Abstract in English:

Abstract Background: Coronary artery disease (CAD) remains a leading cause of death worldwide, with inflammation playing a key role in its pathophysiology. Inflammatory biomarkers may offer valuable insights into disease mechanisms and risk stratification, potentially informing therapeutic decisions. Objectives: This study aimed to investigate the association between key inflammatory markers — C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) — and both the presence and severity of coronary artery stenosis (CAS) in patients with suspected CAD undergoing coronary angiography. Methods: This retrospective study included 767 patients referred for coronary angiography due to suspected CAD. The primary outcome was the presence of significant CAS. Demographic data, medical history, and blood samples were collected. Statistical analyses included descriptive methods and regression modeling as well as receiver operating characteristic (ROC) curve analysis to determine optimal cutoff values for biomarkers, with area under the curve (AUC) used to assess predictive performance. A p-value < 0.05 was considered statistically significant. Results: Of the 767 patients (mean age 58.3±12.4 years; 56.7% men), 496 had significant CAS (≥ 50%) and 271 had nonsignificant CAS (< 50%). Levels of CRP (0.44 vs. 0.13 mg/dL, p = 0.01) and NLR (2.6 vs. 2.0, p = 0.05) were significantly higher in patients with CAS. No significant difference was observed for PLR (129.4 vs. 118.6, p = 0.13). In multivariable analysis, CRP (OR = 1.188, p = 0.044) and NLR (OR=1.567, p = 0.03) were identified as independent predictors of significant CAS. However, ROC curve analysis showed limited discriminative ability for both CRP (AUC = 0.526) and NLR (AUC = 0.510), with values only slightly above chance. Conclusion: Increased levels of CRP and NLR are significantly associated with CAS and may serve as potential biomarkers for detecting CAD.

Abstract in English:

Abstract Background: Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of atrial fibrillation (AF). However, the benefits of catheter ablation (CA) for reducing adverse clinical outcomes in this population are not well established. Objective: To assess the long-term impact of CA on clinical outcomes in patients with HCM and AF through a systematic review and meta-analysis. Methods: Controlled studies of patients with HCM and AF undergoing CA were identified through PubMed/MEDLINE, Embase, LILACS, and Cochrane. Meta-analysis employed a random-effects model in R Studio, version 4.3.2, with p < 0.05 considered significant. Results: Four retrospective cohort studies met inclusion criteria, all with long follow-up period (5.52 ± 0.91 years). Arrhythmia-free survival after multiple CA ranged from 36.3% to 82%. Combined event analysis (mortality, stroke, and heart failure) yielded odds ratio 0.22 (95% confidence interval 0.08 to 0.60; p < 0.05; I² = 64%). In individual analysis, only heart failure hospitalizations were significantly lower in the CA group (odds ratio 0.32; 95% confidence interval 0.13 to 0.82; p = 0.01). Conclusions: This study suggests that CA may improve clinical outcomes in patients with HCM and AF, particularly by improving heart failure hospitalizations. Studies with greater methodological rigor are needed to prove this hypothesis, since only four studies were included in this systematic review.

Abstract in English:

Abstract Background: Infective endocarditis (IE) is frequently caused by viridans streptococci. Short-term in-hospital mortality in high-income settings ranges from 11% to 25%. In Brazil, rheumatic heart disease remains a leading valvular substrate; however, its declining prevalence in developing nations has limited country-specific analyses. Objective: To describe the epidemiological profile of mortality from IE in Brazil, characterizing its magnitude and temporal trend. Methods: We conducted a retrospective, exploratory epidemiological study with descriptive and analytic components using data from the Mortality Information System of the Department of Informatics of Brazil's Unified Health System. Chi-square tests of independence were applied (p < 0.05), and results were summarized in tables and figures. Variables included International Statistical Classification of Diseases and Related Health Problems, 10th Revision categories, year of death, region, and sex. Results: From 1996 to 2022, 40,157 deaths associated with IE were recorded in Brazil (chi-square = 1,701.43). The Southeast region accounted for the greatest burden, with 21,429 deaths (53.36%; chi-square = 15,236.00). By sex (chi-square = 999.32), men were more affected than women (55.57% [22,315] vs 44.41% [17,835]); in 0.02% of records, sex was unspecified. Conclusions: IE remains a condition of national and international concern, with substantial mortality in Brazil over the last 27 years. This overview of mortality patterns highlights regional disparities and sex differences and can inform public-health strategies and evidence-based interventions.

Abstract in English:

Abstract Background: Obstructive sleep apnea (OSA) is increasingly recognized as a potential risk factor for ischemic heart disease (IHD), but its role remains underexplored. This study investigated the association between OSA and IHD using a case-control design. Objectives: The objective of this study was to establish OSA as a risk factor for developing IHD. Methods: A total of 122 participants were recruited and categorized into two groups: patients with a recent history of IHD (< 7 days) (wIHD group, n = 61) and controls without IHD but with hypertension (cIHD group, n = 61). The STOP-Bang questionnaire was used to assess OSA risk, and statistical analyses, including odds ratio (OR), relative risk (RR), and attributable risk (AR), were performed. A significance level of 0.05 was adopted for all statistical analyses. Results: Patients in the wIHD group had significantly higher STOP-Bang scores than the control group (p < 0.01), with an AR of 71.929% and an OR of 40.078. Body mass index showed a significant positive correlation with OSA risk (p = 0.0016, r = 0.396). The OR/RR was calculated at 11.25 (> 1). The level of statistical significance was found to be 0.05. Conclusion: This study identifies OSA as an important risk factor for IHD, supporting the need for routine OSA screening in cardiovascular risk assessment. Larger studies are needed to further explore this relationship

Abstract in English:

Abstract Background: Right ventricular (RV) involvement in acute ST-segment elevation myocardial infarction (STEMI) has scarcely been studied in contemporary cardiology practice. Objective: To evaluate the clinical, angiographic, procedural characteristics and outcomes of patients with STEMI and RV involvement undergoing primary percutaneous coronary intervention (pPCI). Methods: This prospective cohort included consecutive patients with STEMI presenting within 12 hours of symptom onset and undergoing pPCI between 2009 and 2023 at a high-volume tertiary cardiology center in Brazil. Clinical characteristics and outcomes of patients with RV infarction were compared to those without RV involvement. Continuous and categorical variables were analyzed using appropriate statistical tests, with a significance level of 5% (p < 0.05). Logistic regression models were used to identify independent predictors. Results: Among 5,611 patients, 13% had RV involvement. These individuals were more frequently female, had right coronary artery as the culprit vessel, had greater thrombotic burden, and more often presented with total atrioventricular block (TAVB). Acute kidney injury (5.8% versus 4.1%, p = 0.03) and stroke (1.6% versus 0.8%, p = 0.04) were more common in the RV group. Thirty-day (10.5% versus 8.7%, p = 0.16) and 2-year mortality (19.5% versus 18.5%, p = 0.11) were higher among patients with RV infarction, although not statistically significant. In multivariable analysis, TAVB and female sex were independently associated with RV involvement. RV infarction was not an independent predictor of 30-day mortality. Conclusion: In current practice, approximately 1 in 7 STEMI patients present with RV involvement. These patients have a higher-risk profile, though RV infarction was not independently associated with short-term mortality.

Abstract in English:

Abstract Background: The muscle metaboreflex regulates cardiovascular responses during exercise. In patients with coronary artery disease (CAD), this reflex primarily increases blood pressure via sympathetic-mediated vasoconstriction, thereby increasing peripheral vascular resistance (PVR) rather than enhancing stroke volume (SV). This response may result in early fatigue during physical exertion. However, the specific mediators of this response are unclear. Objective: To investigate the association between cardiorespiratory and muscle fitness with cardiovascular responses to muscle metaboreflex activation in patients with CAD. Methods: Twenty patients underwent an exercise test and a maximal voluntary contraction (MVC) test using handgrip strength. Hemodynamic variables were assessed using photoplethysmography during muscle metaboreflex activation via a post-exercise circulatory arrest (PECA) protocol. Changes (Δ) in mean arterial pressure (MAP), SV, and PVR at rest were used to assess the metaboreflex response. Results: Participants (61.7±8.0 years; 28.4±3.9 kg/m²) had a mean VO2max of 31.96±5.70 mL/kg/min, and a MVC of 90.5±21.1 lbs. Metaboreflex activation significantly increased MAP (+14.74±9.56 mmHg, p<0.0001) and PVR (+0.13±0.07 mmHg.s/mL, p<0.0001), but not SV (+1.91±5.54 mL, p=0.13). MVC was directly associated with ΔSV (R=0.54 and p=0.01), but not with ΔMAP (R=0.23 and p=0.31) or ΔPVR (R=-0.10 and p=0.65). In multiple linear regression models adjusted for age and sex, ΔSV emerged as a predictor of MVC (β=+1.37 and p=0.03). Conversely, no significant associations were found between VO2max and ΔSV (R=0.29 and p=0.22), ΔMAP (R=0.14 and p=0.54), or ΔPVR (R=0.05 and p=0.83). Conclusions: These findings underscore the association between SV and muscle fitness during metaboreflex activation in patients with CAD.

Abstract in English:

Abstract Background: Myocardial infarction (MI) is highly influenced by risk factors such as dyslipidemia. Achieving low-density lipoprotein cholesterol (LDL-C) goals is key to reducing the residual cardiovascular risk. However, the proportion of patients with MI who accomplish this goal is unknown. Objective: Assess risk factors, lipid profile evolution from admission to the first outpatient consultation, and the therapy administered. Methods: This is a descriptive study of patient charts from a public hospital in São Paulo from June 2021 to March 2022. The statistical analyses employed were the Chi-square test and the paired t-test, with significance defined as p-values < 0.05. Results: ST-elevation MI (STEMI) occurred in 61% of the patients. Among the patients with previous MI, 50% did not use statins. There was a correlation between STEMI and no statin use (p < 0.05). At hospital discharge, 12%, 17%, and 13% lacked prescriptions for aspirin, clopidogrel, and statins, respectively. At the first outpatient consultation, only 8% of patients with available data reached the absolute LDL-C goal of <50 mg/dL. Only 9% of patients had their cholesterol levels assessed at admission and at the first outpatient consultation, while 26.7% of those achieved at least a 50% LDL-C reduction. The mean LDL-C reduction was 25% (p < 0.05). Conclusion: Considering the severity of the assessed patients, the cardiovascular risk stratification was ineffective, the pharmacologic therapy was not optimized, and the achievement of the LDL-C goals according to guidelines was unsatisfactory in this population.

Abstract in English:

Abstract Background: A Rapid Response Team (RRT) is a multidisciplinary team trained to assist hospitalized patients experiencing cardiac arrest (CA) or sudden clinical deterioration. Its effectiveness, however, remains debatable. Objectives: This study aimed to characterize the changes that occurred in a quaternary, highly complex hospital following the adoption of the RRT and to ascertain whether its implementation was associated with a decline in the mortality rates of patients admitted to wards. Methods: This was a prospective observational study conducted from April 1st, 2014, to December 31, 2019. The study compared patient mortality and clinical outcomes after the implementation of the RRT, focusing on the frequency and outcomes of "code blue" (CA) and "code yellow" (other types of clinical deterioration) calls. Pearson's chi-squared test (χ²) was employed to compare categorical variables, while the Student's t-test was utilized to compare continuous variables for independent samples. P-values < 0.05 were considered statistically significant. Results: The team responded to a total of 2,194 inpatient calls, 495 for code blue and 1,699 for code yellow. In the years following the team's implementation, the number of deaths and code blue calls decreased, while the number of code yellow and total RRT calls increased. When comparing the first and second three-year terms, there were no significant differences regarding code blue mortality (276/293 [94.2%] vs. 184/200 [92%], p = 0.338). Still, survival rates for patients assisted during code yellow calls increased (348/609 [57.1%] vs. 648/1,005 [64.5%], p = 0.003). This improvement in code yellow outcomes was associated with a reduction in the overall ward mortality rate (1,078/96,866 [1.1%] vs. 788/85,019 [0.9%], p < 0.001). Conclusion: The implementation of the RRT was associated with a decrease in the number of in-hospital CA and unexpected deaths over six years, as well as an increase in the number of code yellow and overall RRT calls. Overall ward mortality also declined.

Abstract in English:

Abstract Background: Heart failure (HF) affects an estimated 64 million individuals globally. Current guideline-directed medical therapy (GDMT) comprises four cornerstone pharmacological medications proven to reduce hospitalization and/or mortality: renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Objective: This study aimed to describe, through an exploratory analysis, access to HF drug therapy in Primary Health Care in Brazil, via the Brazilian Unified Health System (SUS). Methods: This was a descriptive, cross-sectional study based on data extracted from Municipal Lists of Essential Medicines (REMUMEs) published on official municipalities’ websites from Brazilian metropolitan regions in June 2024. Results: A total of 387 municipalities were included, of which only 50.9% had a REMUME publicly available. Among these, 61.4% had been published within the previous 2 years. The frequency of each drug class was as follows: angiotensin-converting enzyme inhibitors in 92.4% of municipalities, angiotensin II receptor blockers in 80.2%, cardioselective beta-blockers in 91.9%, and MRAs in 85.8%. No REMUME simultaneously included all four GDMT medications. In 22.3% of the metropolitan cities, only two or fewer drug classes were available to patients’ access. Conclusion: The remarkable variability in the composition of REMUMEs, along with the frequent omission of at least one of the four essential pharmacological pillars, indicates a potential suboptimal management of HF at the population level. Given the importance of comprehensive pharmacological treatment in HF, these findings highlight ongoing challenges in access to essential medicines within the SUS, even in metropolitan areas.

Abstract in English:

Abstract Background: The increase in obesity cases and the lack of screening and diagnosis of childhood hypertension highlight the need to examine these comorbidities in children. Objectives: To investigate the relationships between systemic arterial hypertension (SAH) and childhood obesity (CO) in pediatrics and correlate the obesity level, abdominal circumference (AC), family history, and physical activity (PA) variables. Methods: This cross-sectional study assessed age, sex, height, weight, body mass index (BMI), AC, family history, PA, CO, and blood pressure (BP) percentiles. The Chi-square test, Fisher's Exact test, and Spearman's correlation were used for data analysis, with a statistical significance level of 5%. Results: After applying the inclusion and exclusion criteria, 30 patients aged between 3 and 18 years (incomplete) were evaluated at three different moments. The results showed that 83.3% (n = 25) of the patients were obese and 16.70% (n = 5) had severe obesity. Among them, 20% (n = 6) were diagnosed with SAH. Data showed an independence between CO and SAH (p = 0.702) and between SAH and PA time (p = 0.748). No correlations were observed between SAH and AC (p = 0.313). The history of SAH in first-degree relatives was significantly associated with the diagnosis of SAH (p = 0.004). Conclusion: This study showed no correlation between CO and SAH in the evaluated sample, supporting the need for further research in the area.

Abstract in English:

Abstract Background Prognostic scores such as the Simplified Acute Physiology Score (SAPS) and the Acute Physiology and Chronic Health Evaluation (APACHE) are essential for assessing performance and predicting mortality in Intensive Care Units (ICUs). Objectives To evaluate the performance of SAPS 3 (including the Latin America [LA] and Brazil [BR] versions) and APACHE II in predicting mortality in a cardiac intensive care unit (CICU). Methods Prospective cohort of patients admitted between June 2022 and May 2024, followed until discharge or death. Data were extracted from electronic medical records. The relationship between observed and predicted mortality was calculated using the Standardized Mortality Ratio (SMR), and discrimination was assessed by the Receiver Operating Characteristic (ROC) curve. Results A total of 573 patients were included, 288 (50%) with three or more comorbidities, median age 63 years [IQR: 53–72], and 344 (60%) male. Cardiovascular diseases accounted for 76% of admissions. Overall mortality was 15%. Mean SMR values were: 0.52 (95% CI: 0.32–0.72) for SAPS 3; 0.40 (95% CI: 0.26–0.54) for SAPS 3 Latin America (AL); 0.79 (95% CI: 0.41–1.16) for SAPS 3 Brazil (BR); and 0.86 (95% CI: 0.42–1.29) for APACHE II. The analysis of the area under the curve (AUC) was 0.805 for SAPS 3 and its adapted versions, and 0.704 for APACHE II. Conclusions SAPS 3, particularly SAPS 3 Brazil (BR), demonstrated greater accuracy than APACHE II. Despite mortality being above the national average, the SMR indicated that observed mortality was lower than predicted, suggesting good care performance in the unit.

Abstract in English:

Abstract Background: IQ∙SPECT is a collimator design coupled with a cardio-centric acquisition orbit and specific reconstruction algorithm that increases camera efficiency. However, there is no prognostic data derived from IQ∙SPECT exams. Objectives: To evaluate the prognostic value of IQ∙SPECT myocardial perfusion scintigraphy (MPS) in patients with suspected or known coronary artery disease (CAD). Methods: The study population consisted of 734 consecutive patients with suspected or known CAD submitted to MPS with IQ∙SPECT. Adequate follow-up was obtained in 625 patients. We retrospectively analyzed imaging and clinical data. The follow-up was obtained for no less than 12 months after the MPS study. Statistical significance was taken at p < 0.05. Results: Normal IQ∙SPECT compared to abnormal IQ∙SPECT had lower annualized incidence of hard events (0.2% and 1.1%, respectively, p = 0.02), late combined events (1.1% and 5.5%, respectively, p = 0.008), and revascularization (1% and 14%, respectively, p < 0.001). Left ventricular ejection fraction ≤ 45% was found to be the only clinical predictor of hard events (p < 0.0003, confidence interval [CI] = 5.25 to 129.02). However, for combined events, abnormal MPS (p < 0.0001, CI = 3.39 to 11.13, hazard ratio [HR] = 6.14) and dyspnea/fatigue (p = 0.013, CI = 1.28 to 8.4, HR = 3.3) obtained statistical significance. In contrast, ischemic burden ≥ 5% (p < 0.0001, HR = 30.3) was the most relevant parameter for revascularization, followed by thoracic pain (p = 0.002, HR = 2.4). Conclusion: Our study demonstrates that IQ SPECT MPS has significant prognostic capabilities with very low risk of adverse events in patients with normal findings.

Abstract in English:

Abstract Background: Hypertension and Diabetes Mellitus (DM) are prevalent chronic conditions and major risk factors for cardiovascular diseases. Adequate control of these conditions is challenging, and lifestyle changes are crucial to achieving better management. Objectives: To evaluate the effectiveness of a multifaceted and multidisciplinary intervention to improve the control of hypertension and DM in the primary care setting. Methods: This cluster randomized clinical trial focuses on lifestyle modifications for managing hypertension and DM, addressing gaps in current non-pharmacological interventions. Primary care professionals are trained to promote health education on physical activity and nutrition. Support is provided through a telementoring program, including messaging app communication, biweekly online meetings (teletutoring), and asynchronous teleconsultations. Primary care professionals conduct twice-weekly group activities with structured intensity adjustments and biweekly health education sessions using interactive methods like conversations, games, and group dynamics. For patients unable to join group activities, brief counseling and guidance on unsupervised physical activity are offered. Results: The primary outcomes are blood pressure and glycated hemoglobin values. The innovative intervention program aims to empower primary care professionals and reduce barriers to care through lifestyle changes, improved health education, and support systems for both supervised and unsupervised interventions. Conclusions: Supporting primary care professionals through education and remote assistance can enhance the effectiveness of lifestyle interventions, contributing significantly to the control of hypertension and DM in primary care settings. Trial registration: Previously registered with ClinicalTrials.gov.

Abstract in English:

Abstract Background: Heart failure with preserved ejection fraction (HFpEF) is a highly prevalent syndrome associated with substantial morbidity and mortality. Accurate diagnosis is often challenging and costly. Recently, artificial intelligence-based electrocardiogram (AI-ECG) algorithms have emerged to make the diagnosis of HFpEF less expensive and more accessible. However, there is a lack of data regarding their accuracy. Objective: We aimed to conduct a systematic review and meta-analysis to evaluate the diagnostic performance of AI-ECG algorithms in detecting HFpEF. Methods: We searched PubMed, Embase, and Cochrane databases for studies evaluating AI-ECG algorithms in diagnosing HFpEF. We extracted true-positive, true-negative, false-positive, and false-negative events to estimate pooled sensitivity, specificity with 95% confidence intervals (CI), and area under the curve. Statistical analysis was performed using R under a random-effects model. Heterogeneity was assessed with I² statistics. Results: We included three studies comprising 171,073 patients (66.86% with HFpEF), in which an AI-ECG was evaluated alongside echocardiography, with a left ventricular ejection fraction of ≥ 50%. The patients’ mean age was 65.86 ± 4.5 years, and 48.12% were male. AI-ECG algorithms demonstrated a sensitivity of 0.89 (95% CI: 0.64 to 0.97), specificity of 0.80 (95% CI: 0.65 to 0.89), and an area under the receiver operating characteristic curve of 0.89 (95% CI: 0.85 to 0.92). Conclusion: AI-ECG algorithms demonstrate moderate to high sensitivity, specificity, and accuracy in diagnosing HFpEF, supporting their potential for routine screening and early detection.

Abstract in English:

Abstract Background: ST-segment elevation myocardial infarction (STEMI) remains one of the leading causes of morbidity and mortality worldwide. Although studies indicate sex disparities in risk factors, symptomatology, and outcomes, there is a lack of local research validating these differences. Objectives: To compare the clinical and epidemiological profiles, treatment times, and in-hospital outcomes of men and women diagnosed with STEMI at a private hospital in Salvador, Brazil from 2021 to 2023. Methods: This retrospective observational study analyzed 75 patients, of whom 30.7% were women. Variables assessed included age, cardiovascular risk factors, symptom-to-door time, door-to-ECG time, door-to-reperfusion time, pharmacological therapy, and in-hospital outcomes. Results: Women presented STEMI at a significantly older age compared to men (median age: 73.0 versus 62.5 years; p = 0.002). There were no statistically significant differences in treatment times (symptom-to-door, door-to-ECG, and door-to-reperfusion) between sexes. Women were more frequently treated with high-potency antiplatelet agents (prasugrel and ticagrelor) than men (p = 0.047 and p = 0.012, respectively). No differences in complications or mortality rates were observed between the groups. Conclusions: Despite being older and using more potent antiplatelet therapy, women did not experience significant differences in treatment times or complications. The limited sample size may have affected the ability to detect more significant differences, underscoring the need for larger studies.

Abstract in English:

Abstract Introduction: Evidence suggests that patients with decompensated heart failure who receive loop diuretics earlier experience reduced morbidity and mortality rates. Objectives: To determine the time from admission to administration of the first dose of diuretics in patients with heart failure and to evaluate the risk of readmission within 30 days after hospital discharge. Methods: A prospective and retrospective cohort study of patients with decompensated heart failure treated in a cardiac emergency department between December 2018 and June 2020 was conducted. The risk of readmission was classified using the LACE score. The statistical analysis included the Shapiro–Wilk test for normality, the chi-square test for associations, and the Mann–Whitney test for comparisons, adopting a significance level of 5%. Results: A total of 361 patients were included in the study, with a predominance of males (56%), an average age of 68 ± 12 years, reduced ejection fraction (57%), functional class III (73%), and hemodynamic profile B (81%). The average time from admission to diuretic infusion was 87 (60 to 128) minutes, with 26.3% of patients receiving the infusion within 60 minutes. A significant association was found between receiving diuretics within 60 minutes and a stay in the emergency department of less than 6 hours (early discharge) (p < 0.05). The LACE score indicated that 62% of patients were at moderate risk for readmission, with 21% readmitted within 30 days. Among patients at high risk for readmission (38%), abnormal lung sounds and jugular venous distention were each significantly associated with the high-risk classification (p < 0.05). For clinical follow-up, 274 patients were included; after 180 days, 15% had died, and 46% had been readmitted. Conclusion: In this population, patients who received the medication early (within 60 minutes) had shorter stays in the emergency department.

Abstract in English:

Abstract Background: Acute Coronary Syndrome (ACS) remains one of the leading causes of high morbidity and mortality worldwide. Psychological factors are considered important contributors to increasing recurrence rates in patients. Objective: This study aimed to analyze the association between stress, chest pain complaints, electrocardiographic changes, and cardiac enzyme levels. Methods: A cross-sectional design was employed. A sample of 105 ACS patients presenting to the hospital emergency department was selected using an accidental sampling technique. Variables measured included stress scores, chest pain, electrocardiographic findings, troponin, and CK-MB levels. Data were analyzed using the Spearman rank test and linear regression, with a significance level set at p < 0.05. Results: Stress scores were significantly associated with chest pain (p < 0.001), electrocardiographic changes (p < 0.001), troponin levels (p < 0.001), and CK-MB levels (p < 0.001). ECG findings showed that most STEMI patients (68.9%) experienced severe pain. Linear regression analysis indicated that troponin and CK-MB levels were significantly influenced by chest pain (p < 0.001). Conclusions: Stress is positively correlated with chest pain in ACS patients and is reflected in ECG changes and elevated cardiac enzymes (troponin and CK-MB).

Abstract in English:

Abstract Background: Heart failure (HF) remains one of the leading causes of hospital admissions and in-hospital mortality in Brazil. As the population ages, understanding how these hospitalizations have evolved over time is crucial for improving healthcare planning and reducing the burden on the public health system. Objectives: To evaluate temporal trends in HF hospitalizations in Brazil from 2010 to 2024, considering factors such as time, region, patient profile, and hospital-related costs. Methods: This observational study used data from the Brazilian Unified Health System's Hospital Information System (SIH/SUS). Hospitalization rates per 100,000 inhabitants were adjusted using population estimates from the Brazilian Institute of Geography and Statistics. Temporal trends were assessed using annual percent change (APC) and average annual percent change (AAPC), with statistical significance set at p < 0.05. Results: Over 3 million HF hospitalizations were recorded during the study period. Annual admissions declined from 264,000 in 2010 to 205,000 in 2024, representing an average annual decrease of 1.8%. Adjusted rates fell from 135.3 to 94.3 per 100,000 inhabitants (AAPC: −2.55%; p < 0.001). In-hospital mortality peaked in 2021, reaching 13.5%. The average cost per hospitalization more than doubled, rising from BRL 1,151.42 to BRL 2,459.57. Conclusion: Despite a significant reduction in hospitalization rates, HF continues to pose a major challenge to Brazil's healthcare system due to its high case volume and the steadily rising economic burden.

Abstract in English:

Abstract Background: Hyperglycemia at admission is associated with higher morbidity and mortality in patients with Acute Coronary Syndrome (ACS). However, it remains unclear whether the inclusion of admission glycemia improves risk prediction atop established prognostic models. Objectives: To evaluate the incremental prognostic value of admission glycemia when added to the Global Registry of Acute Coronary Events (GRACE) risk score. Methods: A systematic search of PubMed, Embase, and ScienceDirect was conducted to identify cohort studies comparing GRACE with models that included admission blood glucose in patients with ACS. Random-effects meta-analyses were performed to compare mean differences (MDs) in predictive discrimination between models, measured by the area under the receiver operating characteristic curve (AUROC). Statistical significance was defined as p <0.05. Heterogeneity was assessed using Cochran's Q and Higgins–Thompson's I² statistics. In accordance with Cochrane recommendations, the risk of bias in individual studies was evaluated using the Quality in Prognosis Studies (QUIPS) tool. Results: In a pooled analysis of eight independent comparisons from seven studies encompassing 6,536 patients, a statistically significant difference was observed between GRACE and GRACE-glucose models (MD, 0.03; 95% CI, 0.00–0.05; p = 0.027; I² = 0%). Leave-one-out sensitivity analyses confirmed statistically significant differences in AUROCs. Meta-regression analyses did not demonstrate any modification in predictive discrimination based on overall risk of bias, mortality follow-up, or baseline prevalence of STEMI. Underreporting of calibration measures precluded a definitive assessment of predictive calibration. Conclusions: In this systematic review and meta-analysis, the inclusion of admission blood glucose enhanced prognostic value beyond the GRACE score alone.

Abstract in English:

Abstract Background: Residual cardiovascular risk persists even with adequate serum LDL-c control through statins, possibly due to dysfunctions in serum triglycerides and HDL-c. Elevated TG and reduced HDL-c are associated with metabolic syndrome and cardiovascular diseases. The TG/HDL-c ratio may predict these risks. Selenium, an antioxidant cofactor, may modulate these alterations, especially in diets that dysregulate serum lipid metabolism. Objectives: To evaluate the effects of selenium supplementation on the cardiometabolic risk (CMR) of Wistar rats exposed to a high-fat hyperglycemic diet (HHD). Methods: For 11 weeks, 55 female Wistar rats were divided into the following five groups: standard diet (SD), SD + ContinuousSe, HHD, HHD + LateSe, and HHD + EarlySe. Selenium was supplemented using sodium selenite (1 mg/kg). We performed one-way ANOVA, Kruskal–Wallis, and post hoc tests, adopting a significance level of p < 0.05. Results: Total cholesterol increased in HHD + LateSe compared to SD (p = 0.032) and to HHD (p = 0.013). HDL-c increased in HHD + LateSe compared to SD (p = 0.004) and to HHD (p = 0.008). LDL-c increased in HHD + LateSe compared to HHD (p = 0.008). TG decreased in HHD + LateSe (p = 0.006) and in HHD + EarlySe (p = 0.016) compared to SD. TG/HDL-c ratio decreased in HHD + LateSe compared to SD (p < 0.001) and SD + ContinuousSe (p = 0.013); and in HHD + EarlySe compared to SD (p = 0.005). Conclusion: Selenium supplementation showed potential to increase HDL-c and reduce TG, key diagnostic components of metabolic syndrome. It also demonstrated potential to lower the TG/HDL-c ratio, a possible predictor of CMR, in rats fed HHD. Further studies are needed in subjects with high CMR and statin use to better define the clinical response to this therapy.

Abstract in English:

Abstract Background: Low Vitamin D levels are prevalent in obesity and have been linked to adverse cardiovascular and metabolic outcomes. Objective: This cross-sectional study aimed to assess anthropometric indices, vascular, autonomic function in obese and overweight individuals with suboptimal vitamin D status. Methods: Participants of both sexes, 40-69 years, Body Mass Index (BMI) 25-40 kg/m², were divided into two groups above and under the median vitamin D level (22,6 ng/ml), named Suboptimal (SUB-D) and Lower (LOW-D) vitamin D, respectively. Vascular function was assessed using central hemodynamic parameters (Mobil-O-Graph®), endothelial function (microvascular reactivity; Laser Speckle Contrast Image system), and heart rate variability (Polar® monitor). The groups were compared using an unpaired Student's t-test, and p-values < 0,05 were considered statistically significant. Results: The groups (n = 90) had similar ages and blood pressures. The LOW-D group had a higher body fat percentage (%BF; 29 ± 4 vs. 33 ± 3, p = 0.020) and glycated Hb (5.4 ± 0.4 vs. 5.8 ± 0.4, p = 0.029) in males. Females had higher Visceral Adiposity Index (VAI; 2.33 ± 0.86 vs. 3.32 ± 1.86, p = 0.008) and Lipid Accumulation Products (LAP; 39 ± 23 vs. 63 ± 40, p = 0.005). The LOW-D group showed a lower percentage increase in the area under the curve in post-occlusive reactive hyperemia (%AUC-PORH) (70 ± 30 vs. 55 ± 32%, p = 0.034). Females showed inverse correlation of vitamin D levels and VAI and LAP, and a positive correlation with %AUC-PORH. Conclusions: In obese and overweight individuals, lower vitamin D content was associated with higher levels of body adiposity in males. Furthermore, impaired metabolic functions and endothelial dysfunction were related to lower vitamin D levels in females, as in the central illustration.

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Abstract Background: Congenital heart disease (CHD) in adults has become an area of growing interest in cardiology due to the increased survival of these patients. Objective: to describe the clinical, demographic, and socioeconomic profile of adults with CHD. Methods: Cross-sectional study with 371 patients over 18 years of age, followed up at the adult CHD outpatient clinic of Santa Izabel Hospital. A questionnaire was applied to collect demographic and socioeconomic data, and a form with clinical aspects was completed. The chi-square test was used to compare frequencies between groups, with a significance level of p < 0.05. Results: Mean age was 30 ± 10 years, 188 (50.6%) women, brown race (61.0%), 216 (73.2%) single, 72 employed patients (24.6%). In this study, 249 patients (67.1%) were acyanotic, 138 (55.4%) showed a hyperflow, 90 (24.3%) had tetralogy of Fallot (T4F), 49 (13.2%) had ostium secundum atrial septal defect (ASD), and 30 (8.1%) had ventricular septal defect (VSD). Median age upon surgery was 8.2 years. Patients were classified as: surgically corrected, 194 (52.8%); surgically cured, 89 (24.2%); awaiting surgery, 8 (2.1%); clinical, 36 (9.8%); inoperable, 22 (6.0%); and surgically palliated, 19 (2.1%). Most were in New York Heart Association (NYHA) functional class I (64.5%). Among women, 50 (72.5%) were pregnant, with a neonatal morbidity and mortality rate of 14.0%. Pulmonary hypertension occurred in 17(4.6%) of the patients. Conclusion: Our study found a predominant population in the third decade of life, with late surgical correction, good clinical evolution related to the benign nature of the pathologies, and greater survival of surgically cured or corrected cases.

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Abstract Background: This study evaluates the efficacy of cardiac myosin inhibitors (CMI), which appear to be an innovative alternative for hypertrophic cardiomyopathy (HCM), a disease lacking highly effective pharmacologic treatments. Objective: To provide updated efficacy data on CMI (aficamten or mavacamten) in symptomatic HCM. Materials and methods: We searched PubMed, Embase, and Cochrane databases for randomized controlled trials comparing CMI to placebo in symptomatic HCM, reporting: (1) New York Heart Association (NYHA) functional class improvement; (2) change from baseline in Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS); (3) percent change from baseline in left ventricular outflow tract (LVOT) gradient at rest and after Valsalva maneuver; and (4) serious adverse events. Heterogeneity was examined with I2 statistics, and p values < 0.05 indicated sta tistical significance. Continuous endpoints were analyzed using pooled mean difference (MD), and binary endpoints were analyzed using odds ratios (OR), both with 95% confidence intervals (CI). Results: We included six RCTs with 826 patients, 443 of whom received CMI. Compared to placebo, NYHA class improvement was more frequent in patients receiving CMI (OR: 4.10; 95% CI: 2.79 to 6.02; p < 0.00001), with significant differences in KCCQ-CSS change (MD: 7.15; 95% CI: 4.21 to 10.10; p < 0.00001), as well as in LVOT gradient change at rest (MD: −38.25; 95% CI: −46.76 to −29.74; p < 0.00001) and after Valsalva maneuver (MD: −46.49; 95% CI: −54.70 to −38.27; p < 0.00001). There were no significant differences in serious adverse events (OR: 0.64; 95% CI: 0.31 to 1.31; p = 0.22). Conclusion: CMI shows greater efficacy than placebo in treating symptomatic HCM.

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Abstract Background: Systemic Arterial Hypertension (SAH) is a major public health issue, particularly among older adults, due to its high prevalence and impact on morbidity and mortality. Objective: To investigate factors associated with SAH in older adults from a small municipality in northeastern Brazil. Methods: A population-based cross-sectional epidemiological study was conducted among 232 community-dwelling older adults. Independent variables included socioeconomic, behavioral, and health-related factors, with SAH as the outcome. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated using Poisson regression with a robust estimator. Crude models were followed by a hierarchical multiple explanatory model (Level 1: socioeconomic variables; Level 2: behavioral aspects; Level 3: health conditions). Associations were considered statistically significant at the 5% level (p < 0.05). Results: The prevalence of SAH was 59.1% (men: 50.0%; women: 65.4%). An increased likelihood of SAH was associated with female sex (PR: 1.33; 95% CI: 1.05–1.68), insufficient physical activity (PR: 1.24; 95% CI: 1.01–1.54), abdominal obesity (PR: 1.40; 95% CI: 1.09–1.79), diabetes mellitus (PR: 1.30; 95% CI: 1.03–1.64), and falls (PR: 1.37; 95% CI: 1.07–1.74). Conclusion: A high prevalence of SAH was identified, particularly among women and those with insufficient physical activity, abdominal obesity, diabetes mellitus, and a history of falls.

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Abstract Background: There is a lack of epidemiological data regarding the cardiovascular risk profile of patients with chronic kidney disease (CKD) undergoing hemodialysis in the Brazilian state of Minas Gerais. Objective: To analyze the lipid profile and assess the prevalence of traditional cardiovascular risk factors among patients with CKD on hemodialysis treated at an academic healthcare institution in Belo Horizonte, Minas Gerais, Brazil. Methods: This was a cross-sectional, observational, and non-interventional study. The researchers obtained clinical, laboratory, and demographic data from medical records and conducted structured individual interviews with all participants. The chi-square test of independence, Fisher's exact test, and the Wilcoxon rank-sum test were applied. A significance level of 0.05 was adopted to establish the statistical validity of comparisons. Results: A total of 66 patients were included, representing 91.6% of all individuals undergoing hemodialysis at the study center. The mean age was 56 years. Among participants, 59% were male, and 89% self-identified as mixed race. A high prevalence of traditional cardiovascular risk factors was observed, including hypertension (95%), physical inactivity (69%), dyslipidemia (55%), diabetes mellitus (27%), current smoker (19%), and obesity (15%). The lipid profile analysis showed a median total cholesterol level of 170.9 mg/dL (interquartile range: 142.05 to 195.78 mg/dL) and Low-Density Lipoprotein (LDL-cholesterol) of 98.55 mg/dL (interquartile range: 77.80 to 121.98 mg/dL). Conclusion: This study demonstrated a high burden of cardiovascular risk factors among hemodialysis patients, with systemic arterial hypertension, dyslipidemia, physical inactivity, and diabetes mellitus being the most prevalent conditions. Furthermore, the lipid profile findings suggest suboptimal control of this lipid fraction in the studied population.

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Abstract Background: Coronary artery disease (CAD) continues to be a predominant global cause of morbidity and mortality, with rising prevalence in developing nations like India, emphasizing the need to address risk factors, multimorbidity, and polypharmacy to implement effective lifestyle interventions and drug therapies to enhance patient outcomes. Objectives: To evaluate the risk factors, comorbidities, and multiple drug therapy patterns among patients diagnosed with CAD in a tertiary care setting. Methods: This prospective observational study used medical records to collect data on demographics, comorbidities, lifestyle factors, and medications. Descriptive statistics summarized findings, and Chi-square tests assessed associations between gender, risk factors, and CAD. The significance level adopted in the statistical analysis was 5%. Results: Out of 300 patients enrolled, 69.3% were male, and the highest disease prevalence was noted in the 66–75 age group. Hypertension was the most common comorbidity (71%), followed by diabetes mellitus (DM) (50%). Poor diet was the leading lifestyle risk factor (25.3%), followed by smoking (21%). A significant association existed between gender and CAD type (p = 0.002), with females showing higher angina prevalence and males showing more myocardial infarction (MI). For CAD management, aspirin (92.6%) and enoxaparin (59.3%) were most frequently prescribed, followed by atorvastatin (53.6%) and nicorandil (52%). For comorbidity management, beta-blockers (59.6%) and insulin (48.7%) were commonly prescribed. Increased use of ticagrelor and dapagliflozin was observed, indicating a greater alignment with evidence-based guideline recommendations. Conclusion: This study highlights the burden of multimorbidity and polypharmacy among CAD patients in India, emphasizing the need for individualized, evidence-based therapy.

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Abstract Background: Although randomized controlled trials have demonstrated the efficacy of Sacubitril/Valsartan in heart failure (HF), real-world evidence regarding its impact on cardiac remodeling, particularly in Heart Failure With Reduced Ejection Fraction (HFrEF), remains limited. Objectives: This real-world study aimed to evaluate echocardiographic changes, including ejection fraction (EF), in a cohort of patients with HFrEF treated at a public hospital in Curitiba, Brazil, and to assess clinical outcomes at 6 and 12 months of follow-up. Methods: Longitudinal data were collected from 200 patients with HFrEF at baseline and at 6- and 12-month follow-up. Echocardiographic assessments included EF, left ventricular (LV) dimensions, and other cardiac parameters. Clinical outcomes included HF-related hospitalizations and New York Heart Association (NYHA) functional class. Results: Sacubitril/Valsartan therapy was associated with improvements in EF, with the median increasing from 28% at baseline to 31.5% at 6 months and 34% at 12 months (Teichholz method). Structural remodeling was observed, including reductions in LV end-systolic and end-diastolic dimensions, as well as left atrial (LA) diameter. HF-related hospitalization rates decreased from 31.8% at baseline to 20.6% at 6 months and 11.3% at 12 months. NYHA functional class improved, with the proportion of patients in Classes III and IV decreasing from 53.2% at baseline to 17.4% at 6 months. Renal function remained stable throughout treatment. Improvements in EF were associated with a lower risk of hospitalization at 6 months (OR = 0.95) and 12 months (OR = 0.93), whereas a larger LA diameter was associated with a higher risk of hospitalization at 12 months (OR = 1.06). Conclusions: Sacubitril/Valsartan therapy was associated with improvements in EF, echocardiographic parameters, and NYHA functional class, as well as reductions in hospitalization rates. These findings underscore the role of the therapy in promoting reverse remodeling and suggest that its clinical benefits may extend beyond direct effects on cardiac structure.

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Central Illustration: Low-Dose Colchicine for Secondary Prevention: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Meta-analysis summary plot of colchicine for secondary prevention outcomes. CI: confidence interval; MACE: major adverse cardiovascular events; OR: odds ratio.

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Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency characterized by low survival rates. Vascular access is critical for drug administration during resuscitation. While intravenous (IV) access is the standard, intraosseous (IO) access may provide practical advantages in certain emergencies. Objectives: This meta-analysis aimed to compare IO versus IV access in adult OHCA patients regarding their impact on survival and neurological outcomes. Methods: A systematic search of MEDLINE, Embase, and Cochrane CENTRAL through November 2024 was conducted, including randomized controlled trials (RCTs) comparing IO and IV access in adult patients with OHCA. Meta-analyses employed a random-effects model. A p-value < 0.05 was considered statistically significant. Analyses outcomes included survival with a favorable neurological outcome, survival to hospital discharge, return of spontaneous circulation (ROSC), and sustained ROSC. Subgroup analyses were conducted based on initial rhythm and bystander-performed cardiopulmonary resuscitation. The certainty of the evidence was determined using the GRADE approach. Results: Three RCTs involving 9,119 patients were included. IO access showed no significant differences compared to IV access in terms of survival with favorable neurological outcome (OR 1.07; 95% CI 0.88–1.30; p = 0.49; I² = 0%), survival to hospital discharge (OR 0.97; 95% CI 0.80–1.19; p = 0.80; I² = 0%), ROSC (OR 1.00; 95% CI 0.83–1.22; p = 0.97; I² = 64%), or sustained ROSC (OR 0.92; 95% CI 0.80–1.06; p = 0.25; I² = 44%). Conclusions: IO and IV access yield comparable outcomes in OHCA patients, supporting their use based on clinical context and provider expertise. Further research is needed to confirm these findings across diverse healthcare settings.

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Abstract Background: Early detection of peripheral atherosclerosis remains a clinical challenge, especially in asymptomatic individuals. This study aimed to evaluate the predictive value of systemic inflammatory indices and lipid-related biomarkers for early atherosclerosis. Objectives: To investigate the diagnostic value of systemic inflammation indices, fibrinogen, and lipoprotein(a) as individual biomarkers and as a combined predictive model for early peripheral arterial disease. Methods: A prospective case-control study was conducted in 54 individuals: 20 patients diagnosed with early peripheral atherosclerosis (<55 years) and 34 healthy controls. Laboratory data included complete blood count, lipid profile, fibrinogen, lipoprotein(a), angiopoietin-like protein 3 (ANGPTL3), and Lp-PLA2. Inflammatory indices, including NLR, PLR, SII, SIRI, AISI, and MLR, were calculated. Logistic regression and ROC analysis were performed. A two-sided p-value < 0.05 was considered statistically significant. Results: SIRI (1.70 vs. 0.93, p = 0.0039) and AISI (431.6 vs. 236.4, p = 0.0128) were significantly higher in the atherosclerosis group. Fibrinogen showed the most robust association (5.46 vs. 3.71 g/L, p < 0.00001). Lp(a) alone was not statistically different between groups but improved the multivariate model (AUC 0.85 vs. 0.82). The final model, including age, inflammatory indices, LDL, Lp (a), and fibrinogen, achieved an AUC of 0.91. Conclusion: Systemic inflammation and fibrinogen levels are strongly associated with early atherosclerosis. Their combination with lipoprotein(a) enhances diagnostic performance, offering a simple, cost-effective strategy for early vascular risk assessment.

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Abstract Artificial intelligence (AI) has been driving significant transformations in healthcare by enhancing diagnostics, personalizing treatments, and optimizing clinical workflows. In women's health, it offers innovative approaches for prevention, early detection, and management of various conditions throughout life — from adolescence to old age. Over the past decade, advances in machine learning algorithms, neural networks, and natural language processing have enabled the analysis of large volumes of clinical data with previously unimaginable precision and speed. However, the integration of AI into women's healthcare remains underutilized, representing a valuable opportunity to reduce social inequalities that influence adverse health outcomes. However, the use of AI in women's healthcare raises important ethical concerns, particularly the need to protect patients’ sensitive data, avoid algorithmic biases that may perpetuate stigma or inequality, and ensure safe, equitable, and responsible implementation. Ethical governance — with national and international guidelines and regulations — is essential to ensure that AI benefits all women, including vulnerable and underrepresented populations, without exacerbating existing disparities. This manuscript aims to synthesize the main applications of AI in women's health across different life stages, identifying advances, opportunities, and challenges in this context. Given the complexity and multidisciplinary nature of the topic, we conducted a scoping review – an appropriate methodology for exploring emerging and still underdeveloped fields. In addition to scientific databases, we included a complementary search in digital health app libraries to identify technological solutions already implemented or under development for women's health.

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Abstract At its peak during the pandemic, coronavirus disease 2019 profoundly impacted global populations and introduced numerous post-infection complications, collectively referred to as long coronavirus disease. The mechanisms underlying the syndrome's chronicity are multifaceted; however, a notable aspect of long coronavirus disease pathophysiology is its intricate association with platelets. The chronic inflammatory response triggered by severe acute respiratory syndrome coronavirus 2 is closely related to platelet activity, wherein inflammatory molecules bind to specific platelet receptors, inducing the release of platelet granules containing procoagulant and proinflammatory molecules. Consequently, there is a marked elevation in coagulation-related proteins, fostering the development of abnormal microthrombi and a dysfunctional fibrinolytic system. All these changes are indicative of an imbalance in coagulation regulation. Therefore, investigating pharmacological targets linked to this process is crucial for syndrome management, aiming to enhance the quality of life for affected individuals. This review aimed to highlight the importance of platelet function and activity in the pathophysiology of long coronavirus disease, as well as to identify molecular targets directly related to long coronavirus disease or coronavirus disease 2019–related disturbances in platelet homeostasis.

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Abstract There are a number of guidelines on how to manage obesity, but inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices restrict their global applicability. This underscores the need for universal recommendations that address the unique challenges faced by patients and healthcare providers worldwide. Our Global Guidelines emphasize the incorporation of novel therapies, while integrating standards of care with the most up-to-date evidence to enable clinicians to optimize obesity management. Context-specific recommendations tailored to individual patient needs are highlighted, providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These Global Guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged, and – most importantly – also provide recommendations on several issues where resource limitations may put constraints on the care provided to patients living with obesity. Such "economic adjustment" recommendations aim to guide situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents a comprehensive update to obesity management guidelines, thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, and invasive management of this significant global health challenge that is applicable to the needs of healthcare around the globe.