Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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

Abstract in English:

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