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Central Illustration : Associated Factors to the Risk of Obstructive Sleep Apnea in the Acute Phase ofMyocardial Infarction OSA: Obstructive sleep apnea; STEMI: ST-segment elevation myocardial infarction.

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Central Illustration : Role of the CHA2DS2-Vasc Score in Predicting Contrast-Induced Nephropathy After Primary Percutaneous Coronary Intervention CHA2DS2-VASc score in predicting CIN after PPCI. PPCI: primary percutaneous coronary intervention; CIN: contrast-induced nephropathy; NLR: neutrophil-to-lymphocyte ratio; AUC: Area under the curve; Sens: Sensitivity; ROC: receiver operating characteristic.

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Central Illustration : Enoxaparin Versus Unfractionated Heparin in Acute Coronary Syndrome Without St-Segment Elevation: A Systematic Review and Meta-Analysis Summary of the main findings.

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Abstract Background Right ventricle (RV) involvement in inferior wall myocardial infarction (IWMI) is considered a strong predictor of in-hospital mortality and complications. However, assessment of RV involvement and function remains challenging due to difficulties in chamber visualization. Objective This study aimed to assess RV involvement in patients with IWMI using myocardial wall velocity (tissue Doppler imaging) and strain rate parameters with conventional echocardiographic indices, evaluating RV function and its correlations with in-hospital mortality and morbidity. Methods An observational study was conducted from May 2020 to April 2021 in 210 patients with IWMI visiting a tertiary care center. For each participant, demographics and clinical characteristics were obtained, and an electrocardiography (ECG) was recorded. Following this, right ventricular global longitudinal strain (RVGLS) and echocardiographic parameters (Tei index, right ventricular fractional area change [RVFAC], and tricuspid annular plane systolic excursion [TAPSE]) were estimated. Chi-square test was performed for differences in outcomes between patients with and without RV dysfunction. Correlation analysis was conducted between RVGLS, ECG, and other echocardiographic parameters. P < 0.05 was considered statistically significant. Results Pearson’s correlation analysis between RVGLS and Tei index among patients with IWMI indicated a moderate negative correlation (R = 0.610). Furthermore, RVGLS exhibited a moderate positive correlation with RVFAC (R = 0.635) and TAPSE (R = 0.718). At the cutoff of −16.75, RVGLS predicted RV involvement in patients with 97.0% sensitivity and 68.7% specificity. RVGLS predicted RV dysfunction in 44.8% of the patients in the mortality group. Conclusion RVGLS can be used as an alternative measure for predicting RV involvement in patients with IWMI.

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Abstract Background Psoriasis is a chronic inflammatory disease. Cardiovascular diseases, including arrhythmias, tend to occur more frequently in these patients. Objective This study aimed to investigate new electrocardiographic markers for assessing ventricular repolarization in outpatients with psoriasis in a tertiary center in Brazil. Methods This work is a cross-sectional study, which selected outpatients with psoriasis undergoing follow-up in a tertiary dermatology service in southern Brazil. The controls were selected from a private outpatient clinic. All the electrocardiogram (ECG) analyses were performed by one certified electrophysiologist. Comparative statistical tests and Spearman's correlation analysis were used. Measures with statistically significant differences in the univariate analysis were taken to the multivariate analysis (Generalized Linear Model – Poisson Regression with age adjustment). A P<0.05 value was considered statistically significant for all analyses. Results A total of 130 individuals were evaluated, mean age of 53.1±15.1 years. The univariate analysis showed no difference in Corrected QT interval (QTc) between the groups, considering 411.2±21.2 ms in the psoriasis group (PG) versus 412.8±25.2 ms in the control group (CG) (p = 0.694). The median values of Corrected QT dispersion (QTdisc) were lower in the PG as compared to the CG, 15.7 ms (IQR 11.5–24.2 ms) versus 39.8 ms (Interquartile Range, IQR, 32.8–46.6 ms), respectively (p<0.001). For peak-to-end interval of the T wave (Tp-e) and Tp-e/QTc values, the mean values were also lower in patients with psoriasis. For Tp-e, the mean values in the PG were 91.7±11.6 ms versus 96.0±9.2 ms in the CG (p = 0.024). For The Tp-e/QTc, the mean values in the PG were 0.22±0.03 versus 0.23±0.03 in the CG (p = 0.024). The multivariate analysis, adjusted for age, QTdis, Qtdisc, Tp-e, and Tp-e/QTc, remained independently lower in patients with psoriasis. Conclusion The evaluation of ventricular repolarization parameters in a sample of outpatients with psoriasis in southern Brazil showed that ventricular repolarization values were generally lower when compared to controls. No significant correlation was found between disease activity and ventricular repolarization parameters.

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Abstract Background Current guidelines recommend incorporating exercise and physical activity, such as inspiratory muscle training (IMT) and neuromuscular training, as adjunctive therapies alongside pharmacological treatments for patients with heart failure (HF). Objective To evaluate the effects of IMT and peripheral muscle training (PMT) on respiratory and peripheral muscle strength, lung function, and functional capacity in patients with HF. Methods This is a randomized controlled trial. Prior to randomization, all patients were assessed with the 6-minute walk test, inspiratory muscle strength (maximum inspiratory pressure [MIP]), expiratory muscle strength (maximum expiratory pressure [MEP]), vital capacity (VC), peak expiratory flow (PEF), and peripheral muscle strength (using the Medical Research Council [MRC] scale). Participants were then randomly assigned to one of four groups: group 1 (control), group 2 (IMT), group 3 (PMT), or group 4 (IMT + PMT). This study was registered in the Brazilian Registry of Clinical Trials (ReBEC) under number 2.382.698. One-way ANOVA with Bonferroni post-test was used to evaluate the four groups. The paired Student’s t test was used to compare the groups at different times. A p value < 0.05 was considered significant. Results A total of 52 patients were assessed. Regarding muscle strength, the group that underwent IMT combined with PMT showed a significant increase in both MIP (74 ± 15 at baseline versus 91 ± 16 at hospital discharge, p < 0.01) and MEP (92 ± 19 at baseline versus 102 ± 18 at hospital discharge, p < 0.01). Conclusion Based on these findings, it can be concluded that IMT combined with PMT has a positive impact in patients with HF, including improvements in both peripheral and respiratory muscle strength, reduction in dyspnea and fatigue, and enhanced tolerance to physical exercise.

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Abstract Background It is estimated that 1 in 10 patients will survive a cardiopulmonary arrest (CPA), with half of them occurring in an out-of-hospital setting. Mobile pre-hospital care services aim to reduce morbidity and mortality resulting from CPA. Objective To analyze five years of data regarding response time for assistance, mortality, and characteristics of victims of out-of-hospital CPA cases treated by a public mobile emergency service in Southern Brazil. Methods Data collected between 2018 and 2022 included the number of CPA cases, victim profile (age and sex), and details of each incident (day of the week, month, shift, city area, time elapsed before initiating basic life support [BLS], and mortality prior to arrival at the referral hospital). Pearson's Chi-square and Mann-Whitney U tests were used with a significance level of 5%. Results The victims' profile was mostly elderly (60%) and men (55.9%). The mortality rate from CPA was 87.3%, with over half of the cases (51.11%) requiring more than 15 minutes to initiate assistance. A longer response time was significantly associated with higher CPA mortality rates (p < 0.05). Conclusion The data showed a profile of victims that was mostly male and elderly. In more than half of the cases, BLS initiation took over 15 minutes, a delay that was linked to the high mortality rate of CPA, highlighting the association between mortality and time to assistance.

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Abstract Background Digital health uses innovative information technology for healthcare needs. Virtual reality (VR) is increasingly adopted in healthcare, including cardiovascular rehabilitation (CVR), to improve performance and adherence. However, digital interventions must consider users’ perspectives to prevent VR from becoming a barrier. Objective This study aimed to assess the usability and enjoyment of physical activity associated with VR among inpatients with heart failure (HF). Method A prospective pilot study was conducted with ten patients diagnosed with HF. Participants completed an exercise program on a cycle ergometer with immersive VR for lower limb training. Anxiety and depression symptoms, physical activity enjoyment, and system usability were evaluated. Statistical analysis included descriptive and inferential analyses with a 5% significance level (p<0.05). Pearson's test was used for correlation analysis. Results The population's tendency to experience anxiety and depression was evaluated, and the sample favorably assessed the system’s usability, with a mean score of 68.2 (standard deviation ±17.8); exercise enjoyment scored 79.6 (±7.7). No significant correlations were found between anxiety and depression profiles and usability or exercise enjoyment, suggesting further study phases. Conclusions VR can complement rehabilitation programs for HF patients, potentially improving performance and adherence. Additional research is required to evaluate the effectiveness of VR-associated physical activity on clinical outcomes in HF patients.

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Abstract Background Supraventricular tachycardia (SVT) is a common arrhythmia in pediatric patients. Emerging evidence suggests a link between systemic inflammation and cardiovascular diseases. Objectives This study aims to investigate the relationship between the monocyte/lymphocyte ratio (MLR) and neutrophil/lymphocyte ratio (NLR) with SVT in pediatric patients. Methods: We conducted a retrospective study at Rize Education and Research Hospital’s Pediatric Health and Diseases Department, including 33 patients diagnosed with SVT and 33 control subjects without sinus tachycardia. Hemogram (CBC) parameters, electrocardiography (ECG), and echocardiography (ECHO) were evaluated. NLR and MLR were calculated. The unpaired t-test is designed to compare the means of continuous variables between two groups, while the Mann-Whitney U test was applied for data not following a normal distribution. Correlations between values were analyzed through Pearson correlation. A significance level of p <0.05 was accepted. Results There was no significant difference between the groups in terms of age, lymphocyte count, hemoglobin, hematocrit, platelet count, and NLR. However, leukocyte count, monocyte count, and MLR showed significant differences (p<0.05). The SVT group had higher MLR values compared to the control group. Conclusions Our study found that MLR was significantly higher in pediatric patients with SVT compared to controls, suggesting a potential role of inflammation in SVT pathogenesis. Further large-scale, prospective, and multicenter studies are needed to confirm these findings and clarify the relationship between inflammation markers and SVT.

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Abstract Introduction Intraoperative hypotension (IOH) is a frequent complication associated with adverse cardiovascular, cerebral, and renal outcomes, with increased mortality. Recent evidence indicates that cumulative exposure time to hypotension is a significant factor, related to both the duration and severity of hypotensive episodes. The Hypotension Prediction Index (HPI) algorithm, with active alerts, showed that hypotension periods can be significantly reduced. Objectives To describe an artificial intelligence (AI) algorithm for hypotension prediction integrated into real-time anesthesia record-keeping software and Clinical Decision Support Systems (CDSS) that can warn anesthesiologists about the possibility of the onset of hypotension up to 20 minutes in advance. Methods This prediction tool incorporates four machine learning classifier models developed using the XGBoost, a supervised learning library that works with decision trees with gradient boosting. These models were trained, validated, and tested based on a database of approximately 0.5 million anesthesia records, using real world data. Results Accuracy ranged from 84.92% to 89.07%, and sensitivity ranged from 82.15% to 90.86%, with the best results found in five-minute predictions and the worst in twenty minute predictions. The algorithm was tested in all types of surgical procedures but only using adult data. Separate analyses were performed on small, medium, and large procedures of different surgical specialties with similar results. Conclusions The present study demonstrated the use of an AI algorithm integrated into anesthesia record-keeping software, showing a high accuracy for hypotension prediction. This algorithm is available for all types of anesthesia care in adult procedures.

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Central Illustration : Delay Times in Acute Myocardial Infarction Care: Comparison Between Periods Before and During the COVID-19 Pandemic Time taken to seek emergency care after the onset of pain and from the FMC to percutaneous treatment in patients with acute myocardial infarction with STEMI according to period of the COVID-19 pandemic (times shown in minutes), in addition to the relationship with the mortality rate of each period

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Central Illustration : Platelet Distribution Width as a Marker for Severity and Extent of Coronary Artery Disease in Acute Coronary Syndrome

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Central Illustration : Summary of the study design. The intervention involved digital technology aimed at improving medication compliance, the modification of risk factors, and clinical outcomes

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Central Illustration : Angiotensin-Converting Enzyme Inhibitors Evaluated by Office and Home Blood Pressure Measurements: TeleHBPM Study Rate of patients without hypertension control by HBPM with ACEI monotherapy.

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Abstract Background: Elderly patients are more likely to develop cardiovascular events. Tools for risk stratification serve as support to prevent threats of events and assess eligibility for statin use. Objectives: Evaluate the degree of concordance between tools for cardiovascular risk stratification in elderly patients. Methods: Cross-sectional, observational, descriptive, analytical study, with secondary data from 124 medical records of patients treated at a geriatric outpatient clinic in the South of Santa Catarina, Brazil. Variables present in the cardiovascular disease (CVD) risk stratification instrument were analyzed. Subsequently, the tools were compared. Inferential analysis was carried out with a 95% confidence interval and significance level α = 0.05. The Shapiro-Wilk and Kolmogorov-Smirnov tests were applied to determine the normal distribution of quantitative variables. The degree of concordance between CVD risk stratification instruments was calculated using the kappa concordance index. Results: Most patients were classified as high risk. There was a discrepancy regarding SCORE2/SCORE-OP, as it proved to be highly sensitive to the threat of cardiovascular events (99.2% of patients were high risk). These outcomes relate to the fact that the sample was geriatric patients, with age being an independent risk factor. There was a significant p value (p < 0.001) when comparing ACC/AHA tools and the Framingham Score. Conclusion: CVD risk estimate and its comparison in different stratification tools presented an important concordance between AHA tools and the Framingham score. However, when assessing SCORE2/SCORE-OP, lower concordance was observed.

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Abstract Background: Hypertension is the main risk factor for cardiovascular mortality worldwide. Lifestyle medicine (LM) assesses health through seven domains (diet, physical activity, substance use, sleep, social support, stress management, and environmental exposure), which also include risk factors for hypertension. Purpose: To evaluate the association between lifestyle and hypertension in Brazil and Spain. Methods: Secondary analysis of data from two web surveys conducted in 2020 in Brazil and Spain, which assessed lifestyle through a multidimensional scale. We enrolled 5224 individuals of both genders, aged > 18 years, living in Brazil and Spain, and with Internet access. The main outcome was a self-reported hypertension diagnosis. We calculated the absolute and relative frequency of the independent variables and evaluated the factors associated with hypertension in logistic regression models. Results: 76.2% of participants were women, 57.9% were > 42 years old, and 66.9% had finished higher education. Over the last 12 months, 19.6% of Brazilians and 9.2% of Spanish reported diagnosis/treatment of hypertension. Male and older groups living in Brazil, with lower education and worse lifestyles, were more likely to report hypertension. General lifestyle score was not associated with hypertension in Brazil, while hypertensive individuals had better scores in Spain (p < 0.001). Hypertensive individuals had worse lifestyle scores in physical activity (p < 0.05) and sleep (p < 0.05) in Brazil and better diet scores in Spain (p < 0.001). Environmental exposure was better among hypertensive individuals in both countries (p < 0.001). Our results point to cultural and socioeconomic differences between both countries. Conclusion: LM is an important strategy for the prevention/treatment of chronic diseases such as hypertension

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Abstract Background: The present study describes the prevalence of excess weight, obesity, and high blood pressure (BP) in children from a Brazilian semiarid region (Sertão) and its association with lipid profile and area of residence. Objective: To describe the prevalence of excess weight, obesity, and high BP in children, as well as the association between these variables, lipid profile, and area of residence. Methods: Thi work is a cross-sectional study conducted with schoolchildren, aged 6 to 10 years, from three municipalities in the countryside of Brazil. Weight, height, waist circumference (WC), and BP, together with the analysis of lipid markers, were assessed. Z-scores (BMI-Age) were used to determine the anthropometric classification. Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG) were meseared with eight hours of fasting. The Student's t-test and the Mann-Whitney test were aplied. Perceptual maps were constructed through multiple correspondence analysis. A p-value<0.05 was considered statistically significant. The Institution's Ethics Committee approved this study (CAAE: 35038914.3.0000.5544). Results: Among 138 schoolchildren in this study, 76 (55.07%) were female and 81 (58.7%) were from urban areas. Twenty-one children (15.2%) were overweight, and 44 (31.9%) had a family history of obesity. Children from rural areas showed higher levels of TC (p = 0.041) and systolic BP (p = 0.028). The correlation between excess weight and a family history of obesity (p = 0.029), TG (p = 0.003), TG/HDL ratio (p = 0.009), systolic BP (p = 0.000), and WC (p = 0.000) were observed. In the correspondence analysis, the eutrophic group presented expected values for lipid variables. Conclusion: Overweight indicators are associated with cardiometabolic risk factors, reinforcing the need for early monitoring.

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Abstract Background: Congestive heart failure (CHF) is an intricate clinical syndrome that significantly contributes to morbidity and mortality. Despite extensive advancements, research on markers of severity in CHF remains scarce. Objectives: This study aims to evaluate procalcitonin (PCT) and D-dimer as severity predictors in CHF. Methods: CHF patients were included in this retrospective single-center study between January to December 2022. The population group was randomized and classified as stages I to IV based on the New York Heart Association (NYHA) functional classification system. Mean differences and multivariate analysis were performed with a statistical significance at p < 0.05. Results: A total of 72 CHF patients were included in the study. The correlation analysis revealed that PCT (p ≤ 0.001), D-dimer (p ≤ 0.001), and systolic blood pressure (SBP) (p = 0.005) were all found to be correlated to the CHF stages. In the analysis of mean differences, PCT (p < 0.001) and D-dimer (p < 0.001) showed significant variation across the CHF stages. The optimal PCT and D-dimer cut-off values were 1.190 ng/mL and 2.110 ng/mL respectively. Conversely, the area under the receiver operating characteristic (ROC) curve was significant for both PCT (Area Under the Curve [AUC]: 0.962; 95% CI: 0.921-1.000; p < 0.001) and D-dimer (AUC: 0.929; 95% CI: 0.868-0.989; p < 0.001). Meanwhile, through multivariate analysis, D-dimer is significantly correlated with the various CHF stages (95% CI: 0.034-0.101, p < 0.001) but not for PCT (95% CI: 0.009–0.017, p = 0.561). Conclusion: A significant association between D-dimer levels and CHF stages was found, suggesting the potential of D-dimer as a valuable marker of severity in CHF patients.

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Abstract Background: Cardiopulmonary Resuscitation-Induced Consciousness (CPRIC) is rare and poorly understood, impacting the effectiveness of Cardiopulmonary Resuscitation (CPR). In Brazil, investigating the prevalence and characteristics of CPRIC is essential in order to improve protocols and properly train health professionals and firefighters. Objectives: To investigate the occurrence of CPRIC and to verify the knowledge and experience of health professionals and firefighters concerning this phenomenon. Methods: This work was a cross-sectional observational study conducted with 507 professionals from different regions of Brazil who work directly with resuscitation maneuvers. An online questionnaire, containing 19 questions about professional profile, experience in cardiopulmonary arrest (CPA), and knowledge and recognition of CPRIC, was used. Data were analyzed using descriptive and inferential statistical techniques, including unpaired Student's t-test and chi-square test, along with logistic regression to calculate the odds ratio (OR). The level of statistical significance was p<0.05. Results: The CPRIC presence rate was 0.22%, with 57.2% of the professionals reporting prior knowledge of the phenomenon. Inferential analysis showed that profession, number of CPAs witnessed in the last year, and specialization were significantly associated with CPRIC knowledge. Conclusion: Limited understanding and variability in exposure highlight the need to update CPRIC management guidelines, incorporating specific guidance on CPRIC.

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Abstract Background: Childhood and adolescent obesity has been increasing, particularly in countries with greater social vulnerability. Given this context, assessing schoolchildren from Bahia's backlands — a region known for its low-income population — is essential. Objective: To assess the frequency of overweight and obesity and their association with high blood pressure (BP) in children from urban and rural areas in four municipalities in the backlands of Bahia. Methods: This study is part of a project evaluating the impact of a school meal intervention on the health of children and adolescents in Bahia's backlands. A subset of children aged five to ten from public schools in both rural and urban areas of four cities in Bahia's backlands was selected through random and proportional sampling. The participants had their weight, height, waist circumference and BP measured using standardized protocols. The Body Mass Index (BMI) was expressed as a z-score to determine nutritional status. The Student's t-test and Chi-square tests were used, with 5% statistical significance. Results: The sample consisted of 461 students, 264 (57.3%) from urban areas and 238 (51.6%) males. The prevalence of overweight was 27.9%, and that of increased waist circumference was 7.4%. High BP or hypertension had a prevalence of 8%. A significant difference (p = 0.049) was observed between rural and urban areas in relation to the increased waist circumference. Conclusion: The research revealed a high frequency of overweight, increased waist circumference and systemic BP in students, mainly those from urban areas.

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Abstract Background: The prevalence of patent foramen ovale (PFO) is 27%. PFO is related to paradoxical embolism, which can cause ischemic stroke. Ischemic stroke without an identifiable cause is common, accounting for up to 40% of cases, and PFO is frequently found in these patients. The prevalence of PFO is almost 3 times higher in elderly patients with ischemic stroke without identified etiology, suggesting that these patients may also benefit from PFO closure. Objectives: The primary objective was to assess the recurrence of ischemic stroke or transient ischemic attack during clinical follow-up. The secondary objective was to assess the occurrence of procedural complications, onset of atrial fibrillation, and reduced anticoagulant use. Methods: This retrospective cohort study included 36 patients over 60 years of age with prior ischemic stroke who underwent PFO closure. Survival analysis was performed using the Kaplan-Meier model. Independence tests between categorical variables were performed using the chi-square test and Fisher's exact test, adopting a significance level of 0.05. Results: The patients’ mean age was 69.6 ± 6.5 years, and 55.5% were men. No complications occurred during the procedures. Echocardiography was performed 30 days after the intervention, showing no residual shunts. During the follow-up of 58.9 ± 42.7 months, there were no cases of ischemic stroke, transient ischemic attack, or atrial fibrillation related to the procedure. The use of anticoagulants decreased from 41.7% to 5.6% (p = 0.03). Conclusions: Percutaneous PFO occlusion for the prevention of cerebrovascular events in individuals over 60 years of age with prior ischemic stroke is effective and safe, with a low risk of complications, and it can reduce the risk of bleeding by reducing the use of anticoagulants.

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Abstract Background: Low functional health literacy in anticoagulated patients using warfarin has been widely discussed in medical literature. Objective: To identify the quality of oral anticoagulation (QOA) over time and to analyze the association between this variable and functional health literacy. Methods: Prospective cohort study conducted at an anticoagulation clinic (AC) in Minas Gerais, in a high-complexity hospital. The study included 81 patients, whose data were collected by direct consultation of medical records or by asking questions while patients were waiting for care. The QOA was assessed at 6, 9, 12, 15, and 18 months after the beginning of this study, and analyses of the association between this variable and functional health literacy were performed at the different time points. The QOA was identified by calculating the Therapeutic Time Range (TTR), with good quality being obtained with TTR values >59%. The incidence analysis of the TTR was performed for each of the five time points of the study through univariate Poisson regression. The significance level adopted in the statistical analysis was 5%. Results: Throughout the study, inadequate control of oral anticoagulation was observed, with only 20% of the patients showing persistent improvement in TTR values. No statistically significant association was identified at the different measurement times between TTR and functional health literacy. Conclusion: There was no direct association between the QOA and functional health literacy. However, the low incidence of persistent quality of anticoagulation in patients with low literacy suggests the development of specific educational actions for this subgroup of patients.

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Abstract Background: Considering the uncertainty regarding the cardiovascular safety of anabolic steroid use, we believe that the use of advanced echocardiography techniques, such as speckle tracking, may contribute more objectively to the analysis of cardiotoxicity induced by these substances. Objectives: To compare, through speckle tracking, the echocardiograms of bodybuilders who abuse anabolic steroids with those who do not use these substances. Methodology: This work is a retrospective, observational study that analyzed echocardiograms performed on bodybuilders followed up in an outpatient sports cardiology service, comparing the results between individuals who use and those who have never used anabolic steroids. Continuous data was compared, using unpaired, two-tailed, Student's T test, with a p-value < 0.05 considered to be significant. Results: The final sample of this study included 22 bodybuilders, 14 of whom were anabolic steroid users (UAS) and 8 non-users of anabolic steroids (NUAS). All 22 participants had a left ventricular ejection fraction (LVEF) > 50% (UAS = 55±4 vs. NUAS = 63±1%; p < 0.001). All 14 steroid users showed abnormal global longitudinal strain (GLS), while all 8 non-users presented normal values for this variable (UAS = 13±2 vs. NUAS = 20±2; p < 0.01). Conclusion: Bodybuilders who use anabolic steroids, despite having normal values for conventional echocardiography parameters, show a reduction in GLS of the left ventricle. The use of speckle-tracking echocardiography represents an important tool in the analysis of myocardial injury in UAS, offering the possibility of early detection of systolic dysfunction in these individuals.

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Abstract Background: Metabolic syndrome (MS) is a cluster of conditions, including hypertension, dyslipidemia, and abdominal obesity, associated with increased cardiovascular risk. In the elderly population, the prevalence of MS varies widely depending on region, lifestyle, and diagnostic criteria. Understanding the components that contribute most to MS can aid in targeted health interventions. Objective: This study aimed to investigate the prevalence of MS and identify which components most influence its diagnosis among older adults. Methods: This is an epidemiological, cross-sectional study conducted from January to December 2022, with people aged 60 or over, of both sexes. Data were obtained in three steps (interviews, clinical examinations, and laboratory tests). Data were entered in duplicate and analyzed using PAST software. The criteria and cutoff points adopted to diagnose MS were those proposed by NCEP ATP III. Results: This study evaluated 127 older people, 63% female. The prevalence of MS was 40%, and the most prevalent component was arterial hypertension. Hypertriglyceridemia, waist circumference, and high blood glucose were the components of MS that contributed to 68.2% of the diagnosis of this condition. Conclusions: The prevalence of MS was high in the population assessed. Hypertension was the most prevalent component, and hypertriglyceridemia was the component that most explained it.

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Abstract Introduction: Cardiac surgery is a procedure that requires great assistance and care. In this way, patients are sent to the intensive care unit (ICU), where they are connected to mechanical ventilation (MV). Prolonged treatment of these patients worsens clinical outcomes and leads to mortality. Objective: To evaluate the impact of MV time on patients undergoing cardiac surgery. Methods: This is a retrospective cohort study. After surgery, patients were admitted to the ICU and connected to MV. The entire ventilation adjustment and weaning process was conducted according to the unit's routine. They were divided into two groups, patients who continued on MV for more than eight hours and those who remained for less than eight hours. From this, univariate and multivariate analyses were carried out between predictor variables — MV time, age, sex, and cardiopulmonary bypass (CPB) time — and mortality. We considered p<0.05 as significant. Results: A total of 110 patients were evaluated, 25 stayed on MV for more than eight hours. In the univariate analysis, MV time was associated with mortality (HR 0.7 [0.3–0.9], p = 0.01), remaining in the multivariate analysis (HR 0.4 [0.2–0.6), p = 0.01). The other variables were not associated with death outcome. Conclusion: MV time of more than eight hours is a predictor of mortality after cardiac surgery, given the contribution of some risk factors.

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Abstract Background: Arterial hypertension (AH) is a significant risk factor for cardiovascular diseases (CVDs), including myocardial infarction and stroke. The ITGB3 gene polymorphism, particularly T1565C (rs5918), has been implicated in various cardiovascular conditions, suggesting a potential role in diastolic dysfunction (DD) among AH patients. Objectives: The clinical-genetic relationship was studied between ITGB3 gene polymorphisms and DD in Azerbaijani patients with AH, with or without ischemic heart disease (IHD) and type 2 diabetes (T2D) mellitus. Methods: The study included 100 Azerbaijani patients, divided into case (n = 76) and control (n = 24) groups. Echocardiography was used to assess left ventricular diastolic function. ITGB3 gene was identified using the MassArray system. Statistical analysis involved both parametric and non-parametric tests using the IBM SPSS Statistics 26. Results: The study reported a significant association between ITGB3 gene polymorphisms and DD in AH patients. The T/C, C/C genotypes were particularly correlated with DD. The C/C variant, while more frequent in the AH group, did not reach statistical significance. A direct correlation was observed between DD and the C allele of the ITGB3 gene, with a higher E/e’ ratio and lower e’ velocity among carriers. Conclusion: This study highlights a significant association between ITGB3 gene polymorphisms and DD in Azerbaijani patients with AH. These findings suggest the potential for genetic screening to identify individuals at higher risk of DD among hypertensive patients, underscoring the importance of personalized approaches in managing hypertension and its complications. Further research with larger and more diverse cohorts is needed to validate these results and explore the underlying mechanisms.

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Abstract Background: The impact of the COVID-19 pandemic on the healthcare of patients with ST-segment elevation acute myocardial infarction (STEMI) in Brazil remains unclear. Objective: Provide a descriptive analysis of clinical profiles, time intervals, performance metrics, and outcomes in patients with STEMI before and during the COVID-19 pandemic. Methods: Among a cohort of 193 patients with STEMI diagnosed in five emergency departments within a single Brazilian healthcare network, 187 patients were included between January 2017 and April 2021 and stratified into two cohorts: Cohort I (pre-pandemic, 146 patients) and Cohort II (pandemic, 41 patients). Statistical significance was defined as a two-sided p value < 0.05. Results: The mean age of the participants was 62.7 years (standard deviation: 13.2); 83.4% were male, and 86.1% underwent primary percutaneous coronary intervention (PCI). Duration from symptom onset to emergency department presentation was 60 minutes in both cohorts (interquartile range, IQR: 30 to 150 in Cohort I versus 30 to 152 in Cohort II, p = 0.273). Total ischemic time was 132 minutes in Cohort I (IQR: 94 to 222), and 117 minutes in Cohort II (IQR: 76.3 to 185.6) (p = 0.159). The observed STEMI time delays and performance metrics were comparable between groups, with reperfusion rates within the recommended time frame above 90% in both cohorts. Hospital mortality was 3.4% in Cohort I and 7.3% in Cohort II (p = 0.376). Conclusion: In the context of the COVID-19 pandemic, within a private healthcare network system in Brazil, this study did not uncover statistically significant disparities in clinical profiles, time intervals, performance metrics, or in-hospital mortality when compared to the pre-pandemic period.

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Abstract Background: Patients with chronic heart failure (HF) require outpatient monitoring after hospital discharge. The ability to use a smartphone with a personal messaging application may help. Objectives: Tis study aimed to investigate the feasibility of remote monitoring and evaluate its impact on treatment adherence and prognosis in patients with HF. Methods: A total of 100 patients were enrolled in the study: 57 patients in the mHealth group and 43 in the control group. The observation period lasted six months. Remote monitoring included a daily survey sent to patients via a personal messaging application. This was an open, randomized trial. A p-value < 0.05 was considered statistically significant. Results: After six months, 46 patients (mean age 61.52 ± 13.05 years, 34 men) in the mHealth group and 43 patients (mean age 60.07 ± 10.19 years, 27 men) in the control group completed the study. A total of 11 patients were lost to follow-up. In the mHealth group, two patients (4%) reached the primary endpoint, compared to seven patients (7%) in the control group. Conclusion: The effectiveness of remote monitoring for patients with HF using self-reporting via a smartphone messaging application was demonstrated. Patient adherence to self-reporting was found to be 76%. Those in the mHealth group who reported regularly and consistently demonstrated greater engagement in self-monitoring of vital signs and higher adherence to prescribed therapy.

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Abstract Background: Patients with chronic kidney disease (CKD) are at higher risk of cardiovascular disease. A dysfunctional autonomic nervous system may be the underlying cause. However, very few studies have determined the status of cardiac autonomic neuropathy (CAN) in both non-hemodialysis and hemodialysis CKD patients. Objectives: The present study intended to determine and compare CAN in both non-hemodialysis and hemodialysis CKD patients of primary renal diagnosis only and its correlation with the progression of the disease. Methods: Non-hemodialysis and hemodialysis CKD patients (n = 23 in each group) of both sexes of 18 to 50 years were recruited in this cross-sectional, observational study. Resting blood pressure and heart rate (HR) were measured, and lead II ECG was recorded for analysis of time- and frequency-domain measures of heart rate variability (HRV). Mann-Whitney U test was applied to compare the variables between the two groups. Spearman correlation was conducted to examine the relationship between variables and the stage of the disease (non-hemodialysis and hemodialysis CKD). A 2-tailed p value < 0.05 was taken as the cutoff level of significance. Results: Body mass index (BMI) was significantly higher in non-hemodialysis patients (p = 0.008). Resting HR was significantly higher in the hemodialysis group (p = 0.001). Among HRV measures, standard deviation of RR intervals (SDRR; p = 0.0001), standard deviation of successive differences (SDSD; p = 0.001), and root mean square of successive RR intervals (RMSSD; p = 0.001) were significantly lower in the hemodialysis group. Peripheral blood pressure was not significantly different between the two groups. Resting HR (r = 0.498, p = 0.001) was positively associated with the end-stage renal disease. However, SDRR (r = −0.507, p = 0.001), RMSSD (r = −0.507, p = 0.001), and BMI (r = −0.427, p = 0.004) were negatively associated with end-stage renal disease. Conclusion: Altered autonomic function was more profound in hemodialysis patients as evidenced by increased resting HR and decreased HRV measures (SDRR, SDSD, and RMSSD). Moreover, altered autonomic function was associated with end-stage renal disease. Therefore, CKD patients may be screened for CAN for early detection of cardiovascular disease.

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Abstract Introduction: Cardiovascular diseases (CVDs) remain among the leading causes of morbidity and mortality worldwide, posing a significant public health challenge. Thus, analyzing their prevalence over time is crucial. Objective: To perform an epidemiological analysis of emergency hospital admissions due to CVD in Brazil between 2013 and 2023. Methods: This is an ecological, descriptive study based on data from the DATASUS database. Cardiovascular morbidities classified by ICD-10, along with variables such as sex and age group, were selected for analysis. Data was collected in October 2024 and organized into graphs and tables. Results: From January 2013 to December 2023, 8,208,282 patients were admitted for emergency cardiovascular conditions, 53.7% of whom were male, with 26% aged between 60 and 69 years. A significant reduction in hospital admissions was observed in 2020 and 2021. Ischemic heart diseases were the most frequent cause of hospitalization, accounting for 29.72% of cases. A notable increase in mortality was recorded in 2021 and 2022, with higher mortality rates among male patients and those admitted for cerebrovascular diseases. Conclusion: The observed increase in hospitalizations is attributed to the demographic transition occurring in the country, while the sharp decline in 2020 and 2021 appears to be a consequence of COVID-19-related measures, which is a trend also observed in other countries. These findings underscore the importance of studying the epidemiology of CVD in Brazil and reinforce the need for public investment aimed at reducing their prevalence.

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Abstract Background: Large language models (LLMs) have made a significant impact in medicine and demonstrate substantial promise for further development. However, most of the existing research has predominantly centered on English-language tasks with lower medical complexity. This underscores the importance of investigating the performance of state-of-the-art LLMs in more complex specialties, such as cardiology, and in languages beyond English, such as Portuguese. Objective: This study aimed to evaluate and compare leading LLMs based on their performance on the validated cardiology knowledge assessed by the Brazilian Society of Cardiology's (SBC) Certification Exam. Methods: This study conducted a comparative analysis of 23 LLMs in the context of the SBC's Certification Exam. The exam consists of 100 multiple-choice questions, 20 of which include images that cannot be processed by all LLMs. Therefore, these image-based questions were excluded from the analysis. Results: Proprietary LLMs showed a varying performance, with GPT-4o achieving the highest success rate at 62.25%, followed by Claude Opus at 60.25%. In the medium-sized model category (up to 100 billion parameters), Claude Haiku reached 47.25%. Among open-source models, Llama3 70B Instruct scored 53.50% in the large model category (over 100 billion parameters), while Llama3 8B achieved 36.25% in the small model category (under 20 billion parameters). Conclusions: Both proprietary and open-source LLMs underperformed on the test, failing to meet the exam's cutoff score. Although larger models generally achieved better results, some medium-sized models — such as Llama3 70B Instruct and Claude Haiku—showed noteworthy results. The LLMs lacked specialized knowledge in cardiology and faced challenges in understanding Portuguese, revealing a significant gap in current AI capabilities and emphasizing the need for improvements.

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Abstract Background: The One-Minute Step Test (1MST) seems to be a useful tool for exploring the component of energy metabolism used in Activities of Daily Living (ADL), but it is still little explored in patients with Heart Failure (HF) in the hospital environment. Objective: To evaluate the feasibility and safety of performing 1MST in hospitalized patients with HF. Methods: Data were collected using electronic medical records and evaluative tests from patients with HF. The safety of the 1MST was assessed through vital signs records, perceived exertion, adverse events, and feasibility based on the ability to complete the test. The paired Student's T-test and Wilcoxon test were employed to compare the data before and after the test, depending on the distribution of the data, while the relationship between the variables was examined using Pearson's correlation test. The significance level set was p < 0.05. Results: Twenty patients were evaluated between May and December 2022. All patients completed the test, and no adverse events were recorded. Heart rate (HR) (p < 0.001), systolic blood pressure (SBP) (p = 0.01), mean arterial pressure (MBP) (p = 0.03), and respiratory rate (p < 0.001), and peripheral oxygen saturation showed a reduction (p = 0.04). A negative correlation was observed between 1MST and age (r = −0.46; p = 0.03) and a positive correlation between 1MST and length of stay in the CICU (r = 0.44; p = 0.04). Conclusion: It is concluded that the 1MST is a safe and viable tool for assessing the anaerobic metabolism of patients with HF.

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Abstract Background: Cardiovascular diseases are the leading cause of mortality worldwide. Wine consumption has been associated with cardiovascular benefits, which are attributed to the presence of flavonoids. Objectives: To assess the effects of alcoholic and non-alcoholic red wine on endothelial function by measuring variations in brachial artery flow-mediated dilation (FMD) and analyzing changes in arterial diameter, heart rate, and blood pressure. Methods: A randomized, parallel, controlled clinical trial was conducted with 22 participants assessed at 2 distinct time points. Participants consumed 200 mL of red wine and, after a 7-day washout period, received 200 mL of non-alcoholic wine. Data were analyzed using Student's t test. P values < 0.05 were considered statistically significant. Results: Pre-ischemia brachial artery diameter increased after both interventions: with alcoholic wine (3.21 ± 0.46 mm before versus 3.51 ± 0.53 mm after; p < 0.001) and non-alcoholic wine (3.16 ± 0.48 mm before versus 3.31 ± 0.58 mm after; p = 0.003). FMD showed a decrease after consumption of alcoholic wine (11.88% ± 8.40% before versus 5.98% ± 5.34% after; p = 0.007), whereas consumption of non-alcoholic wine did not result in significant changes (7.26% ± 6.39% before versus 6.01% ± 5.85% after; p = 0.572). Other parameters, such as heart rate and blood pressure, did not show any significant differences. Conclusion: Consumption of red wine, with and without alcohol, increased brachial artery diameter. However, alcoholic red wine was associated with reduced FMD, suggesting that ethanol may negatively affect endothelial function.

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Abstract Background: C-reactive protein (CRP) is a widely available inflammatory biomarker. Its prognostic role during hospitalization in patients with acute heart failure (HF) remains unclear. Objective: To assess whether CRP measured at hospital admission predicts in-hospital mortality in patients with acute HF admitted to a general public hospital ward. Methods: This prospective study enrolled patients (≥18 years old) admitted to a medical ward with a primary diagnosis of acute HF directly from the emergency department. CRP was measured within 72 hours of hospital admission. All patients underwent a structured clinical assessment by a cardiologist and transthoracic echocardiography (TTE). A p-value <0.05 was considered statistically significant. Results: A total of 44 patients were included (mean age 68 ± 16 years). TTE showed left ventricular ejection fraction (LVEF) <50% in 43% of patients, preserved LVEF in 43%, and specific causes of HF in the remaining 14%. The median CRP level (2.5 mg/dL) was used to define high and low CRP groups. Reduced LVEF (<50%) was more common, and heart failure with preserved ejection fraction (HFpEF) was less frequent, in the high CRP group (p = 0.014). Clinical assessment showed no differences in hemodynamic profiles (congestion vs. perfusion). Comorbidities, renal function, and infection diagnoses were also similar between groups. In-hospital mortality was 30% in the high CRP group versus 4.8% in the low CRP group (p = 0.046). In multivariable analysis, increased CRP remained independently associated with in-hospital mortality. Conclusion: CRP measured near the time of hospital admission may serve as a prognostic marker for in-hospital mortality in patients with acute HF.

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Abstract Background: Cardiovascular diseases (CVDs) are the leading cause of death in the world, and companies can implement prevention and control actions aimed at reducing risk factors among their workers. Objectives: To verify whether the result of model A of a CVD prevention and control program was superior to model B in reducing the cardiovascular risk (CVR) of individuals from an oil company. Methods: Retrospective evaluation of secondary data from a restricted and fixed cohort of 670 workers, from 01/01/2016 to 12/31/2018. The workers were divided by program model into Group A (514) and Group B (156). The 2016 CVR was compared with that of 2018, within and between groups, as well as the mean and prevalence of risk factors for CVD. Statistical analysis was set at a significance level of 5%. Results: Group A improved the level of physical activity (PAL), consumption of fruits and vegetables, and consumption of alcohol, but the "high" CVR increased from 0.4% in 2016 to 1.4% in 2018 (p<0.01). In Group B there was no change in the workers’ health profile, but the percentage of individuals with "intermediate" CVR increased from 14.1% to 16.7% (p=0.01). Conclusions: The actions developed by the company had a positive impact on the way of life of workers covered by the model A program; however, they were not sufficient to reduce CVR in this group.

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Abstract Background: Chronic kidney disease (CKD) is a condition characterized by abnormalities in kidney structure or function lasting more than 3 months. CKD is known to increase the risk of cardiovascular events, which may be predicted by electrocardiography (ECG) abnormalities, such as left ventricular hypertrophy (LVH). ECG is widely used in under-resourced health care settings due to its practicality and accessibility. Objective: This study aimed to analyze the relationship between LVH and CKD using ECG. Methods: This analytical observational study used a case–control design. The case group included patients diagnosed with CKD, while the control group consisted of patients presenting with signs and symptoms suggestive of CKD but without a confirmed diagnosis. Each group included 35 participants. Simple random sampling was used for the case group, and stratified random sampling for the control group. ECG examinations were performed, and measurements were taken using calipers in millimeters (mm). The Sokolow–Lyon criteria were applied to identify LVH. Data were analyzed using an independent t-test, with statistical significance set at p < 0.05. Results: The Sokolow–Lyon score was significantly higher in the case group than in the control group (p = 0.03). Conclusion: There is a significant association between LVH, as identified on ECG, and CKD. These findings may assist health professionals in resource-limited settings, where access to ECG is restricted.

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Abstract Background Aortic stenosis is a progressive condition that leads to significant morbidity and mortality if untreated. Transcatheter aortic valve implantation (TAVI) provides a less invasive alternative to surgical aortic valve replacement (SAVR), particularly for high-risk patients. Objectives This study evaluates the outcomes of TAVI procedures performed in a Health Maintenance Organization (HMO) in Brazil from 2013 to 2023, focusing on the impact of clinical guidelines updated in 2018. Methods A retrospective cohort study included 325 patients diagnosed with severe symptomatic aortic stenosis who underwent TAVI. Patients were divided into two groups: those treated before January 2019 (n=56) and those treated from January 2019 onwards (n=269). The primary outcomes included all-cause mortality and major complications, while the secondary outcomes encompassed procedural success rates and specific complication rates. Continuous variables were analyzed using the Mann-Whitney test, and categorical variables were analyzed using the chi-square test or Fisher’s exact test. Statistical significance was defined as p < 0.05. Results After January 2019, the shift to self-expanding valves was associated with a statistically significant reduction in pacemaker implantation rates (from 28.6% to 18.2%, p=0.03), whereas other outcomes did not reach statistical significance. Conclusions The implementation of updated protocols was associated with improved TAVI outcomes, especially a reduced need for pacemaker implantation, supporting its expanded use in intermediate-risk patients.

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Abstract Background Coronary artery disease is the leading cause of death worldwide, with high social and financial costs. Although previous studies have demonstrated the potential of chocolate to reduce coronary events, data on its effects in patients who have suffered an acute myocardial infarction (AMI) are lacking. Objective To evaluate the impact of chocolate consumption on the incidence of events in patients with AMI followed for one year. Methods A subanalysis of the Catarina Heart study, which evaluated patients hospitalized with a diagnosis of the first AMI, was conducted. During hospitalization, patients were asked about their chocolate consumption before the event. The incidence of events was compared between consumers and non-consumers of chocolate before the AMI. The analyzed outcomes included major adverse cardiovascular events (MACE), all-cause mortality, cardiovascular mortality, reinfarction, stroke, in-stent restenosis, acute stent thrombosis, gastrointestinal bleeding, and bleeding requiring transfusion. Cox regression models were applied, and p < 0.05 was considered statistically significant. Results A total of 1404 patients were analyzed, of whom 490 (34.9%) consumed chocolate. Chocolate consumption neither reduced the risk of MACE (hazard ratio [HR] = 0.88 [0.57 - 1.37], p = 0.569) nor showed benefits in other outcomes, such as cardiovascular mortality, reinfarction, or stroke. However, its consumption was significantly associated with an increased risk of gastrointestinal bleeding (HR = 2.89 [1.16 - 7.24], p = 0.023) without increasing the risk of bleeding requiring transfusion or acute stent thrombosis. Conclusion Chocolate consumption before AMI did not reduce major cardiovascular events and was associated with an increased risk of gastrointestinal bleeding.

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Abstract Background: Radial artery access is widely used in coronary procedures, but the optimal choice between left (LRA) and right (RRA) radial access remains controversial, especially in older patients. Objective: Compare LRA and RRA in patients ≥ 70 years undergoing coronary procedures. Methods: This study conducted a systematic review and meta-analysis of observational studies and randomized clinical trials (RCTs), adopting a significance level of 5% for all statistical analyses. We searched PubMed, Embase, and Cochrane Central for studies comparing LRA and RRA in patients aged ≥ 70 years. The main outcomes were fluoroscopy time, contrast volume, and procedure difficulty. Results: We included 1,094 patients from 4 studies, of which 3 were RCTs. Among them, 821 (75%) patients underwent the procedure via RRA. The LRA group showed a significantly shorter fluoroscopy time (standard mean difference [MD]: −0.41; 95% confidence interval [CI]: −0.67 to −0.42; p < 0.01; I2 = 80%), and there was a significant reduction in the contrast volume between the groups, favoring LRA (MD: −13.04 milliliters; 95% CI: −18.0 to −8.20; p < 0.01; I2 = 0%). However, there was no significant difference in the perceived difficulty level between the groups (risk ratio [RR]: 1.03; 95% CI: 0.61 to 1.73; p = 0.92; I2 = 0%). Conclusion: LRA is associated with a significantly shorter fluoroscopy time, suggesting a greater efficiency in terms of radiation exposure. These findings imply that, while LRA may offer some efficiency benefits, the choice between LRA and RRA should consider other clinical and technical factors, such as operator preference and experience.

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Abstract Background: Cardiovascular diseases (CVD) are the leading cause of death worldwide, and behavioral changes are a cornerstone of their prevention and treatment. However, implementing such changes can be challenging, and the use of validated protocols may support this process. Objectives: To develop, implement, and evaluate a continuing education protocol for primary care professionals focused on creating and monitoring action plans for the care of patients with arterial hypertension (AH) and diabetes mellitus (DM). Methods: The strategy involved 20 hours of in-person workshops and 15 hours of online training, based on Ministry of Health guidelines and covering topics such as physical activity, nutrition, and lifestyle. Evaluation was conducted through the development of team-based action plans and the administration of a satisfaction questionnaire. Results: The model was implemented in five municipalities, with 166 healthcare professionals participating in the in-person workshops. All teams developed action plans to implement the covered topics within their local contexts. The workshops on physical activity, nutrition, and lifestyle change were mostly rated as "good," "very good," or "excellent." The most frequently mentioned terms in the qualitative assessments were "content," "knowledge," and "practices." The strategy proved feasible, and partnerships with local public institutions enabled the active involvement of health professionals in proposing solutions to identified issues (Central Illustration). Conclusion: The action plans were tailored to local realities and reflected a high level of satisfaction with both the content and the hands-on approach of the sessions.

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Abstract Background: Cardiovascular disease (CVD) is the leading cause of death among individuals with chronic kidney disease (CKD), particularly those undergoing dialysis, accounting for approximately 40% of deaths. The prevalence of ischemic coronary disease among patients undergoing hemodialysis over the age of 45 reaches 41%. Objective: To analyze outcomes of symptomatic coronary artery disease (CAD) in patients undergoing chronic dialysis, stratified by invasive assessment, and treated with one of three approaches: medical therapy alone (MTA), percutaneous coronary intervention (PCI), or coronary artery bypass grafting. Methods: This was a retrospective, analytical, observational cohort study based on data from electronic medical records collected between 2013 and 2023, including a total of 68 patients. Quantitative variables were analyzed using one-way Analysis of Variance (ANOVA), and qualitative variables were assessed using Pearson's chi-square test. A p-value <0.05 was considered statistically significant. Results: The mean age was 60.2 ± 13.1 years, with a male predominance of 42 patients (62.8%). The highest mortality was observed in the MTA group with 25 deaths (69.4%), followed by PCI with 10 deaths (56.6%), and the lowest in the coronary artery bypass grafting group with six deaths (42.9%). Among patients who did not use statins, 19 (82.6%) died (p < 0.01). The lowest rate of readmission due to coronary syndrome occurred in the MTA group (two patients; 18.2%), while the highest was in the PCI group (six patients; 54.5%) (p = 0.02). Conclusion: Although no statistically significant difference in mortality was found among the three therapeutic strategies, MTA was associated with lower rates of readmission and repeat cardiac catheterization. In contrast, PCI was linked to a higher risk of readmission due to coronary syndrome.

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Abstract Background: Peripheral arterial disease (PAD) is primarily characterized by intermittent claudication (IC), a symptom resulting from insufficient oxygen supply to skeletal muscles during physical activity. IC manifests as discomfort in the lower limbs during exertion due to muscle ischemia and is typically relieved by rest. Objectives: To evaluate the effects of noninvasive electrostimulation on walking distance and claudication-related pain in individuals with lower limb PAD. Methods: This systematic review was conducted in accordance with PRISMA guidelines. Clinical trials published in English, Portuguese, or Spanish were selected from the MedLine, PEDro, and SciELO databases up to December 2024. The search strategy was guided by the PICO framework, using descriptors related to "peripheral artery disease," "intermittent claudication," and "noninvasive electrostimulation." Studies were included if they involved human participants diagnosed with PAD and presenting with Fontaine stage II intermittent claudication. Results: Seven clinical trials involving a total of 314 participants (mean age: 66.8 ± 3.6 years) were included. Four types of noninvasive electrostimulation were identified: neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), and electroacupuncture. Most studies reported that electrostimulation improved both pain-free and maximum walking distances, as well as reduced claudication symptoms. Conclusion: Noninvasive electrostimulation appears to be a promising adjunctive therapy for individuals with peripheral arterial disease, offering potential benefits in symptom relief and walking capacity. Given its safety, low cost, and ease of application, this intervention may serve as a practical strategy to complement traditional treatment approaches. However, further high-quality clinical trials are needed to establish standardized protocols and optimize clinical outcomes.

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Central Illustration : Management of Chronic Coronary Syndromes in Resource-Constrained Settings in India: An Expert Opinion With a Proposed Algorithm Proposed algorithm for the diagnosis and management of CCS in resource-constrained settings

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Abstract Hypertensive emergencies (HE) are life-threatening conditions triggered by sudden increases in blood pressure (BP) exceeding 180 mmHg systolic and/or 110 mmHg diastolic levels, often resulting in acute organ damage (AOD) and the risk of death. This article discusses contemporary practices in diagnosing and managing these episodes, emphasizing early recognition and immediate therapeutic intervention. It highlights the significance of a meticulous diagnostic assessment for appropriate clinical and therapeutic approaches, including detailed medical history, physical examination, and complementary investigations. Treatment focuses on the judicious use of intravenous antihypertensive agents such as sodium nitroprusside, nitroglycerin (NTG), beta-blockers, and calcium channel antagonists, stressing careful administration to prevent further harm. Individualization of treatment in HE is imperative and should be meticulously tailored to the patient's clinical profile and main complications, notably hypertensive encephalopathy, acute pulmonary edema, acute coronary syndromes, acute aortic dissection, and preeclampsia. These conditions require differentiated approaches due to their severity. The article underscores the scarcity of randomized controlled clinical trials addressing all daily practice questions regarding managing HE. This is due to the complexity of available drugs, clinical conditions, adverse effects, and drug interactions in various scenarios. Consequently, clinical wisdom and careful observation remain pivotal in decision-making. It also addresses the complexity of accurately measuring BP in emergency settings, which can pose an additional diagnostic challenge. Finally, it emphasizes the need for new evidence to guide therapeutic practices in HE, aiming to improve patient care and clinical outcomes continuously.

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Central Illustration : Artificial intelligence for nuclear cardiology: Perspectives and challenges Potential roles for AI in nuclear cardiology. AI has the potential to be applied during every step of a typical scan. AC: attenuation correction; ML: machine learning

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Abstract Several anthropometric parameters have been proposed as indicators of health conditions. Some have achieved wide acceptance and applicability. Others, although grounded in solid theoretical frameworks and demonstrating good diagnostic validity, have not gained the same level of recognition. These are referred to here as "unconventional anthropometric indicators". This article aims to provide a descriptive and conceptual synthesis of these measures, addressing their nuances and applicability. It is a narrative review that discusses the following indicators: Head-to-height index (HHI), Waist-to-Height Ratio (WHtR), Conicity Index (C-Index), Waist-to-Hip Ratio (WHR), A Body Shape Index (ABSI), Neck Circumference (NC), and Adductor Pollicis Muscle Thickness (APMT). WHtR, C-Index, WHR, and ABSI are based on the identification of abdominal fat accumulation and its association with cardiometabolic risks. However, for this purpose, waist circumference stands out due to its methodological simplicity and predictive effectiveness. NC is an indicator of subcutaneous fat, whose excess increases disease risk and is not influenced by factors that alter abdominal volume. APMT identifies muscle depletion and is comparable to other anthropometric predictors of malnutrition risk. HHI was proposed to identify individuals who experienced undernutrition early in life. Grounded in a robust theoretical foundation, it is a promising tool for advancing research on the Developmental Origins of Health and Disease (DOHaD). The indicators analyzed are valuable for monitoring cardiometabolic risk factors, each with its unique characteristics. Understanding these particularities is essential for selecting the most appropriate indicators for different contexts, thus enabling more effective interventions.

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Abstract Congenital heart disease (CHD) is a public health issue in developing countries. Effective teaching and training are vital for healthcare professionals to provide adequate care for critically ill cardiac children, but there are many obstacles to adequately training a cohort of healthcare professionals in low- and middle-income countries (LMIC), where education practice is not always aligned with current education evidence. Work overload, time constraints, language, and the healthcare structure itself hinder standardization of an optimal training process for this highly complex scenario. This narrative review aims to explore how current teaching methodologies may help overcome challenges in pediatric cardiac critical care (PCCC) education, thus helping clinical practice, with a special focus on developing countries and the Brazilian scenario.

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Abstract The use of simulation in medical education is now a well-established practice. Many articles currently explore various simulation methods and the impacts reported by students. In cardiology, this is no exception; however, reviews on the topic do not focus on a specific area. The objective of this study was to evaluate the existing evidence on the use of simulation in medical education, with a specific focus on cardiology. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched the Ovid MEDLINE, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), CINAHL, and CENTRAL databases. Clinical trials reporting the use of realistic simulation for teaching cardiology were included. Two independent reviewers assessed the studies for eligibility. The simulation methods and topics, along with their evaluations, were analyzed. A total of 435 articles were initially identified based on the search criteria. Seven articles were selected for detailed analysis. Three of these studies reported an improvement in cardiac auscultation skills through simulation. One study showed improved ability to recognize coronary anatomy; another demonstrated enhanced performance during catheterization, and one highlighted better outcomes during angioplasty. Only one study showed a slight improvement in the diagnosis of acute myocardial infarction. In addition to these clinical improvements, there was also a noted increase in student engagement and satisfaction. Realistic simulation, when integrated as a complement to existing curricula, enhances the performance of cardiology students.

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Figure 1 – 24-hour Holter tracing showing: A) Macroalternation of the T wave, B) QTc interval of 640ms and a short-long-short sequence generating an episode of polymorphic ventricular tachycardia associated with prolonged QTc interval - TdP (B). Source: Research data, 2023

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Abstract Severe cardiac injuries, such as blunt or penetrating injuries caused by bladed weapons, require early diagnosis, usually by electrocardiography, tomography, and Focused Assessment With Sonography in Trauma (FAST). This study describes a case of penetrating cardiac trauma successfully treated by surgical intervention. During surgery, the medical team identified a serrated knife blade in the anterior chest wall, associated with a rib fracture and pericardial injury, without compromising the diaphragm. The patient had a positive outcome after the intervention. Effective management of these injuries depends on understanding the trauma mechanism and the patient's characteristics, allowing for a rapid response and potentially life-saving therapies.

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Abstract Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute myocardial infarction (AMI), especially in young women without risk factors for coronary artery disease. Diagnosis is made by cardiac catheterization, and treatment varies from conservative to surgical approaches, depending on the severity. We report the case of a woman with a history of AMI who underwent initial catheterization without requiring percutaneous coronary intervention due to the absence of an obstructive lesion. Subsequently, the patient presented episodes of angina, and a new catheterization was performed, which revealed dissection in the left anterior descending and right coronary arteries. Given the lack of spontaneous resolution of the dissection, which was initially unilateral and progressed to bilateral, the patient underwent myocardial revascularization with mammary artery and saphenous vein bypass grafts. The objective of this study is to document a case of SCAD and to describe its characteristics, diagnosis, and therapeutic management.

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Abstract The authors describe a case of an infrequent triple association: left pulmonary artery aneurysm (PAA), uncorrected tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA), diagnosed in a 45-year-old adult patient during a check-up. The patient refused to undergo surgery and is currently being followed clinically.

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Abstract Background: Arrhythmias and Electrocardiography changes in Dengue Fever (DF) cases can mimic electrocardiogram (ECG) appearance of threatening clinical conditions such as myocardial ischemia, albeit no significant ischemic injury at the heart muscle. Case Presentation: We report a case of subsequent cardiac memory (CM) in a 50-year-old female with DF. A 12-lead ECG on admission revealed sinus rhythm with Left Bundle Branch Block (LBBB), and it resolved on day 4 of hospitalization. However, deep symmetric T wave inversions (TWI), which were later recognized as CM, occurred. The patient received treatment with Ringer's lactate and paracetamol infusion. A routine 12-lead ECG performed on day 7 of hospitalization revealed the resolution of TWI and normal sinus rhythm. Conclusion: This case report highlights one intriguing phenomenon associated with LBBB in DF, which is CM TWI, where the T wave ‘remembers’ the direction of the QRS complex during prior abnormal ventricular activation. Due to its similarity with TWI caused by myocardial ischemia, understanding of this phenomenon may prevent unnecessary interventions.

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Abstract Mitral stenosis (MS) is a valvular disease that predominantly affects women, with rheumatic fever being the most prevalent etiological cause. The hemodynamic consequences of rheumatic MS may include left atrial (LA) pressure overload and dilation, atrial fibrillation (AF), secondary pulmonary hypertension, heart failure, atrial thrombosis, and systemic thromboembolism. Echocardiography is the gold standard for diagnosing, quantifying severity, and evaluating the hemodynamic impact of MS. We present the case of a 41-year-old female patient who arrived at the emergency department with a 6-hour history of dysarthria and right hemiparesis. Cardiovascular examination revealed sinus rhythm and a diastolic murmur with an opening snap at the mitral focus. Imaging studies revealed severe MS with LA dilation and a patent foramen ovale without hemodynamic impact. The patient underwent percutaneous balloon mitral valvuloplasty, which resulted in an increase in mitral valve area (MVA), a reduction in pulmonary pressure, and significant functional improvement. Cerebral thromboembolism can be the first manifestation of severe MS, even in patients with sinus rhythm. Anticoagulation is crucial for those with severe atrial dilation to reduce the risk of embolic events. This case highlights the importance of early diagnosis and appropriate treatment based on clinical guidelines, as they improve patient quality of life and reduce the risk of future complications. It also serves as a reminder that stroke may be the sentinel event in silent but severe mitral valve pathology.

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Abstract Severe isolated tricuspid regurgitation (TR) is associated with limiting symptoms, negative impact on quality of life, and poor prognosis. The TricValve® device is a transcatheter self-expanding biological valve system designed to mitigate systemic volume overload, improve quality of life, and improve congestive symptoms. We report a 12-month follow-up of a 61-year-old woman with signs of refractory systemic hypervolemia and torrential TR who underwent the procedure. The treatment resulted in significant weight loss, improvement in signs of hypervolemia, and improvement in functional class (FC).

Resumo em Inglês:

Abstract We describe the first case in the literature of transcatheter correction of aortic-right ventricular (Ao-RV) shunt after aortic valve replacement (AVR) with an Intuity® prosthesis (Edwards Lifesciences). A 79-year-old patient with a history of coronary artery bypass grafting and aortic regurgitation underwent AVR using a rapid-release 25-mm Intuity® prosthesis. After 45 days, he presented with severe heart failure, and an Ao-RV shunt was identified on transthoracic echocardiography. Given his history of previous cardiac surgeries, percutaneous correction was attempted. Initially, an attempt was made to catheterize the defect via the transapical approach, which was unsuccessful. The right femoral artery was punctured, and the shunt was catheterized via the aorta, with the implantation of a MemoPart ventricular septal defects (VSD) occluder, resulting in a significant reduction of the shunt. The patient was then transferred to the intensive care unit. However, there was no satisfactory clinical improvement, and transthoracic echocardiography revealed persistent Ao-RV shunt. Therefore, the surgical team opted for a new approach through the femoral artery and a second MemoPart VSD occluder was implanted. A transesophageal echocardiogram showed no leak, and the patient progressed satisfactorily and was discharged from the hospital. Shunts after AVR are rare. In these conditions, percutaneous management is a safe and feasible technical option. This is the first case reported in the literature of this type of complication after Intuity prosthesis implantation.

Resumo em Inglês:

Abstract Duchenne muscular dystrophy (DMD) is a muscular disease genetically linked to the DMD gene, which encodes dystrophin, a protein that is crucial for the integrity of skeletal muscle and myocytes. This condition follows an X-linked inheritance pattern. Female carriers are typically asymptomatic; however, they may develop cardiomyopathy, making screening for structural heart disease advisable. We conducted a cross-sectional study to assess the prevalence of subclinical left ventricular (LV) dysfunction, defined by reduced global longitudinal strain (GLS), in asymptomatic female DMD carriers. Participants underwent 2-dimensional speckle tracking echocardiography following a standardized protocol, with GLS values ≤ 18% classified as reduced. Continuous variables were described as mean ± standard deviation and categorical variables as percentages. The association between left ventricular ejection fraction (LVEF) and GLS was assessed using Pearson's correlation coefficient. The significance level adopted was 5%. Using a convenience sample, 17 participants (mean age 39 ± 5 years) were enrolled. No significant changes were observed in LV diameters, and the mean LVEF was 62% ± 5%. Reduced GLS was identified in 3 participants, indicating a prevalence of 17.6% for subclinical LV dysfunction. A weak correlation was found between GLS and LVEF (r = 0.366). Our findings indicate that approximately 1 in 6 female DMD carriers had subclinical LV dysfunction. These results highlight the need for genetic counseling for mothers of patients with DMD, as well as early screening with sensitive methods to detect heart disease in female DMD carriers.