. P < 0.05 was considered significant. The pcts responded to the questions of the MLHFQ. This battery of 21 items uses a scale for answers from (0–5). Total compilation of scores varied from 0 to 105. A lower score reflects a better QOL. Among the total group of 92 patients studied, initially, LVEF average was 27.02%, end-diastolic diameter average was 66.15 mm, and end-systolic diameter average was 57.04 mm. For the TG, the average dosage of Carvedilol reached 34.37 mg/per day; and with the CG, 13.99 mg/per day. In the initial evaluation, the pcts showed an average score of 82 points in the two separate groups evaluated. With treatment, the TG moved to a score of 63, while the CG scored 73. There was a reduction of 23% in the MLHFQ score for the TG in relation to the CG group (p < 0,001).
Conclusions: Beta blockers rapid optimization dosages during hospitalization of end-stage HF patients is safe and promotes an enhanced patterns of QOL as measured by MLHFQ, indicating that more elevated dosages of BB is probably responsible for this positive outcome than that observed with a usual treatment schedule.
111747
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
ANDRE SCHMIDT1, Maria Fernanda Braggion-Santos1, Marcel Koenigham Santos1, Gustavo Jardim Volpe1, Henrique Turin Moreira1, José Antonio Marin-Neto1
(1) Faculdade de Medicina de Ribeirão Preto – USP
Introduction: Myocardial fibrosis (MF) identified in Cardiac Magnetic Resonance (CMR) is a recognized prognostic marker in Chronic Chagas Cardiomyopathy (CCC). Since CMR is not widely available, it seems relevant to identify markers of MF in other methods that may indicate the need for a CMR in this neglected disease.
Objective: We sought to investigate the relationships between the presence of ventricular premature beats (VPB) in an Electrocardiogram (ECG), Non-sustained ventricular tachycardia (NSVT) on a Holter exam, and the presence of MF at CMR.
Methods: Consecutive CCC patients with an ECG, Holter, and CMR within one year were selected from our institution database, and the presence of VPB on ECG, NSVT on Holter, and MF on CMR were collected, as well as demographic and clinical data. Descriptive statistics, Fisher exact tests, and logistic regression analysis were performed. A 5% level of significance was established.
Results: Inclusion criteria were fulfilled by 121 patients, 53% females, 56 ± 14 years, and most (93%) were in NYHA class I or II. The mean left ventricular ejection fraction was 48 ± 14%. Amiodarone was used by 22 (18%) patients at the physician’s discretion. Twenty-three (19%) patients resting ECG presented VPBs, and 38 (31%) patients had NSVT on Holter. MF was identified in 94 (78%) CCC patients. Concomitant occurrence of VPBs on ECG and NSVT on Holter in the same patient was low (12%) but MF was present in all of those with both VPB and NSVT. VPBs in ECG indicated an odds ratio (OR) of 7.9 (CI: 1.02–61.9; P = 0.04) of having MF, as 22 (96%) out of 23 with VPB had it. NSVT on Holter presented an OR of 16.9 (CI: 2.2–129.8; p = 0.007) as 37 (97%) out of 38 patients with NSVT had MF on CMR. Amiodarone use did not significantly (p > 0.05) influence the results of each exam to predict MF.
Conclusions: Electrocardiogram and Holter may present findings indicating MF occurrence in CCC. Although rare in resting ECGs, VPB significantly increases the odds of finding MF. The presence of NSVT has a much higher chance of finding MF in a CMR exam. These findings may indicate a subgroup of CCC patients that should be followed closely due to the possible presence of myocardial fibrosis.
111933
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
ALTAIR ARGENTINO PEREIRA JUNIOR1, Ana Inês Gonzales2, Darlene Aparecida Pena1, Tales de Carvalho3, Alexandro Andrade3, Sabrina Weiss Sties1
(1) Centro Universitário Avantis – UNIAVAN; (2) Centro Universitário para o desenvolvimento do Alto Vale do Itajaí – UNIDAVI; (3) Universidade do estado de Santa Catarina – UDESC
Introduction: In the context of cardiac rehabilitaion, the practice of regular physical exercises is considered a mandatory therapeutic strategy, since it significantly reduces the morbidity and mortality of patients with heart disease. However, especially in individuals with low exercise tolerance, the overtraining syndrome could occur.
Objective: Evaluate the presence of signs of overtraining syndrome in patients with coronary artery disease undergoing cardiac rehabilitation.
Methods: Seventy-seven adults participated in the cardiac rehabilitation program were analized. For early detection of overtraining syndrome was used the Brunel Mood Scale. Data were evaluated by descriptive statistics.
Results: In this study, the prevalence of overtraining syndrome among patients with coronary artery disease was 11.68%. The tension domain score was 4.44 (±3.25), depression 4.22 (±3.07), anger 0.78 (±1.09), fatigue 4.89 (±3.52) and mental confusion 3.33 (±2.87) were high, while the vigor domain (9.67 ± 3.24) was low, indicating signs of overtraining syndrome.
Conclusion: Some patients with coronary artery disease showed signs of overtraining syndrome. Taken together, these results indicate this target population requires attention to the need for adopt strategies aiming at preventive measures.
111935
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
RAFAEL MODESTO FERNANDES3, Rafael Modesto Fernandes3, Andre Moises de Oliveira Nunes5, Hayala Machado Cavalcante Conceição5, Loren Lacerda Rodrigues5, David Le Bihan4, Andrea A. Vilela1, Rodrigo B. M. Barretto2, Elizabete S. Santos1, Amanda G. M. R. Sousa1, Ari Timerman1
(1) Dante Pazzanese Institute of Cardiology, São Paulo, Brazil; (2) Instituto do Coração (INCOR), University of São Paulo, Brazil; (3) D’Or Institute for Research and Education (IDOR), Hospital Aliança, Salvador, Brazil; (4) Grupo Fleury – São Paulo; (5) Bahiana School of Medicine and Public Health, Salvador, Brazil.
Background: The analysis of left atrial (LA) function can add important information to the understanding of cardiovascular diseases. Therefore, to assess its functioning the use of volumetric measurements is adopted. The maximum LA volume is the most echocardiography parameter used, however, some studies demonstrated that minimum LA volume is better to correlate with atrial dysfunction.
Purpose: The purpose of this study was compare the accuracy of the phasic volumes of the left atrium in determining LA dysfunction identified by the two-dimensional strain.
Methods: This observational, cross-sectional study admitted 109 participants with diagnosis of acute coronary syndrome non-ST-segment elevation. The exams were performed within 72 hours of admission. LA volume was defined by the mean of measurements performed in the four and two-chamber apical windows using Simpson’s method. The phasic volumes of the left atrium were measured using an electrocardiogram synchronized with the device. Reservoir LA strain less than 21% was the cut off to LA dysfunction.
Results: The phasic LA volume variables analyzed were maximal (LAVMAX), minimal (LAVMIN) and before atrial contraction (LAVBAC) volume, and each variable indexed for body surface (LAVIMAX, LAVIMIN and LAVIBAC). Therefore, a Roc curve was generated for each volume variable to assess which would be more accurate in predicting left atrial dysfunction. The Youden index was used to determine the cutoff point for each one of them. The areas under the Roc curves were: 0.83 (LAVIMIN), 0.81 (LAVMIN), 0.78 (LAVBAC), 0.76 (LAVIMAX), 0.74 (LAVIBAC) and 0.71 (LAVMAX).
Conclusion: This study concluded that phasic volumes were good determinants of left atrial dysfunction identified by 2D strain. The minimum left atrial volume was the better correlated with left atrial dysfunction.
111782
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
INGRID LOUREIRO DE QUEIROZ LIMA1, THIAGO CAVALCANTE1, LUIZ CARLOS DE LIMA1, FERNANDO LUIZ WESTPHAL1
(1) UNIVERSIDADE FEDERAL DO AMAZONAS; (2) HOSPITAL DO CORAÇÃO FRANCISCA MENDES
Background: Troponin T (TnT) and troponin I (TnI) are myocardium necrosis biomarkers very sensible and specific used to evaluate a myocardial injury, and their rise after coronary angioplasty correlate with worst prognoses. Complications associated with this procedure are a well-recognized cause of elevated myocardial necrosis biomarkers. In its absence, the exact causes of elevated troponin are merely speculative.
Objective: To evaluate the relationship between troponin elevation and clinical and anatomical variables after coronary angioplasty in the absence of complications.
Method: It is an epidemiological study evaluating 124 patients submitted to coronary angioplasty from December 2018 to December 2019 in the catheter laboratory of University Hospital Francisca Mendes, using clinical variables and troponin doses before, 6 hours and 12 hours after the procedure.
Results: Of all 124 analyzed patients, 63,3% were male and mean age of 63 years old. The mean implanted stents per patients was 1,66. Hypertension was the most prevalent comorbidity. Eighty patients (64,5%) presented high troponin dosage (compared to 99th percentile) and 32 (25,8%) showed troponin dosage above five times the 99th percentile. When analyzing all patients presenting troponin dosage above 99th percentile, none of the clinical characteristics were significantly related to troponin alteration. While analyzing procedure-related characteristics, we observed that troponin elevation above 99th percentile is significantly correlate with the number of implanted stents, the number of treated arteries (p < 0,001 and p = 0,046 respectively), procedure duration (p = 0,032), and contrast media volume (p = 0,008). The number of implanted stents and number of treated arteries were still associated with troponin elevation above five times the 99th percentile.
Conclusion: Clinical characteristics were not associated with troponin elevation above the 99th percentile. However, the procedure duration, contrast media volume, number of treated arteries, and number of stents implanted are significantly associated with troponin elevation when studying the procedure characteristics. Amongst the subgroup of patients with troponin levels above five times the percentile, clinical history of smoking, the number of implanted stents and stent length were significantly associated with the elevation of this biomarker above five times the 99th percentile.
111805
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
GABRIEL ASSIS LOPES DO CARMO1, Bárbara Carolina Silva Almeida1, Gabriela Zamunaro Lopes Ruiz1, Renato Braulio1, Ana Cristina Carioca1, Fábio Morato Castilho1, Cláudio Leo Gelape1, Bruno Rodrigues Pereira1, Luiza Moreira Gomes1, Ana Carolina Sudário Leite1
(1) Universidade Federal de Minas Gerais (UFMG)
Introduction: Rheumatic valve disease (RVD) has a high prevalence in Brazil, but remain poorly studied. Different from developed countries, valvar cardiac surgeries are the most performed procedure in several public hospitals in Brazil. However, impact of RVD on cardiac surgery is not well established.
Objective: Describe baseline characteristics and prognosis of cardiac valve surgery patients in a public hospital in Brazil.
Methodology: Prospective cohort analysis of cardiac surgery patients between 2016 and 2021, excluding heart transplant.
Results: We enrolled 416 patients in the study, median age 57 (47;67) and 377 (49,8%) females. Overall, 287 (69,2%) procedures were elective, while 115 (27,7%) were urgent and 13 (3,1%) emergencies. Most procedures, 330 (79,3%), were isolated valve surgery, followed by combined valve and coronary artery bypass surgery (CABG), 36 (8,6%), valve and aorta, 19 (4,6%), valve and congenital, 8 (1,9%), valve, CABG and aorta, 2 (0,5%), and valve plus other cardiac surgery in 21 (5,1%). 147 (23,3%) had previous cardiac surgery. Diabetes was present in 69 (16,6%), 47 (11,3%) non-insulin dependent and 22 (5,3) insulin dependent. 25 (6%) had a history of previous myocardial infarction, 40 (9,6%) had stroke, 21 (5%) chronic pulmonary disease, 141 (43,9%) atrial fibrillation, 143 (44%) had rheumatic valve disease and 8 (1,9%) were on renal replacement therapy. Heart failure was diagnosed in 303 (73,5%) and 50 (12,1%) had a NYHA IV classification. Median ejection fraction was 63% (55;68), PSAP was 42 (31;55) and creatinine 0,98 (0,8;1,15). Observed in-hospital mortality was 13,0%. Univariate analysis showed that age, 67 (56;74) vs 56 (46;66), p = 0,002, endocarditis, 14 (30,4%) vs 40 (10,8%), OR = 3,60 (1,77–7,31), p < 0,001, mitral replacement plus tricuspid repair, 18 (23,4%) vs 26 (11,6%), OR = 2,34 (1,18–4,63), p = 0,013, and non-elective procedures, 27 (21,1%) vs 27 (9,4%), OR = 2,57 (1,44–4,60), p = 0,001 were related to increased mortality. Rheumatic etiology was a protective factor, 17 (9,3%) vs 37 (15,9%), OR = 0,54 (0,29–0,99), p = 0,045. In multivariate analysis, only age, OR = 1,058 (1,025–1,091), p = 0,001, endocarditis, OR = 4,51 (1,717–11,855), p = 0,002, and mitral replacement plus tricuspid repair, OR = 2,903 (1,325–6,362), p = 0,008, remained statistically relevant.
Conclusion: Our study shows that older age, endocarditis and mitral replacement combined with tricuspid repair are associated with increased mortality after cardiac valve surgery.
111816
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR INTENSIVE CARE/CARDIOVASCULAR EMERGENCIES
JOSÉ EDIVALDO DOS SANTOS1, José Victor Furtado Jacó de Oliveira2, Maria Letícia de França Oliveira2, Rafael Alexandre Meneguz-Moreno2
(1) Hospital de Urgências de Sergipe; (2) Universidade Federal de Sergipe – Campus Lagarto
Introduction: The implementation of Telecardiology (TCL) in the state of Sergipe, Brazil, is a viable, promising and innovative strategy. Regarding specifically STEMI (ST-elevation myocardial infarction), it is known that mortality is directly proportional to the first medical contact to balloon time. The objective of the study is to evaluate data regarding patients with STEMI regulated by TCL service in Sergipe and referred to a tertiary hospital.
Methods: This is a cross-sectional, retrospective, descriptive study, reporting data from June 2021 to April 2022 involving TCL service. Data were collected from electronic medical records, through the e-SUS program.
Results: The resulting analysis population included 444 patients presented with STEMI during 11 months, being 288 (65%) male, mean age 61 years old, ranging from 27 to 102 years. Patient had previous hypertension (55%), diabetes mellitus type 2 (32%), dyslipidemia (12,8%), smoking (12,8%), previous coronary artery disease (5,6%), obesity (4,0%) and 68 (15,3%) reported no comorbidities. From all patients presented with STEMI during the analyzed period, 294 (66,2%) patients were referred to immediate PCI (percutaneous coronary intervention), 51 (11,4%) had been submitted to thrombolytic (TB) therapy, and 99 (22,2%) were not treated with reperfusion therapy within 12 hours of symptoms onset, yet 47 (47,4%) from these 99 patients were referred to urgent coronary angiography after TCL cardiologists evaluation. Among TB group, 32 (62,7%) patients were referred to a CICU (Coronary Intensive Care Unit) immediately after reperfusion, 2 (4%) were referred to rescue PCI and 17 (33,3%) have not been transported. The reasons for choosing TB therapy were, as follows, long distance (21), no transport available (6), no CICU vacancy (6), choice of attending physician (5) and not informed (13). There were 22 (5%) deaths among all patients, 4 from PCI group, 4 from TB group and 14 from the other group.
Conclusion: At the beginning of TCL service in Sergipe, there were some patients that still have no access to PCI. However, with the consolidation of TCL, this flowchart was reorganized and since October 2021, there was no lack of vacancy. Therefore, TCL has improved the quality of STEMI care in the state of Sergipe (northeast Brazil). Strategies must still be implemented to increase PCI rates, such as improvement on medical education, in order to recognize symptom and trigger the TCL service more quickly.
111830
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
GABRIEL ASSIS LOPES DO CARMO1, Bárbara Carolina Silva Almeida1, Gabriela Zamunaro Lopes Ruiz1, Renato Braulio1, Ana Cristina Carioca1, Fábio Morato Castilho1, Cláudio Leo Gelape1, Bruno Rodrigues Pereira1, Luiza Moreira Gomes1, Ana Carolina Sudário Leite1
(1) Universidade Federal de Minas Gerais (UFMG)
Introduction: Knowing baseline clinical information is important to compare results between different institutions. Brazil has a particular socioeconomic scenario and disease profile that make users of public health system (SUS) unique.
Objective: Describe baseline characteristics and prognosis of cardiac surgery patients in a public hospital in Brazil.
Methodology: Prospective cohort analysis of cardiac surgery patients between 2016 and 2021, excluding heart transplant.
Results: We enrolled 633 patients, median age 58 (48;67) and 377 (49,8%) females. Most procedures, 406 (64,1%), were elective, followed by urgent, 109 (31,4%), and emergent, 28 (4,4%). Most surgeries were valvar, 416 (65,5%) followed by coronary artery bypass surgery (CABG), 188 (29,6%), aorta, 43 (6,8%), congenital heart disease, 33 (5,2%), and other surgeries, 50 (7,9%). 147 (23,3%) had previous cardiac surgery. Diabetes was present in 133 (20,9%), 88 (13,9%) non-insulin and 45 (7,1) insulin dependent, myocardial infarction in 76 (12%), stroke in 59 (9,3), chronic pulmonary disease in 29 (4,6%), atrial fibrillation in 150 (23,6%), rheumatic valve disease in 134 (21,1%) and 13 (2%) were on renal replacement therapy. Heart failure was diagnosed in 370 (58,9%) and 56 (8,8%) had a NYHA IV classification. Median ejection fraction was 62% (54;68), PSAP was 38 (29;51) and creatinine, 0,97 (0,8;1,18). Mean and median EUROSCORE II were 3,978 (±6,591) and 1,8 (0,990;4,020), respectively. Observed in-hospital mortality was 13,3%.
Conclusion: Our results show a much higher than predicted mortality according to EUROSCORE II. However, our population has some important differences from that evaluated in EUROSCORE II study, especially a higher prevalence of rheumatic valve disease. Also, more commonly patients were operated on an urgent basis. Our population had more similarities with the InsCor Risk Assessment study performed in Brazil, which found a general mortality of 8,9%, but included only CABG and valve surgeries. Due to these specific baseline characteristics, local developed score would be more appropriate while evaluating cardiac surgery candidates in Brazil.
111860
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
MARCELO CARVALHO VIEIRA1, Fernanda de Souza Nogueira Sardinha Mendes1, Paula Simplício da Silva1, Gilberto Marcelo Sperandio da Silva1, Flavia Mazzoli-Rocha1, Andrea Silvestre de Sousa1, Roberto Magalhães Saraiva1, Vitor Barreto Paravidino2, Luiz Fernando Rodrigues Junior3, Alejandro Marcel Hasslocher-Moreno1, Pedro Emmanuel Alvarenga Americano do Brasil1, Mauro Felippe Felix Mediano1
(1) Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.; (2) Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; (3) Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
Introduction: The association between functional capacity and quality of life (QoL) in individuals with chronic Chagas cardiomyopathy (CCC) is still poorly investigated, with the few studies including indirect measures of functional capacity, limiting the validity and the interpretation of the results.
Objective: The present study aimed to evaluate the association between functional capacity (quantified by cardiopulmonary exercise test [CPET]) and QoL in individuals with CCC.
Methods: A cross-sectional analysis using baseline data from PEACH study, a randomized clinical trial that evaluated the effects of exercise training in patients with CCC, was performed. QoL was assessed using the SF-36 questionnaire. Sociodemographic, anthropometric, clinical, cardiac function and maximal progressive CPET variables were retrieved from PEACH study dataset. Generalized linear models adjusted for age, sex, and left ventricular ejection fraction were performed to evaluate the association between CPET variables and QoL.
Results: After adjustments for potential confounders, VO2peak and VO2AT were both positively associated with physical functioning and physical component summary (PCS). Double product was positively associated with physical functioning, general health perceptions, and PCS, whilst heart rate recovery <12bpm at the first minute (HRR) was negatively associated with physical functioning, role limitations due to physical problems, bodily pain, and PCS. VE/VCO2 slope presented a negative association with all mental scales of SF-36: vitality, social functioning, role limitations due to emotional problems, mental health, and mental component summary. HRR <12bpm was negatively associated with vitality and mental health. Double product was positively associated with vitality. The CPET variables that most explained the QoL variation in the adjusted models were VO2AT (50% for physical functioning and 36% for PCS), VO2peak (31% for physical functioning and 21% for PCS), VE/VCO2 slope (45% for mental health and 31% for mental component summary), and HRR < 12 bpm (20% for vitality).
Conclusions: The association between CPET variables and QoL reinforces the importance of CPET inclusion for a more comprehensive evaluation of individuals with CCC. Intervention strategies aiming to improve functional capacity may also promote additional benefits on QoL and should be incorporated as a treatment strategy for patients with CCC.
111901
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOLOGY OF SPORTS, EXERCISE, ERGOMETRY AND CARDIOVASCULAR REHABILITATION
MARCELO CARVALHO VIEIRA1, Fernanda de Souza Nogueira Sardinha Mendes1, Paula Simplício da Silva1, Gilberto Marcelo Sperandio da Silva1, Flavia Mazzoli-Rocha1, Andrea Silvestre de Sousa1, Roberto Magalhães Saraiva1, Fernanda Martins Carneiro1, Luiz Fernando Rodrigues Junior2, Alejandro Marcel Hasslocher-Moreno1, Pedro Emmanuel Alvarenga Americano do Brasil1, Mauro Felippe Felix Mediano1
(1) Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.; (2) Department of Research and Education, National Institute of Cardiology, Rio de Janeiro, RJ, Brazil
Introduction: Physical exercise has been described as an efficient and safe strategy to improve quality of life (QoL) in heart failure (HF). However, there is a lack of information about its influence on the QoL of patients with chronic Chagas cardiomyopathy (CCC).
Objective: The present study aimed to investigate the effect of physical exercise training on the QoL of patients with CCC.
Methods: PEACH study was a single center, superiority randomized parallel-group clinical trial of exercise training versus a control group with no exercise training. The sample comprised Chagas disease patients with CCC, left ventricular ejection fraction <45% or HF symptoms (CCC stages B2 or C). QoL was assessed at baseline, after three months, and at the end of follow-up (six months) using SF-36 questionnaire. Patients randomized for the intervention group performed physical exercise (aerobic exercise, strength training and stretching exercises) for 60 minutes, three times a week, for a period of six months. Patients in the control group were not provided with a formal exercise prescription. During the study, patients from both groups underwent monthly appointments with the same cardiologist, and with other specialists, if necessary. In addition, patients in both groups received identical nutritional and pharmaceutical counseling during the study. Longitudinal analysis of the effects of physical training on QoL, considering the interaction term (group × time) to estimate the rate of changes between groups in the outcomes (represented as beta coefficient), was performed using mixed linear models. Analyses were adjusted to the baseline QoL values.
Results: There were significant improvements in physical functioning (β = +10.7; p = 0.02), role limitations due to physical problems (β = +25.0; p = 0.01) and social functioning (β = +19.2; p < 0.01) scales during the first three months in the exercise group compared to control group. No significant differences were observed between groups after six months of follow-up.
Conclusion: Exercise training was associated with short-term improvements in physical and social aspects of QoL and should be incorporated as a treatment strategy for patients with CCC.
111898
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
BRÁULIO CRUZ MELO1, Larissa Rebeca da Silva Tavares1, Irlaneide da Silva Tavares3, Antônio Guilherme Cunha de Almeida1, Antônio Carlos Sobral Sousa2, João Vitor Andrade Pimentel2, Emerson de Santana Santos2, Enaldo Vieira de Melo2, Giovanna Medeiros Resende1, Evelen Rouse de Souza Santos1, Diego Henrique da Silva Tavares1, Joselina Luzia Menezes Oliveira2
(1) Universidade Tiradentes; (2) Universidade Federal de Sergipe; (3) Hospital Primavera
Introduction: Hypertrophic Cardiomyopathy (CMH) is the most common genetic disease in the world, and can lead their carriers to death, therefore making it’s correct diagnosis fundamental, along with the follow-up and genetic counseling of patients and their family.
Methods: This is a cross-sectional, prospective and analytical study, with patients diagnosed with CMH in Sergipe between January 2021 and April 2022, being also subjected to genetic study.
Objective: To describe the patient population under CMH investigation.
Results: 80 patients were studied, 49 (61%) being of male gender, with the average age of 49. MRI was performed in 50 patients and positive for CMH in 45 (90%); 71 patients have resting echocardiogram, 60 of which cover CMH criteria. The most relevant echocardiographic variant for CMH is septal thickness, with an average of 15,5 mm on echocardiogram and 16,5 on MRI. It’s obstructive form was present at the MRI in 20% of the cases (10 patients), ischemia in 18 (39% in the septal wall), and fibrosis in 40 patients (80%). The doppler echocardiogram under physiological stress was performed in 21 patients, 11 on the treadmill, 2 on the bicycle and 6 on both methods which made possible the identification of 7 individuals with labile obstructive form. Finally, in the genetic study, the most found genes were MYBPC3 and MYH7 (28 and 12%, respectively), in agreement with whats already described in literature, in addition to 30% of cases being identified as phenocopies.
Conclusion: The CMH can appear more frequently than expected and present variable expressiveness and penetration. Ocasionally, phenocopies and dislead it’s diagnosis. The echocardiographic evaluation under physiological stress can identify higher risk individuals (labile obstructive CMH).
111910
Modality: E-Poster Researcher – Non-case Report
Category: NEGLECTED CARDIOVASCULAR DISEASES
ANDRE SCHMIDT1, Maria Fernanda Braggion-Santos1, Marcel Koenigkam Santos1, Gustavo Jardim Volpe1, Henrique Turin Moreira1, José Antonio Marin-Neto1
(1) Faculdade de Medicina de Ribeirão Preto – USP
Background: Chronic Chagas’ cardiomyopathy (CCC) is a consequence of several insults resulting in myocardial fibrosis (MF). Detection of MF is possible noninvasively through cardiac magnetic resonance (CMR). However, it is an expensive and not widely available method.
Objective: This study aims to correlate ECG Selvester score (or QRS score) with quantification of MF and left ventricular ejection fraction (LVEF) through CMR analysis, in patients with CCC.
Methods: Retrospective analysis of ECG and CMR exams, performed within one year of 194 patients with CCC. Rassi score was evaluated in 171 patients. Continuous variables were presented as median and interquartile range (IQR)and categorical data were summarized as percentages. Spearman’s rank correlation coefficient was used to evaluate the correlation between estimated MF by QRS score and quantified MF by CMR, and LVEF. Bland-Altman plot was applied to compare percentage of MF estimated by QRS score and measured by CMR. Patients were divided into tertiles based on QRS score values and Kruskal-Wallis test was applied to compare MF and LVEF among the groups. Receiver Operating Characteristic curves (ROCcurve) were generated to define cut-off values with the best accuracy to identify MF >= 10% of left ventricular mass, MF >= 12.3 g, LVEF < 50%, or LVEF < 35%. According to Rassi score classification, patients were separated in 3 risk groups, and QRS scores were evaluated by the Kruskal-Wallis test. P < 0.05 was considered statistically significant.
Results: A total of 98 participants were women. Median age was 56 years(IQR: 44–67). Correlation between QRS score and MF by CMR was moderate (r = 0.45,p < 0.001), as well as the negative correlation between QRS score and LVEF (r = –0.42, p < 0.001). Bland-Altman plot showed worse agreement between methods for higher values of QRS score, and a trend to overestimate percentage of MF. QRS score >= 5 was correlated to MF >= 12.3 g, MF >= 10% of left ventricular mass, and LVEF < 50%. QRS score >= 6 was associated to LVEF < 35% with good specificity. Patients classified as high risk by Rassi score had a median QRS score of 5 points (IQR: 3–9).
Conclusion: Higher QRS score in CCC had a moderate correlation with higher burden of MF and worse LVEF. QRS score values tend to overestimate percentage of MF, whereas lower values of QRS seem to have a better correlation with CMR. Selvester scores above 5 or 6 points are associated with more LV impairment, and potentially related to worse outcomes.
111923
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
GABRIEL ASSIS LOPES DO CARMO1, Bárbara Carolina Silva Almeida1, Gabriela Zamunaro Lopes Ruiz1, Renato Braulio1, Ana Cristina Carioca1, Fábio Morato Castilho1, Cláudio Leo Gelape1, Bruno Rodrigues Pereira1, Luiza Moreira Gomes1, Ana Carolina Sudário Leite1
(1) Universidade Federal de Minas Gerais (UFMG)
Introduction: Neurological complications after heart surgeries are relatively frequent. Status epilepticus (SE) is particularly relevant due to its association with increased mortality. However, little is known about its pathogenesis and risk factors.
Objectives: To evaluate the incidence of SE and identify its predictors after heart transplant.
Methods: Prospect cohort of patients referred to heart transplantation in a university health facility in Brazil.
Results: Between April of 2014 and November of 2021, 211 patients were referred to heart transplantation, median age 51 (40;58) and 73 (34,4%) females. In the early postoperative period, 28 (13.27%) patients had SE. Univariate analysis showed that INTERMACS 1 or 2 profile, OR = 4,88 (2,03–11,71), p < 0.001, and cardiorenal syndrome on renal replacement therapy (RRT), OR = 3,87 (1,59–9,39), p = 0.009, were associated with SE. Multivaltivariate analysis showed that only the INTERMACS 1 or 2 classification remained associated with SE, OR 3.88 (CI = 1.43–10.51), p = 0.008. The Hosmer-Lemeshow test had a value of p = 1.000. The occurrence of SE was not associated with increased mortality, OR 1.65 (CI = 0.61–4.45), p = 0.393.
Conclusion: The occurrence of SE was only correlated with the INTERMACS 1 and 2 profile, a well know critical hemodynamic state with low cardiac output (CO). SE may be related to sudden increase in CO after cardiac transplantation, leading to an imbalance in cerebral blood flow. In the present analysis, SE was not correlated with higher mortality, possibly due to the small sample size.
111961
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
MARIA CATARINA DE MELO DIAS GUERRA1, Augusto Hiroshi Uchida1, José Antônio Franchini Ramires1, Eduardo Cavalcanti Lapa dos Santos1, Renata Ávila Cintra1, Jürgen Beuther1, Nevelton Heringer Filho1, Tiago Augusto Magalhães1, William Azem Chalela1, Guilherme Garcia1, Leonardo Filipe Benedeti Marinucci1, Carlos Eduardo Rochitte1
(1) Instituto do Coração (InCor – FMUSP)
Introduction: Myocardial infarction (MI) size is a key predictor of prognosis in post-MI patients. Cardiovascular magnetic resonance (CMR) is the gold standard test for MI quantification but is still limited due to restricted availability in daily routine. Previous studies have documented the capability of different electrocardiogram (ECG) markers for prognosis assessment soon after ST elevation myocardial infarction. Selvester QRS scoring detects scar, although the reported performance varies. A simplified version of this score showed comparable predictive value for infarct size in a prospective study including 201 patients at a median of 2 days after a revascularized MI (area under the curve = 0.64 vs. 0.67).
Methods: Retrospective, observational, single-center study. The sample was obtained through analysis of medical records with a record of clinical diagnosis of MI who underwent CMR to assess myocardial viability. Those who did not present delayed enhancement with an ischemic pattern on CMR and those whose CMR revealed a diagnosis other than MI or did not have satisfactory image quality were excluded. Patients reporting a new acute coronary syndrome in the interval between the available ECG and the CMR were also excluded. The ECG performed 7 days after the infarction and with a maximum interval of 1 year from the CMR were analysed by an evaluator with extensive experience in electrocardiography.
Results: The mean age of patients was 61.3 years and 75% were men. Conventional infarction identification through the presence of a pathological Q wave occurred in 172 of the 245 patients included (70.2%). In the subgroup of 192 patients in which CMR was already analyzed, the median modified Selvester score was 5 and the fibrosis mass was 23.2% ± 11.3 of the left ventricular mass. There was no statistically significant correlation between the modified Selvester score and fibrosis mass on CMR.
Conclusions: After seven days of acute coronary syndrome, the modified Selvester score was not a predictor of fibrosis mass. This correlation had been previously described in smaller studies that evaluated this score at admission of acute MI. Intraventricular conduction disorders and ventricular hypertrophy are factors that may impact the correlation between the Selvester score and fibrosis mass.
111962
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
GABRIEL ASSIS LOPES DO CARMO1, Bárbara Carolina Silva Almeida1, Gabriela Zamunaro Lopes Ruiz1, Renato Braulio1, Ana Cristina Carioca1, Fábio Morato Castilho1, Cláudio Leo Gelape1, Bruno Rodrigues Pereira1, Luiza Moreira Gomes1, Ana Carolina Sudário Leite1
(1) Universidade Federal de Minas Gerais (UFMG)
Introduction: The Society for Cardiac Angiography and Interventions (SCAI) shock classification was published in 2019, but not yet validated in patients referred to heart transplant.
Objectives: To evaluate the association between different groups of the SCAI shock classification and the occurrence of death among patients undergoing heart transplant.
Methods: Prospect cohort of patients referred to heart transplant in a university health facility in Brazil.
Results: Between April 2014 and November 2021, 211 patients underwent heart transplantation, median age 51 (40;58) and 73 (34.4%) females. Baseline population characteristics were similar among the 5 different groups of the SCAI classification, with the exception of insulin-requiring diabetes mellitus (15.1%, 21.4%, 1.5%, 8.3% and 5.6%, p = 0.038), use of intra-aortic balloon prior to surgery (0.0, 4.6%, 20.0%, 55.6%, p < 0.001), days of hospitalization before surgery [0 (0;0); 1.5 (0;22); 30(15;59); 30(15;60); 39 (27;44)], platelet count [191000 (159250;246500); 214500 (172500;287500);221000 (176000;285500); 191000 (146000;250000); 184500 (139500;252500)] and RNI [1.51 (1.22; 2.39); 3.07 (1.65; 4.51); 1.46 (1.23; 2.37); 1.30 (1.12; 1.55) and 1.34 (1.18; 1.65)] respectively for groups A, B, C, D and E. Death occurred in 4 (7,4%) patients in group A, 2 (14,3) in group B, 4 (6,2) in group C, 15 (25,0%) in group D and 7 (38,9%). Compared to group A, patients in classification B had OR 2.083 (0.341–12.733), p = 0.595, those in group C OR 0.820 (0.195–3.444), p = 1.000, group D OR 4.167 (1.288–13.481), p = 0.012 and group E 7.955 (1.979–31.972), p = 0.004, for death. The ROC curve for the SCAI rating was 0.695 (0.590–0.799). Patients classified as D or E had an OR 4.832 (2.146–10.879), p < 0.001. Multivariate logistic regression analysis showed that group D or E classification was the only variable associated with mortality, OR 4.028 (1.397–11.610), p = 0.010.
Conclusion: SCAI shock classification D or E was associated with increased risk of death after heart transplantation. The model had a limited capacity of discrimination, probably due to similar risk of death in groups A, B and C.
111972
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ANA CAROLINA MICHELETTI GOMIDE NOGUEIRA DE SÁ1, Elton Junio Sady Prates2, Deborah Carvalho Malta1
(1) Nursing Post Graduate Program. Nursing school, Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil.; (2) School of Nursing at the Federal University of Minas Gerais (UFMG). Belo Horizonte, MG, Brazil.
Introduction: Cardiovascular diseases (CVD) are the main cause of morbidity and mortality in the world and in Brazil and are caused by unhealthy lifestyles, genetic factors, social and health inequalities. These diseases cause disability and loss of quality of life. Consequently, this situation exacerbates the social and economic burden for society, governments and health services. Evidence has identified that physical inactivity is associated with increased coronary risk. However, there are still scientific gaps about the association of leisure-time physical activity (LPA) and cardiovascular risk in Brazil, even in view of the magnitude of CVD. The National Health Survey (PNS) performed laboratory tests and blood pressure (BP) measurements, thus, it was possible to explore, in an unprecedented way, the effect of AFL practice on cardiovascular risk in a representative sample of Brazilian adults.
Objective: To analyze the association between AFL practice and cardiovascular risk in Brazilian adults.
Methods: Cross-sectional study, with data from the PNS, between 2014–2015, in 8,952 adults. Prevalence and 95% confidence intervals were estimated for the practice of LPA stratified by sex, according to the Framingham risk score and its components. It was defined as sufficient AFL, the practice ≥150 minutes per week of light or moderate intensity or 75 minutes per week of vigorous intensity. The risk score was classified as low, medium and high. Differences were evaluated using the chi-square test or analysis of variance (p ≤ 0.05).
Results: The highest prevalence of sufficient LPA practice was associated with low cardiovascular risk in men (17.9%; 16.0–20.0) and women (12.0%; 10.9–13.4) (p ≤ 0.05). For risk score components, sufficient AFL prevalence was higher: in men aged 18 to 29 years (10.43%; 8.9–12.1), with high-density lipoprotein (HDL) between 35–44 mg/dL (9.8%; 8.5–11.3), total cholesterol (TC) between 160–190 mg/dL (11.2%; 9.8–12.8), untreated BP < 120 mmHg (11.4%; 9.9–13.1), who do not have diabetes (25.5%; 23.6–27.6) and are non-smokers (23.3; 21.4–25.3); and in women with HDL between 50–59 mg/dL (4.43%; 3.8–5.2), untreated BP < 120 mmHg (11.50%; 10.24–12.89) and not are smokers (16.2%; 14.9–17.5) (p ≤ 0.05).
Conclusion: The practice of AFL is associated with a decrease in cardiovascular risk in Brazilian adults. Thus, it is important to encourage the practice of AFL in the country. These results can support CVD prevention actions and policies.
111973
Modality: E-Poster Researcher – Non-case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
SEBASTIÁN DARÍO PERALTA1, Marcelo Omar Bettinotti1, Guillermo Jubany1, Ezequiel José Zaidel1, Luis Murillo1, Juan Grieve Bruno1, Luis Carlos Sztejfman1, Matías Sztejfman1, Carlos Maximiliano Giuliani1, Ramón Gomes Marquez1, Pedro Piccaro de Olivera1, Alexandre Schaan de Quadros1
(1) LATAM CTO registry
Background: The newest techniques for chronic total occlusions (CTO) percutaneous coronary interventions (PCI) may improve technical success.
Purpose: To describe safety and efficacy of ADR (antegrade dissection and reentry) technique as initial revascularization strategy.
Methods: Multicentric registry from Latin American countries. We analyzed baseline characteristics and outcomes of cases using ADR as primary strategy or bailout of antegrade wire escalation (AWE). Retrograde approach cases were excluded.
Results: From 1875 patients analyzed, 50 were planned primary ADR (pADR) and 1825 planned primary AWE (pAWE). pADR was preferred in older patients, with a history of revascularization (CABG: pADR 33.3% and pAWE 13.4%, p < 0,001; PCI: 66.6% and 48.8% respectively, p = 0.012). Longer CTOs (30 mm [22–41] and 21 mm [15–30], p < 0.001), and moderate or severe calcification (62% and 42.6%, p = 0.008) were associated with the selection of pADR instead of pAWE. There was a significant correlation between increasing J-CTO score (Chi2 = 37, df = 5, p < 0.001), and use of pADR. pAWE had a success rate of 88.45%, and pADR of 76.67%. For pAWE and bailout ADR, the use of a dedicated device was related to the highest rates of success (92.31% and 82.69%, respectively). Short term outcomes were similar between groups.
Conclusions: In Latin America, ADR was safe and effective, both as primary or bailout strategy, even when used for higher complexity lesions. The use of dedicated devices was related to a higher success rate.
111999
Modality: E-Poster Researcher – Non-case Report
Category: ACUTE AND CHRONIC CORONARY DISEASE/THROMBOLYSIS
POLLIANNA DE SOUZA RORIZ1, José Victor de Sá Santos3, Murilo Jorge da Silva3, Victor Luis Peixoto Pereira Botelho3, Marcelo Vincenzo Sarno Filho3, Bianca Aparecida Colognese3, Márcio Andrade Barreto Filho4, Rhanniel Theodorus Helhyas Oliveira Shilva Gomes Villar1
(1) Protocolo IAM – SAMU Salvador; (2) Hospital Ana Nery; (3) Universidade Federal da Bahia; (4) Escola Bahiana de Medicina e Saúde Pública
Introduction: An integrated healthcare system plays an important role in ST Elevation Myocardial Infarction (STEMI) assistance. Published data emphasize that the number of hospitalizations, diagnostic and therapeutic procedures performed in STEMI assistance in the pandemic context have decreased.
Objective: Evaluate if there was a change in STEMI care assistance by the Acute Myocardial Infarction Protocol (AMIP) team, as reperfusion strategies and mortality in Salvador’s health public system during the pandemic of Covid 19.
Methods: Ambispective cohort of STEMI patients attended by the AMIP in Salvador. Epidemiologic data, assistance times, reperfusion strategies and intra-hospitalar mortality were compared between pre-pandemic period (jan/2019–feb/2020) and pandemic (march/2020–dec/2021) – groups I and II, respectively. Statistical significance was considered for p < 0.05.
Results: Group I was composed of 542 patients and group II of 932. The mean age and male sex frequency were similar in both groups. There was a higher frequency of hypertension (73.2% × 67.8%, respectively; p = 0.03) and typical A/B pain (91.2% × 85%, respectively; p = 0.01) in group I. Other comorbidities, clinical presentation, Killip and GRACE showed no differences between groups. Controversially, there was no difference in the median symptom-first medical contact time [I–120 (50–270)min × II–123 (60–268.5)min, p = 0.32]. Door-to-ECG time was even shorter in group II [29 (14–70)min] compared to I [35 (16–92.7)min], p = 0.01. There was a shorter door-to-needle time in group II compared to I [111.5 (76–174.8)min × 140 (91.8–202.3)min, respectively; p = 0.002] as well as door-to-balloon time [219 (169.3–317.8)min × 253 (175.8–356.5)min; p = 0.03]. Regarding reperfusion strategies, more patients underwent Percutaneous Coronary Intervention (PCI) in II × I (78.3% vs. 73.5%, p = 0.04), due to a higher frequency of pharmaco-invasive strategy in the second group (II–17.7% × I–3.2%, p < 0.001). There was no difference for primary PCI between groups (57.3% I × 58.8% II; p = 0.64). In-hospital mortality did not differ between the groups (I–17.3%) and (II–16.1%), p = 0.56.
Conclusion: During the pandemic, there was a switch in the reperfusion strategy supported by AMIP in order to offer more room to fibrinolysis. The troubled scenario caused by the COVID-19 pandemic did not have a major impact on mortality of patients with STEMI in Salvador.
112000
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ARN MIGOWSKI ROCHA DOS SANTOS1, Arn Migowski1, Gustavo Tavares Lameiro da Costa1, Helena Cramer Veiga Rey1
(1) Instituto Nacional de Cardiologia (INC)
Introduction: In Brazil, early neonatal mortality is responsible for more than 50% of deaths in the 1st year of life and congenital heart diseases accounts for 40% of malformations. Newborn pulse oximetry screening(POS) test for critical congenital heart defects between 24–48 hours of life is non-invasive, easy-to-perform and highly specific.
Objectives: To estimate the prevalence of POS in Brazil, as well as identify the factors associated with it and the prevalence of positive screening results.
Methods: Prevalence was estimated based on results of the most recent National Health Survey, a nationwide population-based cross-sectional Brazilian study. The adjusted marginal prevalence ratios were estimated from a logistic regression model based on Wilcosky & Chambless approach(R prLogistic package).
Results: The prevalence of POS was 66.3% (95% CI: 65.5–67.1; N = 3,140,023). The screening prevalence in children born in private funded hospitals (PFHs) was higher than in the National Unified Health System (SUS): 78.1% (76.7–79.5) vs 61.1% (60.2–62.1), respectively. Major regions comparison shows important differences. In the North the prevalence in PFHs (64.9%; 59.7–70.1) was lower than in the South (82.5%; 79.4–85.6) and the Southeast (81.5%; 79.3–83.6) and it is even lower when compared with SUS in the North (44.0%;42.4–45.6). An ordinance was published in Aug 2018, allowing SUS to finance after-screening diagnosis to investigate congenital heart diseases, increased the prevalence of screening in SUS: 57.6% (56.2–59.1) before vs 64.6% (63.3–65.9) after the ordinance. Prevalence of positive screening tests was 9.2%(8.9–9.5) in SUS and 7.8% (7.3–8.3) in the PFHs. The proportion of these newborns that underwent complementary exams after screening was lower in SUS than in the PFHs (40.8%; 40.5–41.1 vs 57.2%; 56.7–57.7). In the multivariate model, the main independent predictors of POS were the prevalence of other newborn screening tests, specially the red eye reflex (PR = 2.03; 1.90–2.16) and newborn hearing test (PR = 1.75; 1.64–1.87).
Conclusions: Inequalities were found in the prevalence of screening between major regions, as well as in SUS and PFHs. Government financial incentive has reduced this inequality between public and private, although the percentage of complementary exams after positive screening was also unequal. The main independent predictors of screening prevalence were those related to the organization of health services.
112004
Modality: E-Poster Researcher – Non-case Report
Category: ATHEROSCLEROSIS/CARDIOVASCULAR RISK FACTORS/CARDIOVASCULAR PREVENTION
ANTONIO GABRIELE LAURINAVICIUS1, Antonio Gabriele Laurinavicius1, Alessandra Cristina Vieira1, Julia Luzo Elias Thame1, Rafael Gonçalves Zimmer1, Henrique Marino de Medeiros1, Jorge Tadeu Campos Paixão1, Fernanda Consolim Colombo1, Marcio Gonçalves Sousa1
(1) Instituto Dante Pazzanese de Cardiologia
Introduction: Out-of-Office Measurement of Blood Pressure (BP) is recommended in addition to office BP for the diagnosis and follow-up of hypertensive patients. Ambulatory Blood Pressure Monitoring (ABPM); Home Blood Pressure Monitoring (HBPM); and Self-Monitoring of BP (SMBP) are the currently available options and their indication may vary according to the context. The aim of the present study was to assess how Out-of-Office Measurement of BP takes place in clinical practice and its impact on BP control in a public tertiary outpatient clinic.
Methods: We evaluated 225 consecutive patients seen at a high-complexity public outpatient facility (mean age: 66.7 ± 11.9 years; female: 62.7%). All patients were routinely requested to perform SMBP according to a prespecified institutional protocol. ABPM and HBPM were indicated for selected cases at the discretion of the attending physician. Patient Adherence to Out-of-Office Measurement of BP was labeled into 5 possible categories: a) No Measurement; b) ABPM; c) HBPM; d) Adequate SMBP e) Inadequate SMBP. Patient Adherence was also stratified according to sex, age, number of antihypertensive drugs, schooling, length of follow-up at the facility, comorbidities and availability of BP monitor at home. Rates of BP control were related with Patient Adherence, as well as with the aforementioned variables.
Results: 87.5% of the study population reported having a BP monitor at home. However, adding up the 5 possible categories, adequate Out-of-Office Measurement of BP was available in only 46.7% of the sample (40.9% of the patients did not bring any measurement; 13.8% underwent ABPM; 32.9% adequate SMBP; 12.4% inadequate SMBP; 0% HBPM). Availability of a BP monitor at home (p < 0.001) and the number of antihypertensive drugs in use (p = 0.019) were strongly associated with adherence to SMBP. Prevalence of smoking was 2 folds higher (7.5% vs 3.4%) in those who returned without SMBP. Rate of BP control based on office BP was 42.6% (79.5% of the sample was under ≥3 classes of antihypertensive drugs). Out-of-office BP measurements were not associated with higher rates of BP control (p = 0.377), but allowed to identify a White Coat Effect (WCE) in 1 out of 3 patients with uncontrolled BP according to office BP (WCE prevalence: 29% among uncontrolled patients vs 3.9% among controlled ones.
Conclusions: Out-of-Office Measurement of BP is still an unmet need in the treatment of hypertension.
112035
Modality: E-Poster Researcher – Non-case Report
Category: CARDIO-ONCOLOGY
MONICA DE MORAES CHAVES BECKER1, Gustavo Freitas Alves de Arruda1, Diego Rafael Freitas Berenguer1, Roberto de Oliveira Buril1, Felipe Alves Mourato1, Paulo José de Almeida Filho2, Brivaldo Markman Filho1, Simone Cristina Soares Brandão1
(1) Universidade Federal de Pernambuco; (2) Real Hospital da Beneficência Portuguesa
Introduction: Studies have suggested that the assessment of cardiac 18F-FDG uptake may be an early metabolic marker of cardiotoxicity. Echocardiography is the method of choice for the evaluation and follow-up of patients undergoing chemotherapy (CT) with anthracyclines, especially through the Global Longitudinal Strain (GLS) technique, which would change earlier than the drop of the left ventricular ejection fraction (LVEF) in patients with reduced myocardial performance.
Objective: The objective of this study was to show the cardiac metabolic and functional behavior pre and post-CT with anthracyclines, in patients with lymphoma and to evaluate the relationship between metabolic alteration and cardiac performance.
Methods: 18F-FDG PET-CT and strain echocardiography were prospectively performed before and after CT. On PET-CT, the maximum standardized uptake (SUV) value of 18F-FDG was measured in the interventricular septum (IVS) and aorta – blood pool. An increase above 30% in the uptake of 18F-FDG in the IVS was considered significant. On echocardiography, LVEF and GLS were measured. After CT, patients were divided into two groups according to the drop in GLS ≥15% from baseline. Data were compared pre- and post-CT and between groups.
Results: Twenty-four consecutive patients were selected (mean age 44,5 ± 18 years, 58,3% female and 66,7% with non-Hodgkin’s lymphoma). The mean LVEF did not show significant difference before (63,5% ± 4,6%) and post CT (64,9% ± 4.4%). Subclinical left ventricular dysfunction (GLS drop ≥15%) occurred in seven (29,2%) patients, during or after CT. Significant increase in IVS FDG uptake occurred in 13 (54,2%) patients. The pre-CT median SUV maximun SIV/SUV maximun aorta ratio increased from 0.84 (IQ 0.73–1.01) to 1.06 (IQ 0.84–1.93) after CT, p = 0.02. However, when we compared this relationship between the groups, there was no significant difference.
Conclusions: In this casuistic, we did not observe a significant reduction in LVEF after chemotherapy. However, about 29% of patients presented a decrease in cardiac performance assessed by the strain echocardiography and more than half had a metabolic change in IVS. The relationship between metabolic alteration and subclinical cardiac performance needs to be better clarified.
112042
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
ADRIANO MÁRCIO DE MELO MILANEZ1, Marina Coelho Feitosa2, Yury Pifano Varela2, Josué Viana de Castro Neto3, Flávio Duarte Camurça1
(1) Cardiovascular surgeon, Cardiovascular Surgery Department, Hospital Antônio Prudente, Fortaleza, Ceará, Brazil.; (2) Medical school student, The University of Fortaleza – UNIFOR, Fortaleza, Ceará, Brazil; (3) Cardiovascular surgeon, Professor of Surgery, The University of Fortaleza – UNIFOR, Fortaleza, Ceará, Brazil.
Introduction: The Right Inferior Periareolar Access (RIPA), also known as the Brazilian Technique, has been progressively applied in minimally invasive cardiac surgery (MICS) for atrioventricular valve and septal defect procedures. It provides good functional and aesthetic results, while using a similar fourth intercostal access when compared to the usual inframammary minithoracotomy. We aim to describe a Right Superior Periareolar Access (RSPA), performed one intercostal space above the RIPA, with advantages.
Methods: The RSPA consists of a videoassisted minithoracotomy in the 3rd intercostal space through a superior periareolar incision of 3 cm enlarged by a wound protector (Image 1). The cardiopulmonary bypass was established through a femoral platform and cannulation of the right internal jugular vein was added when necessary. A 5 mm port was inserted through the 2nd intercostal space for non dominant hand instrumentation initially and for clamp placement afterwards. The camera port was inserted through the 5th intercostal space. This technique was performed in 39 patients: 30 with atrial septal defects, 5 submitted to mitral valve reconstruction and 4 undergoing mitral valve replacements. Twenty four were females. The mean age was 40.
Results: The RSPA provided adequate surgical fields for all procedures. The cardioplegia infusion in the ascending aorta was easily done. Conversion to full sternotomy was necessary in one patient due to bleeding. The median lenght of intensive care unit stay was 1 day and the median postoperative hospital stay was 3 days. There were no postoperative wound infections and no postoperative mortality. The RSPA provided easy access to cardiovascular structures, contributing to effective, functional and safe procedures. The resulting surgical scars were very subtle, and did not compromise the areola.
Conclusion: The MICS procedures applying the RSPA technique were effective and safe. Other remarkable advantages were adequate access to the aorta and atriums, low lenght of stay in the intensive care unit and in the hospital and good aesthetic results.
112055
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR IMAGING
MARIA CATARINA DE MELO DIAS GUERRA1, Augusto Hiroshi Uchida1, José Antônio Franchini Ramires1, Eduardo Cavalcanti Lapa dos Santos1, Renata Ávila Cintra1, Jürgen Beuther1, Nevelton Heringer Filho1, Tiago Augusto Magalhães1, William Azem Chalela1, Guilherme Garcia1, Leonardo Filipe Benedeti Marinucci1, Carlos Eduardo Rochitte1
(1) Instituto do Coração (InCor – FMUSP)
Introduction: Fragmented QRS (fQRS) is an easily evaluated electrocardiographic parameter and has been associated with alternation of myocardial activation due to myocardial scar.
Methods: Retrospective, observational, single-center study. The sample was obtained through analysis of medical records with a record of clinical diagnosis of myocardial infarction (MI) who underwent cardiac magnetic resonance (CMR) to assess myocardial viability. Those who did not present delayed enhancement with an ischemic pattern on CMR and those whose CMR revealed a diagnosis other than MI or did not have satisfactory image quality were excluded. Patients reporting a new acute coronary syndrome in the interval between the available electrocardiogram (ECG) and the CMR were also excluded. The ECG performed 7 days after the infarction and with a maximum interval of 1 year from the CMR were analysed by an evaluator with extensive experience in electrocardiography.
Results: The mean age of patients was 61.3 years and 75% were men. Conventional infarction identification through the presence of a pathological Q wave occurred in 172 of the 245 patients included (70.2%). Fragmentation of the QRS complex was identified in 102 of the 245 patients included (41.6%). The prevalence of fQRS was significant even in smaller MI and no correlation was found between the presence of fQRS and the mass of fibrosis on CMR. A higher prevalence of fQRS was observed in infarcts predominantly in the lateral and anterior walls (figure 1).
Conclusions: This study revealed a significant prevalence of fQRS in patients after the acute phase of infarction, even in those with a lower mass of fibrosis. Although the analyzed sample of lateral infarctions is still limited, the high prevalence of fQRS may be a relevant finding, considering the low sensitivity of the classic criteria for identifying lateral infarction on the ECG. Figure 1 – Prevalence of QRS fragmentation according to the wall most affected by the infarction.
112063
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOGERIATRICS
ALEXANDRA CORRÊA GERVAZONI BALBUENA DE LIMA1, Luana de Oliveira Alves1, Laila Morais Nahass Franco1, Pedro Pinto Machado2, Pedro Henrique Parcianello Teixeira2, Luciana Bartolomei Orru D’Avila1
(1) North Wing Regional Hospital – Brasília – Brazil; (2) School of Health Sciences– Brasília – Brazil.
Background: Heart failure (HF) increases significantly in relation to advancing age. With aging, not only do age-related, morphological, and physiological cardiovascular changes predispose to HF, there is also increased prevalence of comorbid conditions that compound cardiac limitations (e.g., renal insufficiency) and others that tend to overwhelm limited cardiovascular reserves (e.g., infections and ischemia). The HF among very old adults, the prevalence, the complications in acute HF demand more studies.
Objective: Evaluate the clinical features and prognostic evolution of individuals 80 years and older with acute HF.
Methods: Retrospective and observational study of patients 80 years or older, hospitalized with acute HF at North Wing Regional Hospital, Brasília, Brazil, January 2017 to May 2020. Patients who did not meet the clinical criteria of HF, with missing or incomplete information in the medical record or were not accessible by telephone were excluded. The minimal follow-up were 12 months and final date were 05.21.2021. Clinical profiles, clinical history, blood test, and mortality were analyzed. The patients were divided into groups: 80 to 84 years and ≥85 years.
Results: A total of 119 individuals (66 and 53) were included, 45% and 47% male, 92% and 83% hypertensive. The mean age of the groups were 81.7 ± 1.3 years (80–84) and 88.6 ± 3.5 years (85–97), hemoglobin 11.9 ± 2.4 mg/dL and 10.8 ± 2.0 mg/dL, creatinine 1.44 ± 1.9 mg/dL and 1.78 ± 1.4 mg/dL, left ventricular ejection fraction 51.8 ± 15.7% and 58.6 ± 11.8%, and follow-up 29.1 ± 25.9 days and 28.4 ± 24.6 days. The presence of pulmonary congestion 40% and 45%, peripheral edema 45% and 43%, and atrial fibrillation (AF) 34% and 35%. During the hospitalization, hemodialysis 15% of both groups, vasoactive drugs 28% and 18%, intensive care unit 45% and 39%, and mortality rate 21% and 18%. In multivariate analysis deaths were related to hypertension (HR = 0.54, 95%CI = 0.29–0.98, p = 0.046), pulmonary congestion (HR = 3.38, 95%CI = 1.97–5.79, p = 0.000), peripheral edema (HR = 4.12, 95%CI = 2.30–7.38, p = 0.000), AF (HR = 0.58, 95%CI = 0.34–0.98, p = 0.043), and hemoglobin (HR = 0.84, 95%CI = 0.75–0.95, p = 0.007).
Conclusion: In our study simple clinical features as pulmonary congestion, peripheral edema and hemoglobin showed association with mortality. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care.
112078
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
PRISCILA VALVERDE DE OLIVEIRA VITORINO1, Alice PInheiro Ribeiro1, Edison Nunes Pereira2, Gustavo Carvalho Marcelino1, Ana Carolina Arantes2, Ademir Schmidt1, Weimar Kunz Sebba Barroso2
(1) Pontifícia Universidade Católica de Goiás; (2) Universidade Federal de Goiás
Introduction: Sedentary behavior (SC) is a habit present in worldwide, with increasing percentages in the last decade, especially among adolescents. With the COVID-19 pandemic, CS increased, especially due to social isolation and school closures.
Objetives: Carachterize adolescens regarding sociodemographic and economic conditions, aspects related to school and work and general health; classify adolescents in terms of SC and compare CS according to gender.
Method: Analytical cross-sectional study, conducted with adolescents (10 to 19 years), enrolled in 19 schools of Goiás. Electronic data collection took place from November 2020 to August 2021. The form contained questions about personal, sociodemographic, lifestyle and CS. Two cutoff points were considered for SC: ≥6 and ≥ to 3 hours/day. The project was approved by Ethics Committee. Descriptive analysis and comparisons were performed using pearson’s Student and Chi-square T tests. Significance level p < 0.05 was considered.
Results: We evaluated 167 students with a mean age of 15.3 DP 2.1 (Table 1). The frequencies of SC 89.1% and 52.7% at the cutoff points of 6 and 3 hours/day, respectively.
Conclusions: The sample was characterized by adolescents who did not work, were mainly from social classes B and C and had a low frequency of bad health habits. There was no difference in the frequency of SC in relation to the variables evaluated.
112101
Modality: E-Poster Researcher – Non-case Report
Category: SPIRITUALITY AND CARDIOVASCULAR MEDICINE
CÉLIDA JULIANA DE OLIVEIRA1, Héryka Laura Calú Alves1, Gabriela de Sousa Lima1, Érica Sobral Gondim1, Emiliana Bezerra Gomes1
(1) Universidade Regional do Cariri – URCA
Introduction: Hypertension evolves slowly and is asymptomatic, so it does not usually receive the proper care, resulting in poor adherence to treatment and an increase in cardiovascular events. It is a disease that requires changes in lifestyle for adherence to treatment, which is influenced by several factors, such as religiosity, which includes people’s beliefs, attitudes and values. Therefore, the pilgrimage of Padre Cícero stands out, a religious manifestation that attracts thousands of faithful to the municipality of Juazeiro do Norte-CE, in which the attendance to pilgrims because of the elevation of blood pressure is a constant, making it necessary to study the relationship between religiosity and adherence.
Objective: To investigate the influence of religiosity in the treatment adherence of hypertension by pilgrims.
Method: Cross-sectional, qualitative, carried out in Juazeiro do Norte, between September 9 and 15, 2018. The question was: “Does religion influence you to comply with treatment for high blood pressure?”. The data collected were organized into thematic categories. The study was approved by the Ethics Committee under opinion number 2,753,051.
Results: 338 pilgrims self-reported with hypertension were investigated, male (62.43%), retired (71.06%) and mean age of 64.5 years. When questioned about the influence of religion on treatment, three categories emerged: Category 1 “Faith”: Faith was answered as the influence of religion on compliance with treatment, either alone or in a complementary way, also as a cure for hypertension. Category 2 “I pray for improvement”: Prayers are the most cited as influencing treatment, for comforting, improving thoughts and guiding behaviors, such as waking up to pray and taking medication. Category 3 “Religion is above all”: Church and masses were cited as contributors. Pilgrims report feeling good and associating religious practices with treatment, combining medication intake times with church participation. The people who are in this space represent a support network, especially the priest, by encouraging self-care related to the treatment.
Final Considerations: It was noticeable that the pilgrimage and its elements influence the perception of health, illness and treatment. Thus, they can be used as beneficial means of promoting health and adherence to therapy through strategies that enhance the spiritual dimension.
112117
Modality: E-Poster Researcher – Non-case Report
Category: PHYSICAL EDUCATION
FÁBIO SILVA MARTINS DA COSTA1, Henrique Silveira Costa2, Lucas Frois Fernandes Oliveira2, Matheus Ribeiro Ávila2, Pedro Henrique Scheidt Figueiredo2, Mauro Felippe Felix Mediano3, Luciano Fonseca Lemos de Oliveira1, Manoel Otávio Costa Rocha1
(1) Universidade Federal de Minas Gerais – UFMG; (2) Universidade Federal dos Vales do Jequitinhonha e Mucuri – UFVJM; (3) Fundação Oswaldo Cruz – FIOCRUZ
Introduction: Patients with Chagas cardiomyopathy (ChC), in addition to having a worse prognosis compared to other cardiomyopathies, can have important consequences, including reduced functional capacity and quality of life. The exercise training (ET) has emerged as an adjuvant option for treatment of ChC, relieving dyspnea and fatigue caused by heart failure. This study aimed to discuss the main findings of effect of ET in patients with ChC, focusing on the functional capacity, hemodynamic and autonomic function, musculoskeletal system, myocardial function and morphology, and health-related quality of life (HQoL).
Methods: This is a systematic review using the descriptors: (“Chagas disease” OR “chronic Chagas cardiomyopathy”) AND (“exercise training” OR “cardiac rehabilitation”). A literature search of the MEDLINE, LILACS, Web of Science, CINAHL, Scopus, PEDro and EMBASE was performed with no data or language restrictions. The study was registered in PROSPERO database (CRD CRD42017064912) and edited following in guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Results: A total of 5 papers (screened from 1.169 studies) reached the inclusion criteria and were included in the present review. The patients with ChC submitted to ET presented improvement of functional capacity (increase in the VO2peak and the walked distance in the 6-minute walk test, but did not reduce the ventilatory efficiency given by VE/VCO2slope), hemodynamic and autonomic function (reduce the HR at rest but do not change the blood pressure; slight increase in the HRV in patients with reduced LVEF and better improvements in the autonomic balance given by increase in the parasympathetic activity and reduction in the sympathetic activity over the heart in patients with preserved LVEF and autonomic dysfunction), musculoskeletal system (increase in the cross-sectional and number of type I fiber, reduce the genes expression involved in the muscle atrophy process, increase skeletal muscle perfusion) and the HQoL (improve domains of vitality and emotional aspects). However, no changes in the myocardial function and morphology were observed.
Conclusion: In conclusion, the ET as a low-cost non-drug therapy option seems to provide important benefits in association with the classic treatment of patients with ChC, however, more studies are warranted to confirm these results.
112137
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
CHARLES SLATER1, Luiz Eduardo Camanho1, Eduardo Benchimol Saad2, Luiz Antonio Oliveira Inacio Jr2, Lucas Carvalho Dias1, Gustavo Vignoli Santos2, Ricardo Mourilhe-Rocha1
(1) State University of Rio de Janeiro (UERJ), Rio De Janeiro, Brazil; (2) Hospital Pro Cardíaco, Rio De Janeiro, Brazil
Background: Conduction system pacing (CSP) (His bundle pacing and left bundle pacing) is a group of techniques intended to achieve cardiac pacing with a narrow QRS complex. The safety and effectiveness of this technique are not yet entirely understood.
Purpose: To describe the implant findings and safety profile of CSP as a first option after 4 years in a single center.
Methods: In a period of 42 months, 214 patients were submitted to CSP as a first strategy to restore AV synchrony (pacemakers for AV block or sinus node dysfunction) or as a resynchronization (CRT) strategy (for patients with heart failure and bundle branch block). CSP was implanted in lieu of a conventional right ventricular lead in pacemaker cases, and in addition or in lieu of a coronary sinus lead, in CRT cases, depending on the technical and anatomical findings.
Results: The mean age was 76.7 ± 16.4 years, 65% males. 162 patients implanted a CSP lead for a dual-chamber pacemaker, 3 patients for a single chamber pacemaker, 32 patients for CRT-D (CSP lead replacing the coronary sinus lead with a defibrillator), and 13 patients for an optimized CRT (CSP lead plus coronary sinus lead). In 16 patients (7.4%) the technique of choice was His bundle pacing. One patient (0.4%) had subacute lead dislodgement, being submitted to repositioning. 4 patients – intended for CRT (1.8%) didn‘t meet the criteria for His Bundle pacing or left bundle pacing, being submitted to conventional coronary sinus lead placement. There were 10 cases (4.6%) of confirmed lead perforation during the lead septum insertion, with prompt repositioning, all uneventful. No pericardium effusion related to lead perforation was observed. One patient (0.4%) had a pneumothorax, requiring chest tube drainage.
Conclusion: Conduction system pacing as a first strategy is a feasible, effective and safe technique, both for pacing and for resynchronization purposes, with complication rates comparable to conventional implantation.
112166
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
DANIELLA CUNHA BRANDAO1, Bruna T.S. Araújo1, Kamyla Maria Alcantara Silva Alves1, Armèle Dornelas de Andrade1, Daniella Cunha Brandão1
(1) Universidade Federal de Pernambuco
Introduction: Studies relating respiratory muscle strength and diaphragmatic mobility in heart transplant patients are scarce, especially when correlated with submaximal exercise tests, such as the Glittre ADL-Test, which is still poorly investigated in this population.
Purpose: To investigate whether the time required to perform the Glittre ADL-Test correlates with respiratory muscle strength and diaphragmatic mobility.
Methods: This was a cross-sectional study with 38 adult individuals aged 21 to 65 years, diagnosed with HF of all etiologies and with reduced ejection fraction. The performance of the Glittre ADL-Test followed the standardization of the literature, using the Total Time to complete the five laps of the test. The assessment of respiratory muscle strength was made by a digital manovacuometer and diaphragmatic mobility was measured by ultrasound in the M. mode.
Results: The mean Glittre ADL-Test time was 286.5 seconds and showed significant correlations with maximal inspiratory pressure (MIP) (r = –0.445 – p < 0.01) and maximal expiratory pressure (MEP) (r = –0.531 – p < 0.01) and with diaphragmatic mobility (r = –0.361 – p < 0.05).
Conclusions: Our findings suggest an inverse relationship between respiratory muscle strength and diaphragmatic mobility with Glittre ADL-Test performance. If respiratory muscle strength and diaphragm muscle movement are lower, the time taken to complete the test will be longer, suggesting that increased respiratory work may potentiate peripheral muscle fatigue. The impairment of respiratory muscles seems to have important implications on the performance of HF individuals in their daily activities, confirming the need for early identification of patients with respiratory muscle weakness, enabling a targeted intervention in this population. Support: Edital PROPG-UFPE 230760186722020-32; CNPq 421656/2021-7 and FACEPE 0801-4.08/21.
112169
Modality: E-Poster Researcher – Non-case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
CHARLES SLATER1, Luiz Eduardo Camanho1, Eduardo Benchimol Saad2, Luiz Antonio Oliveira Inacio Jr2, Lucas Carvalho Dias1, Gustavo Vignoli Santos2, Ricardo Mourilhe-Rocha1
(1) State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; (2) Hospital Pro Cardíaco, Rio de Janeiro, Brazil
Background: Conduction system pacing through direct His bundle of left bundle stimulation is a new alternative to achieve adequate CRT in patients with heart failure with reduced ejection fraction (HFrEF).
Purpose: To describe the short and medium term outcomes of CRT through direct conduction system pacing in a single center.
Methods: 53 consecutive patients who underwent CRT through direct stimulation of the His bundle or left bundle branch were retrospectively evaluated. All presented in functional class III/IV (NYHA). The CRT response criteria were: improvement of functional class and reverse remodeling criteria (increase in ejection fraction (EF) >10% and/or decrease in left ventricular end-systolic diameter (LVESD) >15%). The patients were evaluated at 1 and 3 months and every six months after the procedure.
Results: The mean age was 76,4 ± 14,8 years, 65% males, 42% Ischemic cardiomyopathy. Left bundle branch block (LBBB) was observed in 98% and mean QRS duration was 169 ms; average EF: 28%; mean LVESD and left ventricular end-diastolic diameter (LVEDD) was 53 and 68 mm, respectively. Direct His bundle pacing was the technique of choice in 5 patients, while left bundle branch pacing was used in 48 patients. There were five patients where His bundle pacing of left bundle branch pacing criteria was not met, being submitted to conventional CRT through coronary sinus branches. The mean follow up time was 21 months. Mean QRS duration was significantly shorter after the procedure (128 ms). Improvement of functional class was found in 85,7% of patients. Reverse remodeling criteria was found in 70,5% of patients. 4 patients progressed to end-stage HF and subsequent death.
Conclusion: CRT through conduction system pacing is a valid alternative to conventional CRT, with promising results, allowing cardiac resynchronization in patients with HFrEF.
112201
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
BRUNO FERRAZ DE OLIVEIRA GOMES1, Thiago Moreira Bastos da Silva2, Leticia de Sousa Peres1, Iliana Regina Ribeiro Menezes1, Nathalia Duarte Camisão1, Mariana Moreno Canário da Silva1, Renata Mexias Abdala Felix1, Giovanni Possamai Dutra1, Anna Butter1, Henrique Custódio Goudar1, João Luiz Fernandes Petriz1, Gláucia Maria Moraes de Oliveira2
(1) Hospital Barra D’Or; (2) Universidade Federal do Rio de Janeiro
Introduction: Several studies have already scored the predictors of in-hospital mortality in patients hospitalized for COVID-19. 2 years after the beginning of the pandemic, few studies have evaluated predictors of long-term mortality.
Objectives: To evaluate clinical and laboratory characteristics predictors of mortality using machine learning techniques.
Methods: Retrospective cohort study with patients who were hospitalized with a confirmed diagnosis of COVID-19. Comorbidities, laboratory tests, vaccination status, and clinical characteristics were evaluated. The primary outcome of this study is all cause death occurring in the hospital or after hospital discharge. We used the classification tree model for the survival outcome, available in RStudio 2021.09.0.
Results: 1454 patients were included, mean age of 59.8 ± 17.0, 62.6% men. There were 269 deaths (18.5%) during the study period (mean follow-up = 338 ± 209 days). 44.7% of patients had myocardial injury. The following predictive variables were selected by the method: use of mechanical ventilation, age, platelet count at discharge, CRP at discharge, myocardial injury, SAPS3 score, d-dimer peak of hospitalization, dementia, chronic renal failure, COVID-19 vaccination, and use of anticoagulation therapy. The model is available in the figure.
Conclusion: In patients hospitalized for COVID-19, patients who required mechanical ventilation, with high CRP at discharge and higher age had the worst long-term prognosis. Other markers have shown promise in predicting more severe patients, such as platelet count at discharge and the occurrence of myocardial injury.
112202
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
CHARLES SLATER1, Luiz Eduardo Camanho1, Eduardo Benchimol Saad2, Luiz Antonio Oliveira Inacio Jr2, Lucas Carvalho Dias1, Gustavo Vignoli Santos2, Ricardo Mourilhe-Rocha1
(1) State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil; (2) Hospital Pro Cardíaco, Rio de Janeiro, Brazil
Background: Vascular access is the first step to perform cardiac device (CD) implantation. However, vascular access-related complications still remain a major cause of complications in CD implantation, increasing risk, costs, and hospitalization time. Ultrasound has become an important tool in helping vascular access, and its use has increased recently for CD implantation.
Purpose: To describe the results after 4 years of US-guided vascular access for implantation of CD.
Methods: Over a period of 50 months, 627 patients (average age 77,1 ± 14,6 years – interquartile range: 13 years) were submitted to CD implantation (271 dual-chamber pacemakers, 9 single-chamber pacemakers, 24 CRT-P’s, 167 conduction system pacemakers (His bundle pacing or left bundle pacing), 63 CRT-D’s, 46 dual-chamber ICD’s, 2 single-chamber ICD’s, 4 lead implantations and 41 upgrades for CRT), in a total of 1282 US-guided punctures (longitudinal “out of plane” axillary vein approach) using a “Point of Care” US machine with a 12MHz probe protected with a sterile cover. All punctures were performed on intact skin, followed by an incision. Chest radiography and pulmonary ultrasound were performed in the search for complications immediately after the procedure and the next morning, before discharge.
Results: Vascular access was successful in all cases. In 11 cases (1,75%) there was limiting vascular obstruction, requiring contralateral vascular access to complete the procedure. US image also allowed alternative approaches, such as access to a supraclavicular vein (3 cases/0,47%) in patients with complete obstruction of the axillary vein; and cephalic vein puncture (4 cases/0,63%) when the axillary vein was too deep. Pneumothorax was found in one patient (0,16%) through the pulmonary US the next morning and submitted to chest drainage with no further complications. No haemothorax was found in this sample.
Conclusion: US-guided vascular access technique allows safe implantation, with complication rates considerably lower than that related in literature.
112215
Modality: E-Poster Researcher – Non-case Report
Category: PHYSIOTHERAPY
DANIELLA CUNHA BRANDAO1, Jéssica Costa Leite2, Bruna T.S. Araújo1, Armèle Dornelas de Andrade1, Daniella Cunha Brandão1
(1) Universidade Federal de Pernambuco; (2) UNIFACISA
Introduction: The Glittre ADL-Test appears as one more test option to assess submaximal exercise tolerance in heart transplant patients.
Purpose: To verify the association between the time spent in the Glittre ADL-Test with the variables of the Cardiopulmonary Exercise Test (CPET).
Methods: A cross-sectional study evaluating 53 male and female subjects with Heart Failure (HF), NYHA (New York Heart Association) II–III and left ventricular ejection fraction <45%. The individuals performed the CPET on a treadmill with ramp protocol to evaluate the maximum functional capacity and on another day the Glittre ADL-Test, considering the total time to complete the five rounds of the test. A minimum interval of 24 hours and a maximum of 7 days between the tests was respected.
Results: Glittre ADL-Test time was negatively and moderately associated with peak oxygen uptake (VO2peak) (r = –0.48; p = <0.001) and oxygen uptake at the first ventilatory threshold (r = –0.475; p = <0.001), besides a low negative association with the time to reach VO2peak (r = –0.345; p = 0.014).
Conclusions: We can suggest from the results obtained that the Glittre ADL-Test is an accessible method for assessing individuals with HF and correlates with the oxygen uptake measured by CPET. As clinical implications we have: The Glittre ADL-Test can be a fast and economical alternative for estimating the functional capacity of individuals with HF in the absence of a maximal exercise test. Support: PROPG-UFPE n.23076018672/2020-32; CNPq 421756/2021-7; FACEPE 0801-4.08/21
112236
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
MONICA AMORIM DE OLIVEIRA1, Helena Cramer Veiga Rey1
(1) Instituto Nacional de Cardiologia
HTN is the most common, identifiable and modifiable risk factor for cardiovascular disease. The prevalence of SAH is about three times higher in obese patients. Weight loss has an impact on the treatment of HTN and this should be encouraged. The aim of the study was to evaluate the prevalence of obesity in a group of 1000 patients over 18 years of age treated in primary care in the city of Rio de Janeiro and its relationship with HTN. Of the 1014 patients included, 737 (72.68%) were hypertensive. A sedentary lifestyle was present in 65.5% of the population studied and there was no difference between the group of patients with and without SAH. The average BMI of the general population was 29.6 ± 6.2 kg/m2. Being 30.1 ± 6 Kg/m2 and 27.8 ± 6.5 Kg/m2 for hypertensive and non-hypertensive patients, respectively, with statistical significance. Obesity was found in 41.2% of the population studied. The distribution according to the WHO BMI classification can be verified in the table and showing the association between HTN and obesity. The treatment of hypertension in the obese requires a targeted approach to obesity. Adopting a healthy lifestyle facilitates weight loss, increases responsiveness to antihypertensive drug therapy, and produces independent beneficial effects on factors. did not present SAH, as a measure to prevent its development.
112240
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
CRISTIANO FARIA PISANI1, Rodrigo M. Kulchetscki1, Bernardo Salvajoli2, Marina P. Mayrink1, Ligia Arteaga2, Jason Cook3, William Stevenson3, João Salvajoli2, Mauricio Scanavacca1
(1) InCor – Heart Institute – University of São Paulo Medical School; (2) ICESP – Instituto do Cancer do Estado de São Paulo; (3) Vanderbilt Heart
Background: Stereotactic radiotherapy (SBRT) is a new therapeutic option in cases of recurrent ventricular tachycardia (VT) in patients with structural heart disease where there is a contraindication or a therapeutic failure of the catheter ablation (CA).
Objectives: To describe the initial experience of SBRT for recurrent VT in patients with Chagas Cardiomyopathy (CCM) in whom catheter ablation is not an option.
Methods: The target sites and SBRT doses were planned based on imaging exams and on bipolar voltage maps from previous CA procedures and new electrophysiologic study was also performed aiming to evaluate the exit site of induced VT.
Results: Five patients with CCM and recurrent VT underwent SBRT from July 2021 to April 2022. Most patients were male (60%), mean age 61,4 ± 5, years and EF 22% (Q1: 20 Q3:45). One patient (20%) had two prior catheter ablation and the others only one. The median number of VT episodes in the six and two months prior to SBRT was 13 (Q15.5–Q348.5) and 11 (Q1:2.5;Q3:26.5), respectively. The mean PTV (planning target volume) was 82 ± 17 mL and the ITV (internal target volume) was 29 ± 5 ml, with safe constraints regarding the esophagus and stomach. In a median FU of 194 days, 2 (40%) patients presented VT recurrence. No patients died. The median number of VT episodes reduced from 24 (4.75;52.25) to 2 (0;8.5) (P = 0.068).
Conclusion: SBRT is safe and seems to be effective in Chagas Disease patients
112483
Modality: E-Poster Researcher – Non-case Report
Category: DIGITAL HEALTH/INNOVATION
ANDREY GARANIN1, Andrey Garanin1, Dmitriy Duplyakov1, Irina Mullova1, Oksana Shkaeva1, Polina Duplyakova1
(1) Samara State Medical University
Introduction: The pandemic of a new coronavirus infection has shown the need for the development of telemedicine technologies, especially remote medical monitoring using telemonitoring of vital body functions. In some regions, this approach is also justified by the factor of distance and the shortage of certain categories of medical workers.
Objective: Decrease of repeated hospitalizations and mortality in patients with chronic heart failure by means of remote monitoring system including arterial pressure monitoring.
Methods: 401 patients, who were randomized into two equal groups comparable by sex, age, left ventricular ejection fraction, functional class of heart failure, six-minute walking test results, body mass index, baseline systolic and diastolic blood pressure, and heart rate of the underlying disease and hospitalized for myocardial infarction or decompensation of chronic heart failure, were examined at two research centers. In group 1, remote blood pressure monitoring using oscillometric method was performed using certified tonometers with the ability to transmit the measurement results via cellular communication channel to the research center. Based on the results of the data obtained, the physician was able to contact the patient and adjust the previously prescribed treatment. Group 2 patients performed self-monitoring of blood pressure. All the patients were observed for 3 months. Treatment in both groups was prescribed according to the latest recommendations of the European Society of Cardiology.
Results: Group 1 showed a tendency to blood pressure lowering from 130 mmHg to 125 mmHg. In contrast, Group 2 showed an increase in blood pressure from 125 mmHg to 130 mmHg. Group 1 showed 4 hospitalizations related to acute cardiac pathology with a total duration of 30 days; group 2 showed 13 hospitalizations with a total duration of 133 days (p = 0.027; OR; 95% CI 3.4; 1.1–10.8). Total mortality was 6 in group 1 and 11 in group 2 (p = 0.226; OR; 95% CI 1.9; 0.7–5.3). Cardiovascular mortality was 3 in group 1 and 10 in group 2 (p = 0.052; OR; 95% CI 3.5; 0.9–12.9).
Conclusions: Remote management of patients with chronic heart failure, including blood pressure monitoring, over 3 months demonstrates a significant reduction in hospitalizations and a trend toward lower total and cardiovascular mortality.
112516
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR PHARMACOLOGY
OLGA PECHANOVA1, Andrej Barta1, Martina Cebova1
(1) Centre of Experimental Medicine, Slovak Academy of Sciences
Background: Aliskiren, a renin inhibitor, has been shown to exert cardio-protective, reno-protective, and anti-atherosclerotic effects independent of its blood pressure lowering activity. However, relatively high dose and frequency of the treatment, which is needed for beneficial effects of the drug, may incur several side effects such as high blood potassium levels, particularly when used with ACE inhibitors in diabetic patients. We hypothesized that gradually released aliskiren from polymer-based nanoparticles could at least partially solve the problem of bioavailability. Therefore, we aimed to determine the effects of aliskiren-loaded polymeric nanoparticles on blood pressure, nitric oxide synthase (NOS) activity and structural alterations of the heart and aorta developed due to spontaneous hypertension in rats.
Methods: Twelve-week-old male spontaneously hypertensive rats were divided into the untreated group, group treated with powdered aliskiren or aliskiren-loaded nanoparticles (25 mg/kg/day) and group treated with nanoparticles only for 3 weeks by gavage. Blood pressure was measured by tail-cuff plethysmography. NOS activity, eNOS and nNOS protein expressions, and collagen content were determined in both the heart and aorta. Vasoactivity of the mesenteric artery and wall thickness, inner diameter, and cross-sectional area (CSA) of the aorta were analyzed.
Results: After 3 weeks, blood pressure was lower in both powdered aliskiren and aliskiren-loaded nanoparticle groups with a more pronounced effect in the latter case. Only aliskiren-loaded nanoparticles increased the expression of nNOS along with increased NOS activity in the heart (by 30%). Moreover, aliskiren-loaded nanoparticles decreased vasoconstriction of the mesenteric artery and collagen content (by 11%), and CSA (by 25%) in the aorta compared to the powdered aliskiren group. In conclusion, aliskiren-loaded nanoparticles represent a promising drug with antihypertensive and cardioprotective effects.
112557
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR PHARMACOLOGY
NGO YOUMBA EP NTEP GWETH1, Marie Ndjie Ndzana1, Liliane Mfeukeu Kuate1, Chris Nadège Nganou Gnindjio1, Valerie Ndobo1, Sylvestre Efonle Ngoh1, Samuel Kingue2
(1) HOPITAL CENTRAL DE YAOUNDE (HCY); (2) HOPITAL GENERAL DE YAOUNDE
Randomized control trial comparing efficiency between losartan and amlodipine to hypertensive Cameroonian in Yaounde SUMMARY.
Introduction: High blood pressure is the first chronic disease in the world and which also increases the cardiovascular risk. The reduction of this particularly high risk in patients from sub-Saharan Africa should be the main goal of care in our setting. Numerous studies on the choice of a better antihypertensive treatment of arterial hypertension have been conducted but the inherent specificities of our populations, in particular a lower renin activity, a tendency towards sodium-water retention and vascular hyperreactivity, impose a customization of the pharmacological treatment in Africans. Although there is a difference in response to antihypertensive classes in African subjects who respond better to amlodipine than to losartan, few study in our context has yet demonstrated this to the best our knowledge.
Objective: The main objective of this study was to compare the efficacy of a amlodipine blocker and losartan receptor blocker in Cameroonian hypertensives at the Yaounde Central Hospital.
Methods: This was a randomized, controlled clinical trial phase IV. It involved patients with grade 1 or 2 clinical hypertension, naive to antihypertensive therapy. The intervention consisted in starting the recommended average doses in monotherapy for 12 weeks (84 days) of losartan 50 mg in single dose per day in group 1 and amlodipine 5 mg in single dose per day. Group 2. The follow-up were scheduled 2 weeks. The increase in monotherapy doses occurred from the fourth week (S4) when the blood pressure goal was not reached with losartan 100 mg once a day and amlodipine 10 mg once daily for group 1 and 2, respectively. The patients for whom BP was still not controled despite the increase in monotherapy doses adding a low dose of hydrochlorothiazide at 12.5 mg at eight week (S8) to achieve the blood pressure goal. Compliance assessment was done through Morisky’s questionnaire and telephone calls.
Results: In all 46 patients initially included, 40 were selected including 21 women and 19 men. The mean age was 54.0 ± 5.5 years in the losartan group 1 and 58.05 ± 7.1 years in the amlodipine group2 (P = 0,350). The two groups were substantially comparable at inclusion for the clinical measurement of blood pressure, the biological parameters tested namely lipid profile, blood ionogram, blood glucose and serum uricemia. After intervention, the mean SBP.
112572
Modality: E-Poster Researcher – Non-case Report
Category: CARDIAC ARRHYTHMIAS/ELECTROPHYSIOLOGY/ELECTROCARDIOGRAPHY
PEDRO GABRIEL MELO DE BARROS E SILVA1, Renato Delascio Lopes1, CR. Hoffmann Filho4, MA. Cavalvante5, C. Miranda6, RB. Esper7, G. Lima8, L. Zimerman9, O. De Souza11, A. Fagundes12, E. Saad10, R. Teixeira12
(1) Brazilian Clinical Research Institute; (2) IP-HCor; (3) Duke Clinical Research Institute, Durham, United States of America; (4) Hospital Regional Hans Dieter Schmidt, Joinville, Brazil; (5) University of the West of Sao Paulo, Presidente Prudente, Brazil; (6) Hospital Madre Teresa, Belo Horizonte, Brazil; (7) Prevent Senior, Sao Paulo, Brazil; (8) Institute of Cardiology of Rio Grande do Sul, Porto Alegre, Brazil; (9) Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; (10) Cardiologia Americas; (11) D’Or Institute for Research and Education, Rio De Janeiro, Brazil; (12) Sociedade Brasileira de Arritmias Cardiacas, Sao Paulo, Brazil
There is limited prospective real-world evidence of patients with atrial fibrillation (AF) in Latin America.
Methods: RECALL was the first nationwide prospective study of patients in Brazil with known atrial fibrillation. A total of 4,585 patients were included among 89 sites from April 2012 to August 2019. The follow-up was one year by the protocol. Patient characteristics, medications under use and clinical outcomes during the follow-up were collected.
Results: From the total of patients enrolled, 41 were excluded from the analysis since they did not have a confirmed diagnosis of AF. The median age was 70 (61–78) years, 46% were women and the majority of the cases were permanent AF (53,8%). The mean CHA2DS2VASc was 3.2 ± 1.6 and the median HASBLED was 2 [2–3]. The most common risk factor was arterial hypertension (77.9%). The median heart rate was 74 [65–85] and the mean ejection fraction was 52.2 ± 2.6 (%). Only 4.4% of patients had history of previous ablation and 30.4% were using anti-arrhythmic. At baseline, 22.0% did not use anticoagulants and 9.1% did not use any antithrombotic therapy. The most common anticoagulant was vitamin K antagonist (VKA) (62.6%) while the remaining 37.4% were direct oral anticoagulants. The main reasons for not using an oral anticoagulant were physician judgment’s (low risk of stroke – 24.6%) and difficult to control (14.7%) or perform INR (9.9%) while patient preference and adverse event represented respectively 5.3% and 4.1%, respectively. Only 42.5% of the INRs at baseline were between 2 and 3. During follow-up, the use of anticoagulants and INR in the therapeutic range increased to 87.1% and 59.1%, respectively. The use of antithrombotic therapy changed not only during follow-up but it was different also according to the CHADSVASC of the patients. Regarding clinical outcomes in one year, 17.8% of patients were hospitalized due to AF and the rates of death, stroke, systemic embolism and major bleeding were 5.76 [5.12–6.47], 2.77 [2.32–3.32] 1.01 [0.75–1.36], 2.21 [1.81–2.70], respectively. Among VKA users, the rate of mortality and bleeding was higher in the group with time in therapeutic range below 60%.
Conclusion: RECALL represents the largest prospective registry of patients with atrial fibrillation in Latin America. Our findings highlight important gaps in the treatment of patients which can inform clinical practice and help to guide future interventions to improve the care of these patients.
112591
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR SURGERY
OMAR ASRUBAL VILCA MEJIA1, Bianca Meneghini1, Ligia Cristina Fonseca Hoeflinger1, Fabiane Leticia de Freitas1, Bruno Mahler Mioto1, Luis Augusto Ferreira Lisboa1, Luis Alberto de Oliveira Dallan1, Alexandre Chiapina Hueb2, Mauricio Landulfo Jorge Guerrieri2, Rodrigo Coelho Segalote3, Felipe Cosentino3, Fabio Biscegli Jatene1
(1) Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; (2) Hospital das Clinicas Samuel Libanio; (3) Instituto Nacional de Cardiologia do Rio de Janeiro
Background: The world is getting older. This change in demographics increases the overall prevalence of coronary artery disease. The growing number of elderlies is not only related to an increase in the number of coronary heart diseases but also frailty, a syndrome that affects at least 10% of the elderly population and is an exceedingly effective parameter for correlating with the adverse effects of aging. Regarding CABG surgery, randomized controlled clinical trials have mainly focused on low-risk, elevated-risk, or high-risk patients, but not on frail patients.
Purpose: The aim of this study was to evaluate the impact of coronary artery bypass graft surgery on the frailty index of patients in the 6-month follow-up.
Methods: This was a subanalysis of the national, multicenter, randomized, controlled trial called the FRAGILE clinical trial. We analyzed 62 patients aged 60 years or older undergoing coronary artery bypass graft surgery with and without cardiopulmonary bypass in 8 main cardiac surgery centers in Brazil. Fried’s Frailty Criteria were used to classify patients into frail, pre-frail, and non-frail. The parameters evaluated were unintentional weight loss, self-reported fatigue, physical activity level, grip strength, and gait speed. We divided the patients into two groups: the off-pump CABG group (n = 30) and the on-pump CABG group (n = 32). We compared each group for frailty variables before and after surgery using the Mann-Whitney test and Stuart-Maxwell marginal homogeneity using the R software. The study was approved by the local Ethics Committee and all patients signed the informed consent.
Results: We observed an improvement in the frailty of patients undergoing CABG. Overall, the number of pre-frail patients doubled in 6 months after surgery (from 11 to 22 patients), and the number of frail patients decreased from 19 to1 patient. Nine patients included in the study no longer had any degree of frailty after 6 months of surgery. No patient was classified as non-frail preoperatively in both groups because it was one of the exclusion criteria of the study. There is no difference between the groups. Regarding the frailty criteria, all tests showed differences in the pre and post-surgical comparison, except the unintentional weight loss variable.
Conclusion: CABG played a role in improving frailty at the 6-months follow-up. Both techniques, on-pump and off-pump CABG, showed similar results when comparing frailty features before and after CABG surge.
113890
Modality: E-Poster Researcher – Non-case Report
Category: COVID-19 AND CARDIOVASCULAR SYSTEM
RENATO DELASCIO LOPES1, Pedro Gabriel Melo de Barros e Silva2, Ariane Vieira Scarlatelli Macedo2, Alexandre B. Cavalcanti4, Regis G. Rosa6, Otávio Berwanger7, Viviane C. Veiga8, Luciano C.P. Azevedo9, Murillo O. Antunes10, Otávio Celso Eluf Gebara11, Eduardo Ramacciotti1, Alvaro Avezum12
(1) Brazilian Clinical Research Institute, Sao Paulo, Brazil; (2) Duke University Medical Center, Durham, NC, USA; (3) Hospital Samaritano Paulista, São Paulo, Brazil; (4) HCOR Research Institute, São Paulo, Brazil; (5) Brazilian Research in Intensive Care Network; (6) Hospital Moinhos de Vento, Porto Alegre; (7) Academic Resaearch Organization (ARO) – Hospital Israelita Albert Einstein; (8) BP–A Beneficência Portuguesa de São Paulo; (9) Hospital Sírio Libanês Research and Education Institute; (10) Hospital Universitário São Francisco de Assis na Providência de Deus and Irmandade do Senhor Bom Jesus dos Passos da Santa Casa de Misericórida de Bragança Paulista, Bragança Paulista; (11) Dasa-Hospital Santa Paula, São Paulo, Brazil; (12) International Research Center, Hospital Alemão Oswaldo Cruz
The efficacy and safety of anticoagulation in the early phase of COVID-19 is unknown.
Methods: APOLLO is an academic-led, multicenter, randomized, double-blinded clinical trial that planned to enroll 1000 patients from 30 sites participating in the Coalition COVID-19 Brazil initiative. Eligible patients with a confirmed diagnosis of COVID-19 with onset symptoms up to 10 days at increased risk for thrombotic complications were randomized to apixaban (2.5 mg twice daily) or placebo for 30 days. The primary outcome was the number of days alive and out of the hospital at 30 days. Secondary outcomes included hospitalization for bleeding (key safety outcome), hospitalization for cardiovascular/pulmonary causes (key secondary efficacy outcome).
Results: The trial was stopped prematurely due to slower than expected recruitment and low overall event rates. Among 411 (41% of the initial sample size) patients randomized (207 in apixaban and 204 in the placebo group), the mean (+/– SD) age was 44.0 years (±14.0), 58.4% were women, three patients from the apixaban group withdrew the informed consent, and all the remaining 408 patients completed the 30-day follow-up. The mean time (+/– SD) from symptom onset to randomization was 6.2 (2.4) days. There was no significant difference in the number of days alive and out of the hospital in patients assigned to apixaban and placebo (29.6 ± 1.6 and 29.5 ± 2.4 days, respectively; mean difference 0.18, 95% confidence interval [CI] –0.22 to 0.58; P = 0.38). Among patients assigned to apixaban versus placebo, there was also no significant difference in secondary endpoints including all-cause hospitalization (4.9% vs. 6.9%; odds ratio [OR] 0.70, 95% CI 0.30–1.61), and hospitalization for cardiovascular/pulmonary causes (4.4% vs. 6.9%; odds ratio [OR] 0.63, 95% CI 0.26–1.48). There was no hospitalization due to bleeding and no arterial and venous thrombosis in either study groups. One patient died (in the placebo group) due to a non-cardiovascular cause.
Conclusions: In symptomatic, but clinically stable outpatients with COVID-19 and additional risk factors for thrombotic complication, treatment with apixaban 2.5 mg twice daily compared with placebo did not improve the number of days alive and out of the hospital. No major bleeding was observed in the trial population. While the power is limited due to not reaching the intended sample size, our results do not support the routine use of low dose apixaban for outpatients COVID-19.
113909
Modality: E-Poster Researcher – Non-case Report
Category: CARDIOVASCULAR PHARMACOLOGY
GWO-PING JONG1
(1) Chung Shan Medical University Hospital; (2) Chung Shan Medical University; (3) Taoyuan Armed Forces General Hospital; (4) National Defense Medical Center; (5) Central Taiwan University of Science and Technology; (6) Taichung Armed Forces General Hospital
Background: Epidemiological evidence suggests the association of diabetes with an increased risk of stroke. Clinical studies have investigated the effects of sodium-glucose co-transporter-2 (SGLT2) inhibitors on new-onset stroke (NOS), but the results are inconsistent.
Objectives: To determine the association between the use of SGLT2 inhibitors and NOS in patients with type 2 diabetes mellitus (DM).
Methods: We conducted a nationwide retrospective cohort study based on the Taiwan Health Insurance Review and Assessment Service database (2016–2019). The primary outcome of the assessment was the risk of incident stroke by estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Multiple Cox regression was applied to estimate the adjusted HR of NOS. Subgroup analysis was also conducted.
Results: Among the 232,101 eligible patients with type 2 DM aged ≥20 years, SGLT2-inhibitor users were compared with non-SGLT2-inhibitor users based on age, sex, and the duration of type 2 DM matching at a ratio of 1:2. The event rate per 10 000 person-months was 9.20 (95% CI 8.95 to 9.45) for SGLT2-inhibitor users and 10.5(10.3–10.6) for non-SGLT2-inhibitor users. There was a decreased risk of NOS for SGLT2-inhibitor users (adjusted HR 0.85, 95% CI 0.82–0.88) compared with non-SGLT2-inhibitor users. Results for the propensity score-matched analyses showed similar results (adjusted HR 0.87, 95% CI 0.84–0.91 for both SGLT2-inhibitor users and non-SGLT2-inhibitor users).
Conclusion: The risk of developing NOS was lower in patients with SGLT2-inhibitor users than in non-SGLT2-inhibitor users. The decreased risk of NOS in patients with type 2 DM was greater among patients with concurrent use of statins, biguanides, thiazolidinediones, and glucagon-like peptide-1 receptor agonists. We, therefore, suggest that the long-term use of SGLT2 inhibitors may help reduce the incidence of NOS in patients with type 2 DM.
107880
Modality: E-Poster Researcher – Non-case Report
Category: EPIDEMIOLOGY AND HEALTH POLICIES/GLOBAL HEALTH
ANTONIO DE PADUA MANSUR1, Carlos Henrique Del Carlo1, José Antonio Ramos Neto1, André Barbosa de Abreu1, Airton Roberto Scipioni1, Antonio Carlos Pereira Barreto1
(1) Insituto do Coração – HC FMUSP
Background: Chronic Chagas cardiomyopathy (CCC) is one of the leading causes of congestive heart failure (CHF) in Latin America and carries a high morbidity and mortality burden. Previously, it was believed that there was no epidemiological and clinical evidence of a gender-associated risk of death in patients with CCC.
Purpose: To analyze the mortality of congestive heart failure due to CCC in women and men.
Methods: From February 2017 to September 2020, we followed a cohort of patients with CHF (Framingham criteria) due to CCC in a single-center outpatient clinic. Appropriate serologic tests defined Chagas disease. Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses were performed with the Kaplan-Meier (K-M) method to analyze time-to-event data and the Cox proportional hazards methods to search for predictors of death.
Results: We studied 733 patients, mean of 61.4 ± 12.3 years, 381 (52%) males. Females were older (63.0 ± 11.9 vs. 60 ± 12.4 years; p = 0.01), had a higher baseline mean left ventricular ejection fraction (LVEF) (44.5 ± 14.6% vs. 37.3 ± 14.8%; p < 0.001), and a lower left ventricular diastolic diameter (LVDD) (56.7 ± 8.9 vs. 62.4 ± 9.4 mm; p < 0.001). Over a 3-years follow-up period, 168 (44%) men and 126 (36%) women died (K-M: log-rank p = 0.002; Figure). Women had more implantable pacemakers (PM) (26.1% vs. 16.5%; p = 0.002) and men more implantable cardioverter-defibrillators (ICDs)(20.7% vs. 12.5%; p = 0.003). Heart transplant occurred in 10.8% of men and 7.4% in women (p = NS). Cox regression for death adjusted for age, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation, PM, ICD, heart transplant and LVEF, showed, in descending order, previous stroke (HR = 2.4; 95%CL:1.5–3.6), diabetes (HR = 2.0; 95%CL: 1.3–3.1), and CKD (HR = 1.8; 95%CL:1.3–2.6) as the main predictors of death in men, and in women diabetes (HR = 2.2; 95%CL:1.4–3.4), previous stroke (HR = 1.8; 95%CL:1.1–2.9), and CKD (HR = 1.7; 95%CL:1.1–2.7).
Conclusions: Women had a better prognosis than men but similar predictors of death. Control of diabetes and prevention of stroke and CKD could significantly reduce the death rate in CHF due to CCC.
107731
Modality: E-Poster Researcher – Case Report
Category: HEMODYNAMICS AND INTERVENTIONAL CARDIOLOGY
FREDERICO LOPES DE OLIVEIRA1, Giulliano Gardenghi2, Adriano Gonçalves de Araújo1, Maurício Lopes Prudente2, Flávio Passos Barbosa1
(1) Hospital de Urgências Governador Otávio Lage; (2) Hospital Encore; (3) Hospital Samaritano de Goiânia
Introduction: Coronary perforation is a potentially fatal complication during percutaneous coronary intervention. Although rare (0.2 to 0.6% of procedures), it is life-threatening, which justifies its immediate diagnosis and correction.
Objective: We report two cases of coronary perforation and alternative management of current practice. Case reports: CTO 78 years old, admitted on 04/16/2020 and WlSO, 61 years old on 01/12/22, men with previous AMI of more than 12 hours of evolution (CTO with 36 hours and WISO with 18 hours), still in typica pain refractory to intravenous nitrate, dual product control and potent analgesia, thus opting for invasive stratification in both cases. After anterior descending recanalization, a type III rupture with the presence of pericardial contrast was observed. Heparin action was immediately reversed, the balloon was inflated with low pressure and the echocardiography and cardiac surgery teams were contacted. Manufactured coated stents were made (CTO with balloon catheter segment and WISO with a sterile adhesive skin dressing) successfully correcting its perforations.
Discussion: In coronary perforation, reversal of anticoagulation and occlusion of the bleeding orifice are essential to prevent tamponade until definitive treatment (lately only direct suture of the vessel by open thoracotomy). However, with the evolution of materials and techniques, it has been proven that ballooning at low pressures and protamine infusion have high success rates in punctual occlusions. Circulatory assist devices and decompressive pericardiocentesis (Marfan puncture) are still needed, increasing costs, morbidity and mortality. In case of failure, polymerized mesh stents (Graft stent) are able to “seal” the leak to pericardial sack, however, their value is high and their numbering is restricted. Thus, alternatives manufactured stents with venous grafts, parts of coronary balloon catheters, sterile skin patches (such as Tegaderm®) or even intentional infusion/embolization of autologous fat are good examples of low cost. Other techniques that are also costly, such as the use of microcatheters for infusion of “coils” and the implantation of successive smaller-caliber stents (decreasing the lateral holes), are also used.
Conclusion: In the cases reported here, the procedures presented were able to contain the bleeding. We understand that disseminating this knowledge, we can contribute with other colleagues in solving this complication.
107875
Modality: E-Poster Researcher – Case Report
Category: CARDIO-ONCOLOGY
NATHALIE JEANNE MAGIOLI BRAVO-VALENZUELA1, Eliane Lucas4, Juliane R Sousa2, Fernanda C Lemos3, Patrícia S Correia2
(1) Curso de Pós-Graduação em Cardio- Oncologia da Sociedade Brasileira de Cardiologia, Instituto Nacional de Cardiologia e Instituto Nacional do Câncer, Rio de Janeiro, RJ, Brasil; (2) Hospital Federal de Bonsucesso (HFB), Rio de Janeiro-RJ, Brazil; (3) Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil; (4) Faculdade de Medicina do Centro Educacional Serra dos Órgãos (UNIFESO), Teresópolis-RJ, Brazil
Introduction: Cardiac myxomas are the most common primary cardiac tumors in adults but rare in children. However, in Carney syndrome, myxomas develop at an earlier age and tend to recur more frequently. SC is considered a familial multiple endocrine neoplasia (such as primary adrenal nodular disease, cardiac and cutaneous myxoma, testicular neoplasia) that results from PRKAR1A gene mutations.
Case report: We present the case of a 14-year-old male patient who was admitted to our hospital for exercise-induced fatigue, acute chest pain, and mental confusion. His mother reported a history of high blood pressure since the age of 5 that worsened in the last 2 months. His maternal family history was positive for atrial myxoma. A physical examination revealed skin hyperpigmentation, obesity, and hirsutism. Chest radiographic and electrocardiographic findings were normal. Fundoscopy revealed grade II hypertensive retinopathy. Elevated serum ACTH levels were consistent with primary hypercortisolism. The transthoracic echocardiography showed the image of a single, hyperechoic, and irregular mass located in the left atrium (Figure 1). The mass was voluminous, pedunculated, and adhered to the anterior leaflet of the mitral valve, causing obstruction of the left ventricular inlet blood flow. Surgical resection of the tumor was performed, and the histopathological features confirmed the diagnosis of myxoma. Screening for Carney complex was performed. Testicular ultrasonography and abdominal tomography revealed testicular microcalcifications and adrenal tumors, respectively. The patient underwent an uneventful adrenalectomy and was discharged from the hospital on corticosteroid therapy. PRKAR1A gene sequencing showed heterozygosity for the nonsense variant R228X in the patient and his mother.
Conclusion: Atrial myxoma justifies surgical resection due to the risk of cardiovascular embolization, complications, and sudden death. Pediatric cardiac myxomas should raise the suspicion of a Carney complex. The early diagnosis of this syndrome contributes to the optimization of the treatment of these patients and can have a positive impact on their management and prognosis.
107905
Modality: E-Poster Researcher – Case Report
Category: HEART FAILURE/CARDIOMYOPATHY/TRANSPLANT
ANTONIO TANAJURA GOMES NETO1, Bruna Aparecida Souza Machado1
(1) Clínica Médica Santa Helena – CMSH
Introduction: The clinical presentation of myocarditis is variable and often mimics myocardial infarction. The diagnosis of acute myocarditis is frequently empirical and is made based on clinical presentation, electrocardiographic alterations, elevated cardiac enzymes, and theabsence of epicardial coronary artery disease. We report the case of a 46-year-old patient with a history of IgA nephropathy (NIgA) admitted for atypical acute precordial pain associated with ST-segment elevation in the inferiorwall lead.
Description: A 46-year-old man with a history of NIgA, SAH, PLD, obesity (BMI 34) and sedentary, using anlodipino/losartan (2.5 mg/50 mg daily), succinato de metoprolol (50 mg daily) and simvastatin (20 mg daily). He was a non smoking and had no family history of coronary heart disease. The patient complained of chest pain into his right hemithorax over the 2 days, stabbing, intermittent, of moderate intensity that traveled into his sternum and right shoulder. The patient looked anxious and high blood pressure (200 × 100 mmHg). His vital signs were stable. Performed ECG and measurement of myocardial necrosis markers (MNM). He was classified as MNM and after improvement he was discharged in a reasonably good condition. ECG: showed ST-segment elevation in the inferior wall. Lab: Hb/Ht: 16/54 U: 35 Cr: 1.39 CKMB: 12 U/L (VR <5 U/L) Troponin: 13 ng/ml (VR: Between 0 and 0.5 ng/ml) Proteinuria 4,488.96 mg/24h Urine volume 1,120 ml Negative thrombophilia investigations. Echo TT: Preserved global and segmental LV systolic function, LV concentric remodeling, and type I diastolic dysfunction. Cate: Myocardial bridge with mild systolic constriction. Cardiovascular magnetic resonance (CMR): Presence of late mesocardial enhancement (n