Postoperative myocardial revascularization atrial fibrillation (POAF) is a clinical complication that affects about 30% of patients and its mechanisms of origin are still poorly understood. This fact ...makes it difficult to identify the patient at greatest risk for this arrhythmia. This mission seems evident due to the complications it entails, including longer hospital stays, risk of stroke, heart failure, and death. There are reports of preoperative clinical aspects inherent to the patient's condition, such as gender and age, and discontinuation of beta-blockers as risk factors. In addition, additional information obtained by electrocardiogram, echocardiogram, and blood count data, for example, present only modest predictive results. The analysis of heart rate and heart rate variability obtained by the Stroke Risk Analysis System (SRA) is a technique used to predict ambulatory atrial fibrillation (AF), using recordings of only one hour showing good accuracy. This system, however, has not yet been used to predict the emergence of POAF. The rationale for its use is based on the suspicion that the emergence of POAF is strongly related to sympatho-vagal imbalance and the increase in atrial ectopia, that is, changes in heart rhythm, the main variables analyzed by the SRA algorithm.
To assess the accuracy of the SRA to identify patients at risk of having POAF after coronary artery bypass graft surgery (CABG).
114 consecutive patients with coronary artery disease underwent coronary artery bypass grafting between the years 2015 and 2018. Between the first and fifth postoperative days, they underwent continuous electrocardiographic monitoring using the Holter system for cardiac rhythm analysis. Patients were divided into two groups: Group I was formed of those with POAF and Group II included patients without POAF. The tracings obtained by Holter were reanalyzed using the CardioManager®/Cardios program, converted and divided into one-hour sections using the SRA®/Cardios and Geratherm Converter program and submitted to the SRA-Apoplex medical/Geratherm® analysis algorithm. The SRA identifies three possibilities for classifying patient risk: a) Risk 0: patient in sinus rhythm; b) Risk 1: patient at increased risk for paroxysmal AF; c) Risk 2: patient with AF already present. For Group I, SRA were considered positive when Risks 1 and 2 were identified. For Group II, those identified as Risk 0 were considered negative SRA.
POAF occurred in 33/114 patients (28%). The sensitivity, specificity, positive predictive value, and negative predictive value of the SRA to identify patients with POAF were 69%, 84%, 69%, and 82%, respectively; the positive and negative likelihood ratios, in addition to the accuracy of the SRA were, respectively, 4.3%, 0.36%, and 79%. A subanalysis of the results of the day on which AF occurred was performed on the records obtained in the first three hours of recording and up to three hours before the appearance of POAF. In the first period, the SRA was able to predict POAF in 57% of cases, while in the second period, the system identified the arrhythmia in 83% of cases.
a) The SRA presents good accuracy to predict POAF; b) its accuracy is moderate in the first three hours of recording; c) the accuracy increases significantly near the beginning of POAF; d) these findings indicate that electrophysiological changes that precede POAF are acute, occurring a few hours before the event and are identified by the SRA algorithm.
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Chagas disease is one of the most important endemic parasitic diseases in Latin America. In its chronic phase, progression to cardiomyopathy has high morbidity and mortality. The persistence of a ...normal electrocardiogram (ECG) provides a similar prognosis to that of a non-diseased population. Benznidazole (BNZ) is the only drug with trypanocidal action available in Brazil.
A group of 310 patients with chronic Chagas disease who had normal ECGs at the first medical visit performed before 2002 were included. There were 263 patients treated with BNZ and 47 untreated. The follow-up period was 19.59 years. Univariate analyses showed that those treated were younger and predominantly male. As many as 79.08% of those treated and 46.81% of those untreated continued with normal electrocardiograms (p <0.0001). The occurrence of electrocardiographic abnormalities and relevant clinical events (heart failure, stroke, total mortality, and cardiovascular death) was less prevalent in treated patients (p <0.001, p: 0.022, p: 0.047 respectively). In multivariate analyses, the parasiticide treatment was an independent variable for persistence of a normal ECG pattern, which was an independent variable in the prevention of significant clinical events. The immunofluorescence titers decreased with the parasitological treatment. However, the small number of tests in untreated patients did not allow the correlation of the decrease of these titers with electrocardiographic alterations.
These data suggest that treatment with benznidazole prevents the occurrence of electrocardiographic alterations. On the other hand, patients who develop ECG abnormalities present with more significant clinical events.
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Teste de Inclinação (Tilt Test) Claudia da Silva Fragata
Journal of cardiac arrhythmias,
10/2018, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Open access
O Teste de Inclinação (Tilt Test) é um exame complementar que pode ser utilizado para diagnosticar a causa e definir o tratamento de pacientes com síncope. A síncope neurocardiogênica ou neuromediada ...é a principal causa de desmaios em pessoas sem doença cardíaca pré-existente e que pode ser desencadeada pelo estresse ortostático, ou seja, pela permanência do indivíduo imóvel na posição em pé. Pode também ser provocada por fatores associados como: medo, forte emoção, dor intensa, ato miccional, desconforto ao ver sangue e em coleta de exames de sangue, entre outros. Estudos epidemiológicos encontraram prevalência de que ao menos 40% da população geral apresenta pelo menos um episódio de síncope ao longo da vida. A fisiopatologia da hipotensão e da bradicardia envolvida na síncope neuromediada ainda não é completamente explicada pela ciência. Os mecanismos centrais e periféricos que são implicados na sua patogênese são complexos e implicações prognósticas de cada um dos tipos de resposta ainda são controversas.
Teste de Inclinação (Tilt Test) Claudia da Silva Fragata
Journal of cardiac arrhythmias,
10/2018, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Open access
O Teste de Inclinação (Tilt Test) é um exame complementar que pode ser utilizado para diagnosticar a causa e definir o tratamento de pacientes com síncope. A síncope neurocardiogênica ou neuromediada ...é a principal causa de desmaios em pessoas sem doença cardíaca pré-existente e que pode ser desencadeada pelo estresse ortostático, ou seja, pela permanência do indivíduo imóvel na posição em pé. Pode também ser provocada por fatores associados como: medo, forte emoção, dor intensa, ato miccional, desconforto ao ver sangue e em coleta de exames de sangue, entre outros. Estudos epidemiológicos encontraram prevalência de que ao menos 40% da população geral apresenta pelo menos um episódio de síncope ao longo da vida. A fisiopatologia da hipotensão e da bradicardia envolvida na síncope neuromediada ainda não é completamente explicada pela ciência. Os mecanismos centrais e periféricos que são implicados na sua patogênese são complexos e implicações prognósticas de cada um dos tipos de resposta ainda são controversas.
Teste de Inclinação (Tilt Test) Claudia da Silva Fragata
Journal of cardiac arrhythmias,
10/2018, Volume:
31, Issue:
4
Journal Article
Peer reviewed
Open access
O Teste de Inclinação (Tilt Test) é um exame complementar que pode ser utilizado para diagnosticar a causa e definir o tratamento de pacientes com síncope. A síncope neurocardiogênica ou neuromediada ...é a principal causa de desmaios em pessoas sem doença cardíaca pré-existente e que pode ser desencadeada pelo estresse ortostático, ou seja, pela permanência do indivíduo imóvel na posição em pé. Pode também ser provocada por fatores associados como: medo, forte emoção, dor intensa, ato miccional, desconforto ao ver sangue e em coleta de exames de sangue, entre outros. Estudos epidemiológicos encontraram prevalência de que ao menos 40% da população geral apresenta pelo menos um episódio de síncope ao longo da vida. A fisiopatologia da hipotensão e da bradicardia envolvida na síncope neuromediada ainda não é completamente explicada pela ciência. Os mecanismos centrais e periféricos que são implicados na sua patogênese são complexos e implicações prognósticas de cada um dos tipos de resposta ainda são controversas.
Objetivou-se avaliar o perfil dos metabólitos sanguíneos de novilhas leiteiras alimentadas com dietas isoproteicas constituídas por quatro fontes de proteína (farelos de soja, algodão, girassol e ...amendoim) contendo cana-de-açúcar como volumoso exclusivo. O delineamento experimental adotado foi um duplo quadrado latino 4 x 4, com oito animais, quatro tratamentos e quatro períodos experimentais. Na análise dos parâmetros sanguíneos foi utilizado um modelo que incluiu o efeito do quadrado, período, fontes proteicas, horário, e interação fontes proteicas x horários e as médias comparadas pelo teste de Tukey a 5% de probabilidade.As concentrações de proteínas totais, albumina, ureia e creatinina no soro sanguíneo das novilhas não foram influenciadas pelas diferentes fontes proteicas (P>0,05), porém, observou-se diferença significativa apenas nas concentrações médias de creatinina entre os horários de coleta de sangue (P<0,05). Entre os horários de coleta do sangue foi observada diferença significativa (P<0,05) nas concentrações médias de beta-hidroxibutirato e ácidos graxos não esterificados, e uma tendência para triglicérides (P=0,06).As fontes proteicas não causam alterações nas atividades séricas, sendo que os valores do perfil metabólico sanguíneo mantiveram na faixa dos valores considerados referência.
Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks.
To assess the different LA functions (reservoir, conduit and pump ...functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions.
10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging.
Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e' (average) with the reservoir and pump functions (TEF and AEF), and a positive correlation of e' (average) with s' wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions.
An impairment of LA functions in Chagas cardiomyopathy was observed.
The accuracy of the Stroke Risk Analysis Serafim, Kleber Rogério; Moreira, Dalmo Antônio Ribeiro; da Costa, Paulo Alexandre ...
PloS one,
03/2023, Volume:
18, Issue:
3
Journal Article
Peer reviewed
Postoperative myocardial revascularization atrial fibrillation (POAF) is a clinical complication that affects about 30% of patients and its mechanisms of origin are still poorly understood. This fact ...makes it difficult to identify the patient at greatest risk for this arrhythmia. This mission seems evident due to the complications it entails, including longer hospital stays, risk of stroke, heart failure, and death. There are reports of preoperative clinical aspects inherent to the patient's condition, such as gender and age, and discontinuation of beta-blockers as risk factors. In addition, additional information obtained by electrocardiogram, echocardiogram, and blood count data, for example, present only modest predictive results. The analysis of heart rate and heart rate variability obtained by the Stroke Risk Analysis System (SRA) is a technique used to predict ambulatory atrial fibrillation (AF), using recordings of only one hour showing good accuracy. This system, however, has not yet been used to predict the emergence of POAF. The rationale for its use is based on the suspicion that the emergence of POAF is strongly related to sympatho-vagal imbalance and the increase in atrial ectopia, that is, changes in heart rhythm, the main variables analyzed by the SRA algorithm. To assess the accuracy of the SRA to identify patients at risk of having POAF after coronary artery bypass graft surgery (CABG). 114 consecutive patients with coronary artery disease underwent coronary artery bypass grafting between the years 2015 and 2018. Between the first and fifth postoperative days, they underwent continuous electrocardiographic monitoring using the Holter system for cardiac rhythm analysis. Patients were divided into two groups: Group I was formed of those with POAF and Group II included patients without POAF. The tracings obtained by Holter were reanalyzed using the CardioManager®/Cardios program, converted and divided into one-hour sections using the SRA®/Cardios and Geratherm Converter program and submitted to the SRA-Apoplex medical/Geratherm® analysis algorithm. The SRA identifies three possibilities for classifying patient risk: a) Risk 0: patient in sinus rhythm; b) Risk 1: patient at increased risk for paroxysmal AF; c) Risk 2: patient with AF already present. For Group I, SRA were considered positive when Risks 1 and 2 were identified. For Group II, those identified as Risk 0 were considered negative SRA. POAF occurred in 33/114 patients (28%). The sensitivity, specificity, positive predictive value, and negative predictive value of the SRA to identify patients with POAF were 69%, 84%, 69%, and 82%, respectively; the positive and negative likelihood ratios, in addition to the accuracy of the SRA were, respectively, 4.3%, 0.36%, and 79%. A subanalysis of the results of the day on which AF occurred was performed on the records obtained in the first three hours of recording and up to three hours before the appearance of POAF. In the first period, the SRA was able to predict POAF in 57% of cases, while in the second period, the system identified the arrhythmia in 83% of cases. a) The SRA presents good accuracy to predict POAF; b) its accuracy is moderate in the first three hours of recording; c) the accuracy increases significantly near the beginning of POAF; d) these findings indicate that electrophysiological changes that precede POAF are acute, occurring a few hours before the event and are identified by the SRA algorithm.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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