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Central Illustration Garlic Extract Reverses Ischemic Heart Disease in Female Rats Exposed to Combined Oral Contraceptive Pills Effect of aqueous garlic extract on ischemic heart disease induced by combined oral contraceptive pills in female rats COC: combined oral contraceptive.

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Central Illustration : Heart Rate Reactivity to Acute Mental Stress is Associated With Parasympathetic Withdrawal and Adiposity in Firefighters

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Central Illustration : Characteristics of ST-Elevation Myocardial Infarction during the SARS-CoV-2 Outbreak Comparison of AMI cases during the SARS-CoV-2 outbreak with the previous year. Figure created with BioRender.com AMI: Acute myocardial infarction

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Abstract Background: People with haemophilia (PwH) are living longer. Therefore, they can develop atherosclerotic cardiovascular disease (ASCVD). Electrocardiogram (ECG) alterations may be a sign of initial ASCVD before the occurrence of symptoms. Objective: To describe the prevalence of resting ECG alterations among PwH adults asymptomatic for ASCVD. Methods: PwH aged ≥ 30 years without previous ASCVD events were considered for the analysis. Resting ECG traces were analysed according to international reference values and the Brazilian Longitudinal Adult Health Study (ELSA-Brasil) results for asymptomatic Brazilian men. Based on the established normal values and using the QT index, we further described the altered ECGs as minor or major changes, according to the Minnesota Code. Differences between prevalences were evaluated by Pearson's χ2 test. Differences between medians were evaluated by the Mann-Whitney U test. A p-value < 0.05 was accepted as statistically significant. Results: A total of 64 PwH were included in the study. Median age was 44 years (interquartile range 35-52). Most patients had haemophilia A (81%) and 47% were severe. The prevalence of obesity, systemic arterial hypertension (SAH), diabetes mellitus (DM), and dyslipidaemia were 16%, 56%, 14%, and 72%, respectively. All the PwH had sinus rhythm, except for one, who had an implanted pacemaker due to idiopathic third-degree atrioventricular block. Altered ECGs were found in 25% and 30% of PwH, according to established criteria and ELSA-Brasil criteria, respectively. Major changes were found in eight (13%) PwH according to the Minnesota Code, including two ECGs with ischaemia-like wall inactivity. Conclusions: The prevalence of altered ECG varied from 25% to 30% among asymptomatic PwH.

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Abstract Background Biomarkers related to the pathogenesis of atrial fibrillation (AF) have attracted the attention of experts. One of these recently studied biomarkers is Fetuin-A. Objectives This study aimed to evaluate the relationship between serum Fetuin-A levels and AF. Methods This study used the convenience sampling method, based on inclusion criteria and consent to participate in the study. The Shapiro-Wilk test was used to confirm the normal distribution of all continuous variables. Categorical variables were presented using absolute and relative frequencies. Both groups (48 patients with AF and 47 controls) were compared in terms of biochemical, hematological, and echocardiographic findings and Fetuin-A. the Chi-square or Fisher's exact test were used to compare groups concerning categorical variables. Continuous variables were compared using the independent samples t-test. P<0.05 was considered statistically significant. Results Serum Fetuin-A values increased in AF patients when compared to the controls (544±49 μg/mL versus 484±46 μg/mL, p=0.001). Moreover, Fetuin-A level was independently associated with AF — AOR = 0.978, 95%; confidence interval (CI) 0.969-988, p < 0.001. The cut-off values in Fetuin-A levels in patients with AF were >511.80 μg/mL with a sensitivity of 75% and a specificity of 73% — area under the curve (AUC) = 0.804, 95% CI = 0.715 - 0.892. Conclusions According to this study, there was a relationship between serum Fetuin-A levels and AF, regardless of conventional cardiovascular risk factors. Therefore, Fetuin-A may play a role in the pathophysiology of AF. Prospectively designed cohort studies are necessary to assess whether or not the results can be generalized for other populations.

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Abstract Background Congenital heart diseases (CHD) are one of the most prevalent malformations, and the screening tests to identify critical congenital heart disease (CCHD) is the pulse oximetry test, with subsequent investigation and treatment. Objective To quantify positive pulse oximetry tests and verify the prevalence of CCHD detected by it in asymptomatic newborns, ≥35 gestational weeks, in a Brazilian maternity hospital. Methodology This is an observational, retrospective, quantitative, analytical and cross-sectional study, conducted from October 2020 to May 2022, in a maternity hospital in southern Brazil, through the collection of records of positive oximetry pulse tests, following the norms of screening CCHD test of the Brazilian Society of Pediatrics (SBP), after they were evaluated with echocardiography for confirmation or exclusion of CHD. Results A total of 5,667 newborns were evaluated in this study, according to the inclusion criteria; 0.17% (n = 10) had a positive pulse oximetry test. Regarding the results of the echocardiography of the neonates with a positive test, two were normal, seven were cases of patent foramen ovale (PFO), and one was a case (0,017%) with interatrial communication (IAC) diagnosis. In the same period, five neonates with CCHD were born, symptomatic, diagnosed by physical examination, and referred to neonatal intensive care units (NICU) before taking the neonatal cardiac screening (< 24 hours of life). Conclusion The prevalence of positive pulse oximetry tests was 0.17% and none CCHD was detected. Five cases of CCHD were born in this period, but they were diagnosed before the recommend time to perform the screening test.

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Central Illustration : Therapeutic Adherence According to the Morisky Scale in Patients with Hypertension

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Central Illustration : Sociodemographic, Clinical Condition, and Functional Aerobic Capacity in Patients With Heart Failure With Varying Ventricular Ejection Fraction HF classified with different LVEFs, sociodemographic and clinical conditions, functional aerobic capacity, and HRQL.

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Central Illustration : Evaluation of Symptomatic and Asymptomatic Outpatients in the Post-COVID-19 Period With Electrocardiographic Ventricular Depolarization and Repolarization Parameters ECG: electrocardiogram; Tp-e: Tpeak-Tend; QTd: QT dispersion; fQRS-T: frontal QRS-T; FQRS: fragmented QRS; EF: ejection fraction; QTc: corrected QT.

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Central Illustration : Key Nanotechnology Breakthroughs in Cardiovascular Disease Therapy Nanometric scale figure illustration.12

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Central Illustration Effect of Ticagrelor on Left Ventricular Function in Patients with Mildly Reduced Ejection Fraction after Acute Myocardial Infarction CABG: coronary artery bypass graft; LVEF: left ventricular ejection fraction; tPA tissue plasminogen activator.

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Central Illustration : Hemoglobin/Red Cell Distribution Width Ratio is Associated With Poor Prognosis in Patients With Acute Coronary Syndrome in Long-Term Follow-Up Hb: Hemoglobin; RMI: recurrent myocardial infarction; R-TVR: recurrent target vessel revascularization; PTCA: percutaneous transluminal coronary angioplasty; STEMI: ST segment elevation myocardial infarction; NSTEMI: Non-ST segment elevation myocardial infarction; RDW: red cell distribution width; ACS: acute coronary syndrome; MACE: major adverse cardiac events; CAG: coronary angiography; AUC: Area Under the Curve ; ROC: Receiver Operating Characteristic Curve.

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Central Illustration : Evaluation of the Profile and Quality of Sphygmomanometers Available at a Health Education Institution in Belo Horizonte

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Abstract Background: Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, is associated with cardiovascular disease (CVD) development. TMAO can trigger an inflammatory response by inducing the nuclear factor-kappa B (NF-κB) signaling cascade and increasing the expression of pro-inflammatory cytokines, contributing to the worsening of CVD. This study aimed to evaluate the association between TMAO plasma levels and inflammation in patients with coronary artery disease (CAD). Methods: A cross-sectional study was carried out including 29 patients with CAD. Peripheral blood mononuclear cells (PBMC) were isolated from fasting blood samples, and NF-κB and vascular cell adhesion protein 1 (VCAM1) mRNA expression were estimated using real-time quantitative PCR. We determined TMAO plasma levels by LC-MS/MS and TNF-α by ELISA. Routine biochemical parameters were evaluated using an automatic biochemical analyzer. Correlations were estimated by Spearman or Pearson test. Statistical significance was set at the level of p < 0.05. Results: All patients presented TMAO levels within the normal range according to EUTox (normal range: 2.83 ± 1.53 mg/L; CAD patients: 0.2 [0.1 to 0.2] ng/μL). TMAO plasma levels were positively correlated with NF-κB mRNA expression (0.555; p = 0.002). Conclusion: TMAO plasma levels may be associated with NF-κB mRNA expression in patients with CAD and may contribute to the pathogenesis of this disease.

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Abstract Background: Vasovagal syncope (VVS) results in impaired quality of life (QoL). The response during the head-up tilt test (HUTT) influences QoL and recurrence. Objectives: To analyze the influence of the type of HUTT response on QoL in patients with VVS and recurrence of events after the exam. Methods: The SF-36 and Impact of Syncope on Quality of Life (ISQL) questionnaires were applied over 12 months after the HUTT. Unpaired Student's t test was used for differences between 2 groups of quantitative data with normal distribution. The recurrence of syncope episodes was analyzed using a Kaplan-Meier curve, and the log-rank test was applied to compare the curves regarding responses to the HUTT. Statistical significance was set at p value < 0.05. Results: We analyzed 82 patients (43.7 years old), 69% with previous recurrence (2.8 prior episodes). Cardioinhibitory response occurred in 46 patients; vasodepressor response occurred in 36, and 85.4% of patients received non-pharmacological treatment after the HUTT. During clinical follow-up, 43.9% had recurrence, mainly young patients (35.7 years; p = 0.002). On the SF-36, the best score was in functional capacity in men (p = 0.04) and patients without prior trauma (p = 0.001). There were lower limitations due to pain in patients without prior trauma (p = 0.003) and patients without prodromes (p = 0.009). On the ISQL, there were better mean scores in men (p = 0.002) and in patients without prior trauma (p = 0.02). Patients with cardioinhibitory response had better SF-36 and ISQL scores (p < 0.001). There was greater VVS recurrence in the cardioinhibitory response group (log-rank p = 0.011; hazard ratio: 8.48; 95% confidence interval: 7.59 to 9.3) from the second to the fourth month, with stabilization in the eighth month after the HUTT, when compared to patients with vasodepressor response. Conclusion: The majority of patients with VVS reproduced during the HUTT under non-pharmacological treatment did not report worsening of QoL during clinical follow-up. Worse QoL was observed in non-young patients and in patients with vasodepressor response, and it was not influenced by recurrence after the HUTT.

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Abstract Background: Arterial hypertension (AH) is a chronic disease distributed worldwide, and the Angiotensin II receptor type 2 (AGTR2) gene variants are potential DNA markers to study in association with this disease. Objective: This systematic review (SR) aimed to identify single nucleotide variants in the AGTR2 gene as genetic markers associated with AH. Methods: The electronic databases MEDLINE, Web of Science, SCOPUS, Cochrane Central Register, EMBASE, SciELO, and TripDatabase were searched for research up to September 2023. Case-control studies with DNA variants in the AGTR2 gene associated with AH as the outcome were included in the review. Boolean connectors and keywords were used according to each database. Results: After diverse rounds of scrutiny, a final number of eight articles were included for 8911 participants, comprising 5451 cases and 3460 controls. A significant proportion of the selected studies were performed in Asian populations and were heterogeneous. Although 238 variants were shown in the gnomAD v2.1.1 database for September 2023, only six variants were identified in all the analyzed studies. Conclusions: The results obtained were not conclusive that a specific variant located in the AGTR2 gene has a strong association with AH. The study of this gene re-emerged last year as an essential target to investigate due to its participation in the development of agonist therapy to treat mild COVID-19 cases. Future studies with better statistical power are desirable to replicate the primary findings.

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Abstract Introduction: Metabolic syndrome (MS) and obesity are risk factors for cardiovascular diseases (CVD). However, the development of cardiovascular pathologies in obese individuals without MS is being investigated. Objective: To investigate whether there are similar electrocardiographic (ECG) and echocardiographic changes in individuals with obesity with and without MS. Methodology: A retrospective, descriptive cross-sectional study was carried out with obese patients at a university hospital in Belém, Pará, Brazil. Anthropometric, laboratory, ECG and echocardiographic data were evaluated in both populations. The chi-square test was used to describe the relationship between variables among groups; hypothesis tests with p < 0.05 were considered statistically significant values. Results: The study evaluated 100 individuals with obesity, 60 of whom had MS. The average age was 54 years, and the female sex was prevalent. Systolic blood pressure, HDL, and waist circumference were altered in both groups. Systemic arterial hypertension and low HDL demonstrated 4.27 times and 3.32 times greater likelihood of presenting changes in the ECG and echocardiogram for both groups. On the ECG, diffuse changes in ventricular repolarization were observed in both groups. On echocardiography, left ventricular diastolic dysfunction and left ventricular hypertrophy were present in both populations studied. Conclusion: Obese individuals without MS present a similar risk, requiring adequate attention to their cardiac health.

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Central Illustration : Feasibility of the Two-Minute Walk Test in Elderly Patients After Acute Myocardial Infarction: A Cross-Sectional Study

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Central Illustration : Determination of Shock Index and Age Shock Index Cut-Off Points in Patients with ST-Segment Elevation Myocardial Infarction: SEMI-CI Study Summary characteristics of SI and ASI and their associations with MACEs ASI: age shock index; AUC: area under curve; CI: confidence interval; HR: heart rates; MACE: major adverse cardiovascular events; SBP: systolic blood pressure; SI: shock index.

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Central Illustration : Strengthening the Concept of Burden in Congenital Heart Diseases as a Contributor in Achieving Sustainable Development Goals: A Bibliometric Study

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Central Illustration : The Association Between Presystolic Wave and Subclinical Left Ventricular Dysfunction in Asymptomatic Hypertensive Patients GLS: Global longitudinal strain. *Assessed by GLS.

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Central Illustration : Hypertension, Hypercholesterolemia, and Insufficient Physical Activity Associated with Diabesity in Older Adults: A Cross-Sectional Study Factors associated with diabesity in older adults. PA: physical activity

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Central Illustration : Factors Associated with Variation in Time in Therapeutic Range in Two Anticoagulation Clinics in Brazil

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Central Illustration : Comparison of Chitosan-Containing Hemostatic Pad and Manual Compression after Coronary Angiography with Femoral Access Comparison of HP and MC in terms of hemostasis time

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Central Illustration : Brazilian Policies and Programs in Urgent and Emergency Care Services in the Context of Cardiovascular Diseases: A Scoping Review CVD: cardiovascular diseases; PP: policies and program; RUE: Urgency and Emergency Network; BPC: Good Practices in Cardiology

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Central Illustration : Development and Implementation of a Computerized Decision Support System for Screening Hypertension and Diabetes in a Resource-Constrained Region Flows for hypertension and DM screening. *The initial total number of individuals assessed includes those who followed the two flows concurrently (n = 1,203 individuals). Thus, the new diagnosis includes those patients who were screened for both disease (n = 5). DM: diabetes mellitus.

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Central Illustration : Evolution of Patients With Atrial Fibrillation According to the EHRA Categorization AF: Atrial Fibrillation; EHRA: Evaluated Heart valves, Rheumatic or Artificial; EF: Ejection fraction; OAC: oral anticoagulation.

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Central Illustration : A Geoprocessing Approach for Mortality and Social Vulnerability Analysis during the COVID-19 Pandemic ICU: intensive care unit

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Central Illustration : Quality of Life Assessment of Patients Infected With COVID-19 and Prior Coronary Artery Bypass Graft Surgery in Brazil: Four Years Follow-up CABG: coronary artery bypass graft surgery; QOL: Quality of Life

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Abstract Background Coronary artery disease (CAD) is the leading cause of mortality worldwide. Adequate management of risk factors is directly correlated with better outcomes. Objectives This study aims to identify risk factors and evaluate the indicated medical treatment (both pharmacological and non-pharmacological) in patients with CAD. Methods Epidemiological data were collected from electronic medical records of patients treated at Cardiology outpatient clinics of a Tertiary Hospital and a descriptive analysis of the data was performed. Results Patients with documented CAD (n = 230) were selected for the study, with a predominance of white (60%) men (62%), most of whom were monitored following an Acute Coronary Syndrome (ACS) (63.9%). High prevalence and irregular control of risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and sedentary lifestyle were observed. Target blood pressure was achieved in 52.6% of patients, low-density lipoprotein (LDL) in 5.7%, and HbA1c in 50.8%, despite appropriate prescriptions for most patients – 100% were prescribed statins, and over 90% received antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers, and beta-blockers. Few patients were encouraged to quit smoking and engage in physical activities. Conclusion Significant recording errors were noted in the medical records, along with inadequate control of CAD-related risk factors. Improvements in both recording and management of these risk factors are necessary to enhance CAD outcomes. The study utilized a straightforward and cost-effective model, which effectively mapped the local population profile and managed CAD risk factors.

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Abstract Background: In transthyretin amyloid cardiomyopathy (ATTR-CM), the assessment of functional capacity is of great importance. A distance < 300m covered in the 6-minute walk test (6MWT) is linked to a poorer prognosis in heart failure (HF) patients. However, in ATTR-CM, this association is not well-established, particularly among its various presentations and variants. Objectives: To evaluate functional capacity and, the prognostic value of the 6MWT in patients with ATTR-CM and to identify their clinical characteristics according to the type of ATTR-CM. Methods: This was a retrospective, single-center study that included patients with a confirmed diagnosis of ATTR-CM who performed the 6MWT. Median follow-up was 19 months (8 – 29). The significance level was set at P < 0.05. Results: A total of 32 patients were analyzed; 59.4% had the hereditary form (ATTRh), of which 63.2% were Val142Ile. Mean left ventricular ejection fraction (LVEF) was lower in the ATTRh group when compared to the wild-type form (ATTRwt) [42 ±11 versus 52± 9 %; p = 0.029]. Median distance walked in the 6MWT was 328 m (269 – 397; IQR) in ATTRwt and 304 m (246 – 387; IQR) in ATTRh, with no difference between groups (p = 0.833). In patients with a distance <300 m in the 6MWT, survival was lower (28.8 vs 36.3 months; p = 0.041). Conclusions: A distance <300 m walked in the 6MWT was linked to shorter event-free survival in patients with ATTR-CM. Functional capacity of most patients was very low, and no differences were observed in the distance covered between the wild-type form and the hereditary form of ATTR.

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Abstract Background: The triglyceride glucose (TyG) index is known to indicate conditions such as metabolic syndrome and atherosclerotic process. SYNergy between PCI with TAXUS (SYNTAX) and Cardiac Surgery scoring systems (SS) can show coronary anatomic severity and complexity because it is a quantitative and reproducible basic measurement before revascularization. There is no study in the literature investigating the relationship between the TyG index and the SYNTAX SS. Objective: This study aims to investigate a potential association between the TyG index and the SYNTAX score in patients with acute coronary syndrome (ACS). Methods: We retrospectively analyzed 214 patients hospitalized for ACS. Patient demographics and clinical characteristics were recorded, and participants were categorized into low, intermediate, and high SYNTAX score groups. The relationship between SS and TyG index was then evaluated using statistical analysis (chi-square test, p < 0.05). Results: The mean age of participants was 63.15 ± 12.69 years, with 67.8% being male. The majority (65.4%) had low SS, while 24.3% had intermediate SS, and 10.3% had high SS. As expected, the SYNTAX score correlated significantly with diabetes mellitus (DM) (p < 0.001). However, no statistically significant association was found between the SYNTAX score and the TyG index (p = 0.312). Conclusion: In patients diagnosed with ACS and undergoing coronary angiography (CAG), our study confirmed a strong link between SYNTAX score and DM. Unexpectedly, we did not find a significant relationship between the TyG index and SYNTAX score, suggesting that TyG may not directly reflect coronary artery disease (CAD) complexity as assessed by the SS.

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Abstract Background: Aortic Stenosis (AS) is one of the most common valvular heart diseases in adults, especially the elderly. The persistence of heart failure symptoms and worse outcomes despite valve replacement treatment may be associated with the coexistence of Cardiac Amyloidosis (CA). Objective: To determine the prevalence of CA in patients with calcific AS. Methods: This was a cross-sectional study. Elderly patients with moderate to severe AS underwent cardiac scintigraphy with bone radiotracer for diagnosis of CA. Patients diagnosed with Transthyretin (TTR) amyloidosis by scintigraphy underwent genetic studies. Groups with altered and unaltered scintigraphy results for continuous variables were compared using an independent t-test for normally distributed variables and a Mann-Whitney test for those with asymmetric distribution. Statistical significance was set at p-value < 0.05 Results: Forty-one patients with AS underwent pyrophosphate scintigraphy. The mean age of the cases was 79 ± 6 years, 23 (56%) were female, 23 (56%) had classic severe AS pattern, and 8 (19.5%) had low-flow low-gradient AS with reduced Ejection Fraction (EF). Carpal tunnel syndrome was present in 2 (4%) patients, 8 (19%) had polyneuropathy. A RAISE score ≥ 2 was found in 4 patients (9%). Four patients were diagnosed with TTR amyloidosis, one of whom had a Val122I genetic mutation. Three (75%) of the patients diagnosed with AE/AI were male. There were no statistically significant differences between the isolated AS and AS/CA groups. Conclusion: The prevalence of CA in patients with moderate to severe AS of probable calcified etiology in our sample was 10%.

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Abstract Background: Distal transradial access (dTRA), an improvement of the conventional proximal transradial access (pTRA), has advantages in terms of faster hemostasis and lower rates of proximal radial artery occlusion (RAO). Objectives: We aim to describe our real-world experience with dTRA as the default approach for routine coronary angiography and percutaneous coronary interventions (PCI) in a large-scale sample of all-comers patients. Methods: From February 2019 to April 2024, 6,800 consecutive patients undergoing coronary procedures via dTRA were enrolled in the DISTRACTION (DIStal TRAnsradial access as default approach for Coronary angiography and intervenTIONs) Registry. Results: Mean patient age was 63.8 ± 15.7 years; 65% were male. Overall, 20.8% of patients had non-ST-elevation myocardial infarction (NSTEMI); 22.3% had ST-elevation myocardial infarction (STEMI), and 2.5% presented in cardiogenic shock. There were only 2% access site crossovers, mainly to ipsilateral pTRA. In only 119 patients dTRA sheath insertion could not be obtained. Right dTRA was the most frequent access, followed by redo ipsilateral dTRA, left dTRA, and simultaneous bilateral dTRA. PCI was performed in 59.5% of all cases, and the left anterior descending artery was the most treated vessel. No significant access site-related bleeding and no hand/thumb dysfunction after any procedure were documented. There were neither major complications nor major adverse cerebrovascular and cardiac events directly related to dTRA. Conclusions: In this real-world large-scale registry of all-comers patients, the adoption of dTRA by proficient operators as the default for routine coronary angiography and interventions was safe and feasible.

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Abstract Background: It is crucial to monitor blood lipid levels accurately in older adults to assess cardiovascular risk. Although several portable strip-based devices are commercially available, their accuracy has not been well established. Objective: To evaluate the agreement of the Mission Cholesterol device and standard laboratory method results, using samples from older adults. Methods: Forty-nine patients (42 females) with an average age of 70 ± 8 years were included. The participants were instructed to fast for 12 hours before undergoing venous and capillary blood sampling for lipid analysis (total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], and triglyceride [TG] levels). The agreement between the Mission Cholesterol device and laboratory test results was assessed using the concordance correlation coefficient (CCC) and Bland–Altman plots. The accuracy levels were assessed based on the percentage bias recommended by the National Cholesterol Education Program (NCEP). Results: The TC measurement had a better accuracy level (bias = 10.91%; CCC = 0.89) than other lipid measurements. However, none of them met the NCEP's acceptable standards for bias and concordance (CCC ≥ 0.90). Furthermore, the device demonstrated modest overall agreement in classifying lipid risk according to clinical reference values (agreement rates: TC, 67.3%; HDL-C, 65.3%; LDL-C, 49.0%; and TG, 61.2%). Conclusion: The Mission Cholesterol device exhibited insufficient agreement levels for effective lipid profile monitoring and screening in older adults.

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Abstract Background: Rheumatic heart disease (RHD) is the leading cause of valve disease in developing countries, with intracardiac thrombus events as one of the frequent manifestations. Based on Trias Virchow, a thrombus occurs because of endothelial injury, blood flow abnormality, and hypercoagulability. In RHD, this condition is caused by inflammation, mitral stenosis (MS), and atrial fibrillation (AF). Pro-inflammatory cytokines promote thrombus formation, and anti-inflammatory cytokines inhibit it. IL-4 is an anti-inflammatory cytokine that can potentially inhibit thrombus formation because it can inhibit other pro-inflammatory cytokines and polarize M2 macrophages. Objectives: This study aims to know the association of IL-4 expression with thrombus events in RHD patients. Methods: Twenty-five (25) patients enrolled in this study were diagnosed with RHD and underwent mitral valve replacement surgery. Valve tissues were collected for histopathological and immunohistochemical examination using IL-4. Thrombus event obtained from echocardiography result. The Mann-Whitney test was used to compare IL-4 expression in thrombus and non-thrombus patients. A p-value of less than 0.05 (p<0.05) was considered the significance level. Results: Of the 25 patients, 88% were older than 30 years. Thrombus occurs in 28% of RHD patients and is associated with AF (p 0.001). Patients with moderate and high IL-4 expression did not have less thrombus than patients with low IL-4 expression. Conclusions: Intracardiac thrombus formation in RHD patients is not associated with IL-4 expression but is strongly associated with AF. Further research that identifies other cytokines coexisting with IL-4 at the site of injury may reveal better insight into the event.

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Abstract Background: Acute pulmonary embolism (PE) is a significant cause of morbimortality. Epidemiological data in Portugal are limited, potentially leading to underdiagnosis. Catheter-directed therapy (CDT) is a promising alternative treatment, particularly for high-risk patients. Objectives: To evaluate the impact of CDT on intermediate-high-risk and high-risk acute PE. Methods: This is a retrospective single-centre study conducted from 2019 to 2023 in Portugal. Data included patient demographics, clinical presentation, procedural characteristics, and outcomes. Comparisons before and after the procedure were carried out, using two-sided paired Student´s T-test or McNemar´s test. P-value < 0.05 was considered statistically significant. Results: Among the 21 patients included in this study, the mean age was 62.5 (±16.8) years and 57% (n = 12) were female. Bilateral PE was predominant (n=18, 86%), with fifteen patients (75%) classified as high-risk PE and five (25%) as intermediate-high-risk PE. Overweight (n = 12, 57%), hypertension (n = 9, 45%), dyslipidaemia (n = 8, 40%), immobility (n = 4, 20%), and active cancer (n=3, 14%) were prevalent comorbidities. The median Charlson Comorbidity Index score was 3.5 (IQR 1.2–4.0). Two-thirds (n = 10, 67%) of the patients with high-risk PE exhibited contraindications to systemic fibrinolysis, while one-third (n = 5, 33%) had previously undergone failed thrombolysis. CDT improved hemodynamic parameters, significantly reducing the right ventricular (RV) dysfunction after the procedure (72.2% vs 23.5%, p=0.008). There was a low incidence of bleeding complications, with only one patient (5%) experiencing life-threatening haemorrhage. Despite these improvements, in-hospital mortality remained high (n = 5, 24%). No deaths occurred within three months post-discharge. Conclusions: Despite being in its early stages, CDT showed encouraging results in improving hemodynamic and clinical parameters in intermediate-high-risk and high-risk acute PE patients. Larger trials are warranted to further evaluate its efficacy and establish its role in treatment protocols.

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Abstract Background: Atrial fibrillation (AF) stands out as the most prevalent arrhythmia, and its incidence increases with age. Stroke ranks as the second leading cause of mortality in Brazil and represents the primary contributor to global disability. Objective: Considering the severity of these conditions, this study seeks to elucidate the epidemiological landscape of AF and stroke-related deaths in Brazil from 1996 to 2022. Methods: The following variable were analyzed in the study - geographic region, federative state, age demographics, gender distribution, year of mortality, race/ethnicity, educational attainment, and place of death. This research adopted a descriptive approach through a retrospective, exploratory, epidemiological analysis of data sourced from the Mortality Information System (SIM) accessible through the Department of Health Informatics of the Brazilian Unified Health System (DATASUS) website. Results: Over the 26-year period, 1,201,327 deaths from AF and stroke were registered in Brazil. These deaths were mostly caused by stroke (94.5%) and were more concentrated in the southeast region, where the highest number of doctors capable of identifying and notifying these deaths are also concentrated. Conclusion: This study claims for a paradigm shift in disease control strategies and underscores the imperative of bolstering the efficacy of public health policies to address the huge impact of stroke and AF-related mortality on population health.

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Abstract Breast cancer (BC) is the most common malignant neoplasia in women and is responsible for one in six deaths from cancer in the female population. Five years after diagnosis, BC survival rates currently exceed 80%. Cardiovascular disease (CVD) is a frequent cause of morbidity and mortality in BC, mainly in patients receiving cardiotoxic drugs (anthracyclines, immunotherapy) and radiotherapy (RT). CVD and BC have common risk factors (RF), which are related to aging, traditional and cardiometabolic RFs (obesity, dyslipidemia, consumption of alcoholic beverages), and others associated with sex and reproductive women's age, such as early menarche, late menopause, nulliparity, use of oral contraceptives, as well as hormone replacement therapy in postmenopause. Risk stratification and the promotion of an ideal state of cardiovascular (CV) health are fundamental in preventing CVD in survivors. Therapeutic management and follow-up of patients with BC require a multidisciplinary team to reduce complications and mortality of CV origin.

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Abstract Hemostasis is a complex set of biological processes responsible for blood fluidity within normal vessels and for the physiological interruption of bleeding in cases of vascular injury. Bothrops moojeni snake venom is rich in bioactive compounds of pharmacological and clinical interest since its protein components are capable of interfering with many points of the hemostatic process. Here, we present the B. moojeni venom proteins that affect hemostasis and discuss their pharmacological and clinical potential. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Data were obtained from the CAPES Journal Portal database, using the terms “Bothrops” AND “hemostasis”, in a search for scientific articles made available in the last 20 years. Many components isolated from B. moojeni snake venom are characterized for their effect on hemostasis and possible application in the diagnosis and treatment of hemostatic disorders.

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Central Illustration : Cardiovascular disease in Latin America Women. Gaps and Opportunities. GDMT: guideline-direct medical therapy; RVD: rheumatic valve disease; CR: cardiac rehabilitation; ICD: implantable cardioverter defibrillation; CRT: cardiac resynchronization. Source: prepared base on summary references 1 to 20.

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Central Illustration : Heart Failure Management of Patients with Amyloid Cardiomyopathy CA has a restrictive physiology, characterized by elevated filling pressures and low stroke volumes. Initially, patients present with preserved ejection fraction, which may decrease in late stages of disease. The use of diuretics is crucial in the treatment of patients with CA. The evidence of GDMT in the treatment of patients with CA is not very robust and is based on retrospective cohort analysis. Heart transplantation may be considered for patients with advanced HF. ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II receptor blocker; HFpEF: heart failure with preserved ejection fraction; HFrEF: heart failure with reduced ejection fraction; SGLT2i: sodium-glucose transport protein 2 inhibitors; CA: cardiac amyloidosis.

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Central Illustration : A Critical Review of Echocardiographic Findings for Diagnosing Cardiac Amyloidosis Temporal evolution of changes in echocardiographic parameters used in the diagnosis of CA. Blue indexes represent early changes, green indexes represent intermediate changes, and orange indexes represent later changes in amyloid infiltration. LV: left ventricular; GLS: global longitudinal strain; SAB: septal apical to base strain; LVEF: Left ventricle ejection fraction; APS: apical sparing, or ratio of average apical longitudinal/average of base and mid longitudinal strain; WT: wall thickness; RWT: relative wall thickness; RV: right ventricular; TAPSE: tricuspid annular plane systolic excursion; MCF: myocardial contraction fraction;

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Central Illustration : Computer-Interpreted Electrocardiograms: Impact on Cardiology Practice The impacts of CI-ECGs on cardiology practice

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Central Illustration : Use of Extracorporeal Membrane Oxygenation in Adult Patients During Cardiac Arrest ECPR: extracorporeal cardiopulmonary resuscitation; ECLS: extracorporeal life support.

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Central Illustration : Pyrophosphate Scintigraphy: Use in the Diagnosis and Monitoring of Cardiac Amyloidosis

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Central Illustration : The Role of Strain in the Prognosis of Transthyretin Amyloidosis LVEF: Left ventricular ejection fraction; RVFWS: Right ventricular free wall strain; RAS: Right atrium strain; GLS: global longitudinal strain; LAS: Left atrium strain; NYHA: New York Heart Association Classification of Heart Failure.

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Central Illustration : Multimodality Imaging of Chagas Heart Disease: Review and Case Presentation Role of education, appropriate use of medical imaging and research for the effective management of CD

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Central Illustration : Genetic Testing in Cardiomyopathy: Decoding Molecular Underpinnings and Influencing Treatment Decisions Genetic implications of cardiomyopathies. Genes. PLN: phospholamban; LMNA: lamin A/C; FLNC: filamin C; TMEM43: transmembrane protein 43; DSP: desmoplakin; RBM20: RNA binding motif protein 20; TTR: transthyretin; PRKAG2: protein kinase AMP-activated non-catalytic subunit gamma 2; DCM: dilated cardiomyopathy; ACM: arrhythmogenic cardiomyopathy; HCM: hypertrophic cardiomyopathy; LVEF: left ventricular ejection fraction; P/LP: Pathogenic/likely pathogenic; ICD: implantable cardioverter defibrillator; AG10: acoramidis; MEK: MAPK-ERK kinase.

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Central Illustration : Maternal Deaths by Chagas’ Disease in Brazil Description of the results of the review. The maternal mortality rates shown are the minimum and maximum values found in the references used for the revision of literature; the rates were not calculated. SBC: Sociedade Brasileira de Cardiologia.

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Central Illustration : Syncope and Rhythm Disturbances as Common Clinical Manifestations in Amyloidosis The interaction between multifactorial causes of syncope in CA. LV: left ventricle. Figure generated with assistance of Microsoft Bing.

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Central Illustration : Cardiac Amyloidosis in Women: An Underappreciated Diagnosis Differences of CA between men and women. LV: left ventricle; HFpEF: HF with preserved ejection fraction; LVWT: left ventricular wall thickness; GLS: global longitudinal strain; BSA: body surface area; NT-proBNP: N-terminal pro-B-type natriuretic peptide.

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Abstract The ability to measure myocardial blood flow (MBF) offers significant advantages in interpreting the phenomena underlying myocardial ischemia. Nuclear cardiology using hybrid positron emission tomography/computed tomography (PET/CT) systems allows accurate measurement of MBF using noninvasive techniques. Short- or very short-lived radiopharmaceuticals are now available, as well as standardized analytical models and software for clinical use. The incremental value of quantitative measurement of MBF in the pathophysiologic assessment of ischemic heart disease compared with anatomic variables or qualitative or semi-quantitative assessment by single-photon emission computed tomography (SPECT) with gamma-emitting tracers will be analyzed. The clinical role of MBF, myocardial flow reserve (MFR), and coronary flow capacity (CFC) will be clarified. However, the widespread availability of this technology is limited by the need for on-site cyclotron tracer production or the purchase of expensive radionuclide generators. The ability to obtain quantitative measurements using newer SPECT with cadmium-zinc-telluride technology and technetium-labeled tracers may offer the possibility of extending MBF measurement to most nuclear cardiology units in the near future.

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Abstract Amyloidosis is caused by the extracellular deposition of insoluble protein arrangements, formed from structural changes in different precursor proteins. The prominent clinical and epidemiological relevance of transthyretin amyloid cardiomyopathy (ATTR-CM), whose increased incidence is associated with the aging of the global population, given its high prevalence in the elderly population, has motivated the intensification of the search for specific therapeutic targets capable of altering the natural course of the disease. The past few years have been especially prolific with the emergence of significant new therapies for ATTR-CM, with important trials demonstrating positive results and changing the natural history of an inexorable and deadly disease. Up to now, the available drugs mainly promote stabilization of disease progression in patients with no advanced heart disease but grant no reversal of the structural cardiac disease in most cases. The transthyretin (TTR)-depleters based on monoclonal antibodies directed against the deposited amyloid fibers hold promise to fulfill these expectations. The DepleTTR-CM will test the safety and efficacy of a monoclonal antibody directed against TTR fibrils deposited in the myocardium of patients with ATTR-CM. This will be the first multicenter randomized controlled trial to test this new class of anti-amyloid treatment, the "amyloid fibril depleters". This is a strategy designed to revert the amyloid accumulation in the cardiac interstitium, which is expected to translate into relevant clinical benefits, with the potential to close a gap in the ATTR-CM treatment strategies, mainly in patients with more severe disease.

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Abstract Fulminant necrotizing eosinophilic myocarditis (FNEM) is a rare form of EM characterized by biventricular heart failure with hemodynamic deterioration, often requiring inotropes or mechanical circulatory support. Here, we report a case of a 43-year-old healthy woman with FNEM who was admitted with acute heart failure that rapidly progressed to cardiogenic shock and electrical storm, culminating in cardiac arrest. Early diagnosis and prompt administration of corticosteroids in combination with veno-arterial extracorporeal membrane oxygenation allowed complete recovery of biventricular systolic function.

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Abstract We report the case of a patient with symptomatic pulmonary hypertension (PH) associated with diffuse systemic sclerosis (SSc) whose initial assessment suggested a group 3 (clinical classification) PH. The patient had a history of drugs/toxins consumption, which contributed to the development of intrinsic pulmonary vascular disease. This changed the panorama towards the diagnosis of pulmonary arterial hypertension (PAH), with important therapeutic and prognostic implications. In fact, the excellent clinical, laboratory and hemodynamic response to therapy confirmed the hypothesis of a case of drug-associated PAH (DPAH) in a patient with diffuse SSc and lung disease. Considering the presence of DPAH, it was deemed necessary to assess acute vasoreactivity during right heart catheterization (RHC). If criteria were met, the clinical scenario may change towards a favorable and sustained clinical and hemodynamic response with oral calcium channel blockers. However, the response to inhaled nitric oxide was negative in our patient and the therapeutic strategy with dual oral combination therapy with tadalafil and ambrisentan was continued. After six-months of therapy the patient significantly improved, from a high to a low risk of one-year mortality.

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Abstract In some transcatheter aortic valve implantation (TAVI) procedures, difficulty in crossing the valve delivery system occurs. There are some described anatomical risk factors as extreme angulation, heavy calcification, and bicuspid morphology. A possible reason may be an unfavorable angle of approach because of the outward push by the incoming crimped bioprosthesis and insufficient support/trackability of the extra stiff wire. Several techniques, tips, and tricks have been developed to overcome this problem and avoid procedure failures, such as the “pull-and-push” technique, pre-dilation, buddy wire, balloon cushion, buddy balloon and snare techniques. Here, we report a case of TAVI complicated by the difficulty in crossing the calcified native aortic valve (AV) that was solved with the snare technique without complications.

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Abstract The BAG3 gene encodes the BAG3 protein, a multifunctional chaperone involved in proteostasis and protection of cardiomyocytes. Pathogenic BAG3 variants have previously been associated with dilated cardiomyopathy (DCM), including peripartum cardiomyopathy (PPCM). We present the case of a woman who complained of palpitations during the late postpartum period and was diagnosed with left ventricular dysfunction; genetic testing revealed a pathogenic variant of the BAG3 gene. Several cases of sudden death were noted in her family history. After 3 years of follow-up, ventricular function was significantly improved with regular cardiovascular medication, and no symptoms were reported. We emphasize the role of genetic testing in this case.

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Abstract Despite being a rare condition, Brugada syndrome (BrS) poses a significant risk of arrhythmic death, and managing associated ventricular arrhythmias is particularly challenging. Here, we present a case where percutaneous ablation targeted an arrhythmogenic substrate in a patient with BrS and recurrent ventricular fibrillation (VF). Epicardial mapping revealed abnormal potential areas in the right ventricle's outflow tract and free wall. Injection of warmed saline into the pericardial space caused further delay in local electrograms and expanded the abnormal potential area. Radiofrequency applications in this region successfully eliminated abnormal electrograms, leading to the disappearance of the coved-shape ST-segment elevation in leads V1-V2. No recurrence of ventricular arrhythmias was reported in a twelve-month follow-up.

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Abstract Myxoma is the most common primary cardiac tumour, especially in adults. However, reports on this nosological entity in patients over the age of 80 are scarce in the medical literature. Echocardiography is a useful diagnostic tool for detecting cardiac myxomas. These tumours are usually surgically removed soon after diagnosis, limiting knowledge of their natural evolution. In this report, we describe the case of an 86-year-old woman who had been followed irregularly for arterial hypertension since 2016, when an echocardiogram showed a left atrial myxoma adhered to the interatrial septum, initially without impairment of the mitral valve (MV) or obstruction of the pulmonary veins (PV). The patient refused surgical removal at the time. Six years later, she was hospitalized for urinary sepsis. A new echocardiogram revealed an increase in the size of the myxoma, which occupied around 80% of the left atrium (LA), obstructing the PV and MV. New suggestion of surgery was refused by the patient.