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The aim of this study was to develop an experimental hemodynamic bench to elucidate the influences of such geometrical parameters on the FFR assessment. As a first approach, the present work was focused on the influence of the severity of S1 and S2.

FUNDAMENTO: Participantes dos programas de reabilitação cardiopulmonar e metabólica (RCPM) podem apresentar alterações locomotoras que prejudiquem a aderência e a efetividade do tratamento. OBJETIVO: Desenvolver instrumento para avaliar o sistema locomotor e identificar problemas, principalmente aqueles relacionados com o exercício, possibilitando a triagem dos pacientes, ou seja, liberação sem restrições, liberação com restrições e não liberação antes de aval especializado. MÉTODOS: Construção e validação (segundo o alfa de Cronbach) de inventário de avaliação do sistema locomotor (IASL), para subsequente aplicação em participantes da RCPM. RESULTADOS: Por meio do IASL, cuja avaliação interna apresentou parâmetros de validade e confiabilidade satisfatórios, foram avaliados 103 indivíduos participantes de programas de RCPM, sendo 33 homens (32%) e 70 mulheres (68%), com idades entre 36 e 84 anos, dos quais 47 (45,6%) já haviam recebido diagnóstico de problema do sistema locomotor, 39 (37,9%) já haviam recebido tratamento específico para o sistema locomotor, 33 (32%) costumavam usar fármacos para alívio de sintomas do sistema locomotor, e 10 (9,7%) haviam recebido proibição médica para algum tipo de exercício. Ressalte-se que 48 indivíduos (46,6%) relataram sentir dor no sistema locomotor que, em 14 (13,6%) deles, piorava com o exercício, o que deveria impedir a participação em programa de exercícios antes de aval de especialista. CONCLUSÃO: O IASL, que apresentou parâmetros de validade e confiabilidade satisfatórios, evidenciou que, para praticamente metade dos participantes de programas de RCPM, existia alguma restrição para a prática de exercícios e que alguns não deveriam ter sido liberados sem o aval de especialista. BACKGROUND: Participants of cardiopulmonary and metabolic rehabilitation (CPMR) programs may present with musculoskeletal changes that may affect treatment compliance and effectiveness. OBJECTIVE: To develop an instrument for evaluation of the musculoskeletal system and identification of problems, especially those related to exercise, so that patients can be cleared to exercise with no restrictions, cleared with restrictions, or not cleared before approval from a specialist. METHODS: Construction and validation (according to Cronbach’s alpha) of a musculoskeletal system assessment inventory (MSSAI), for subsequent administration to participants in CPMR programs. RESULTS: A total of 103 individuals participating in CPMR programs were evaluated by means of the MSSAI, whose internal validity and reliability proved to be satisfactory. Of these, 33 were men (32%) and 70 were women (68%), with age ranging from 36 to 84 years; 47 (45.6%) had already been diagnosed with musculoskeletal system disorders; 39 (37.9%) had already received specific treatment for the musculoskeletal system; 33 (32%) used to take medications to relieve symptoms related to the musculoskeletal system; and 10 (9.7%) had a medical restriction for performing some type of exercise. We should point out that 48 individuals (46.6%) reported pain in the musculoskeletal system; in 14 (13.6%) of them, the pain worsened by exercise, and this should have prevented them from participating in exercise programs before receiving approval from a specialist. CONCLUSION: The MSSAI, whose internal validity and reliability proved satisfactory, showed that there was some restriction to exercise practice for almost half of the individuals participating in CPMR programs, and that some of them should not have been cleared without approval from a specialist.

FUNDAMENTOS: Modelos de estratificação de risco são utilizados em cirurgia para avaliar risco de morte. OBJETIVO: Fazer análise crítica da aplicação do EuroSCORE (ES) em amostras de prontuários de 2692 pacientes submetidos à cirurgia de revascularização miocárdica em 4 hospitais públicos do município do Rio de Janeiro, no período de 1999 a 2003. MÉTODOS: Foram selecionadas, em quatro hospitais públicos da cidade do Rio de Janeiro, amostras aleatórias de 150 prontuários de pacientes por hospital, sobreviventes e óbitos. Aplicou-se o ES utilizando-se o modelo logístico. A letalidade observada e prevista pelo modelo foi comparada. A aferição do poder discriminante foi estimada pela área sob a curva ROC. RESULTADOS: Localizados 546 dos 600 prontuários selecionados. Observou-se significativa diferença entre prevalências dos fatores de risco entre nossa população e européia. Letalidade prevista foi 3,62% (IC-95%: 3,47-3,78) e observada estimada foi 12,22% (IC-95%- 10,99-13,46). Em todas as faixas de risco, há subestimação da letalidade prevista, com diferenças notáveis entre prevista e observada.Área sob a curva ROC foi estimada em 0,62. CONCLUSÃO: Diferenças das prevalências dos fatores de risco que compõem o ES associado ao baixo poder discriminatório desaconselham a utilização do modelo em nosso meio sem devidos ajustes. BACKGROUND: Risk stratification models are used to assess the risk of death in surgery. OBJECTIVE: To conduct a critical analysis of the EuroSCORE logistic model (ES) application in 2,692 patients undergoing Coronary Artery Bypass Grafting (CABG) in four public hospitals in the Rio de Janeiro Municipality, from 1999 through to December 2003. METHODS: Random samples of 150 medical records for surviving and deceased patients were selected at four public hospitals in the City of Rio de Janeiro. The ES was applied, using the logistical model. The observed lethality rate and that forecast by the model were compared. The measurement of the discriminatory power was estimated by the area under the ROC curve. RESULTS: 546 of the 600 selected medical records were located. A significant difference was noted between the prevalence rates for the risk factors in the Brazilian and European populations. The forecast lethality rate was 3.62% (CI-95%: 3.47-3.78) while the estimated observed rate was 12.22% (CI-95%- 10.99-13.46). In all risk ranges, the predicted lethality rate is under-estimated, with notable differences between the predicted and observed rates. The area under the ROC curve was estimated at 0.62. CONCLUSION: The differences in the prevalence rates for the risk factors constituting the ES, associated with its low power of discrimination, hamper any recommendation of the use of this model in Brazil, without the necessary adjustments.

p.149-154 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-07-23T11:15:12Z No. of bitstreams: 1 Tais S. Sena.pdf: 993661 bytes, checksum: fd25f4b7e6e718514b281fc4cbf8c159 (MD5) Approved for entry into archive by Flávia Ferreira(flaviaccf@yahoo.com.br) on 2013-07-31T19:42:21Z (GMT) No. of bitstreams: 1 Tais S. Sena.pdf: 993661 bytes, checksum: fd25f4b7e6e718514b281fc4cbf8c159 (MD5) Made available in DSpace on 2013-07-31T19:42:21Z (GMT). No. of bitstreams: 1 Tais S. Sena.pdf: 993661 bytes, checksum: fd25f4b7e6e718514b281fc4cbf8c159 (MD5) Previous issue date: 2010 As cardiopatias congênitas apresentam elevada prevalência no Brasil, sendo responsáveis por morbi-mortalidade importante, principalmente em menores de 5 anos de idade. Relacionam-se a um perfil complexo de alterações hemostáticas, predispondo tanto a eventos trombóticos como hemorrágicos, e cujo conhecimento é fundamental para o manejo adequado de cada paciente. O presente artigo objetiva descrever as alterações da coagulação relacionadas às cardiopatias congênitas, cianogênicas ou não, em menores de 18 anos de idade, submetidos ou não a procedimentos cirúrgicos.

BACKGROUND: Epidemiologic studies have suggested that flavonoid intake plays a critical role in the prevention of coronary heart disease. Because atherosclerosis is considered a low-grade inflammatory disease, some feeding trials have analyzed the effects of cocoa (an important source of flavonoids) on inflammatory biomarkers, but the results have been controversial. OBJECTIVE: The objective was to evaluate the effects of chronic cocoa consumption on cellular and serum biomarkers related to atherosclerosis in high-risk patients. DESIGN: Forty-two high-risk volunteers (19 men and 23 women; mean +/- SD age: 69.7 +/- 11.5 y) were included in a randomized crossover feeding trial. All subjects received 40 g cocoa powder with 500 mL skim milk/d (C+M) or only 500 mL skim milk/d (M) for 4 wk. Before and after each intervention period, cellular and serum inflammatory biomarkers related to atherosclerosis were evaluated. RESULTS: Adherence to the dietary protocol was excellent. No significant changes in the expression of adhesion molecules on T lymphocyte surfaces were found between the C+M and M groups. However, in monocytes, the expression of VLA-4, CD40, and CD36 was significantly lower (P = 0.005, 0.028, and 0.001, respectively) after C+M intake than after M intake. In addition, serum concentrations of the soluble endothelium-derived adhesion molecules P-selectin and intercellular adhesion molecule-1 were significantly lower (both P = 0.007) after C+M intake than after M intake. CONCLUSIONS: These results suggest that the intake of cocoa polyphenols may modulate inflammatory mediators in patients at high risk of cardiovascular disease. These antiinflammatory effects may contribute to the overall benefits of cocoa consumption against atherosclerosis. This trial was registered in the Current Controlled Trials at London, International Standard Randomized Controlled Trial Number, at controlled-trials.com as ISRCTN75176807.

SummaryThe progress of retinal imaging techniques has made retinal microvascular circulation easier to study. A number of observational studies were conducted to characterise the different abnormalities encountered and to determine the factors contributing to their onset. Three lesion groups were highlighted, including reduced arteriolar diameter, venular dilatation and retinopathy lesions. Retinal arteriolar narrowing signals the presence of hypertension (current or old) and the risk of hypertension onset. A genetic factor was implicated in this relationship. Venular dilatation and retinopathy correlate with the presence of diabetes, obesity and metabolic disorders. This association appears to be mediated partly by the presence of endothelial dysfunction and inflammation. The relationship between these abnormalities and cardiovascular risk was also studied in a number of longitudinal studies: the presence of retinal microvascular abnormalities is related with an increased risk of cardiovascular morbidity and mortality predominantly in individuals under the age of 75. More specifically, retinopathy is correlated with the presence of cerebral white matter lesions detected by MRI, an increased stroke risk and deterioration in cognitive function. On the cardiovascular level, a correlation was demonstrated between diminished coronary reserve, increased coronary calcifications observed by CT scan, coronary morbidity and mortality, and risk of heart failure. New techniques of retinal imaging, such as laser Doppler flowmetry, are still undergoing assessment and will help further to clarify these correlations.

A freqüência cardíaca (FC) também está no centro das determinantes do tempo de vida dos seres vivos animais. Há quase uma constante quando se multiplica a FC pelo número de anos que, em média, vive um animal. O ser humano também tem correlações interessantes de tempo de vida e FC, com estudos epidemiológicos demonstrando maior sobrevivência naqueles com menor FC em repouso, hipertensos, com doença coronariana e na população geral. Neste artigo, revemos estes estudos epidemiológicos e a perspectiva de se, de fato reduzindo a FC, poderemos aumentar o tempo de vida, no caso dos pacientes com doença cardiovascular, de forma independente de outros fatores.Heart rate (HR) is known to be one of the factors that in the animal world are related to mortality. When one multiplies resting HR by the average life time, for each animal species, the result is almost the same number, similar to a constant. Apparently, each class of living beings has its "maximal number of heart beats for a life". Herein considerations are made about the relationship between HR and survival in human beings. Some epidemiological studies are reviewed, especially those related to cardiovascular and coronary diseases correlated to deaths and discussions are directed towards the perspective of living longer by lowering the HR.

Background: Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD – previously or newly diagnosed – in patients with IHD treated with PCI. Methods: Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed. Results: A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%–75%]: 546–1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76–44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04–3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12–2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08–3.1), The CATEPOC study was supported in part by Menarini Spain

Resumen Introducción: las enfermedades de las arterias coronarias son raras en el niño y debido a su complejidad, pueden ser causa de muerte súbita. Objetivo: el propósito de este estudio es revisar los casos de patología coronaria estudiados en los últimos 25 años en la Policlínica de Cardiología Pediátrica del Centro Hospitalario Pereira Rossell (CP-CHPR) y en el Instituto de Cardiología Infantil (ICI), incluidos los casos de consulta. Material y método: se revisan los archivos e historias clínicas de pacientes pediátricos con enfermedad coronaria de CP-CHPR e ICI. Se registran presentación clínica, estudios realizados, tratamiento instituido y evolución. Resultados: se individualizaron 20 pacientes. Dos casos de enfermedad de Kawasaki; un caso de síndrome de Williams con estenosis supravalvular aórtica y estenosis de ostium coronario; 2 casos de hipoplasia de arteria coronaria; un caso de arteria coronaria izquierda originada en seno de Valsalva derecho, con recorrido interarterial; un caso de oclusión de arteria coronaria luego de cirugía de switch arterial en paciente con transposición completa de los grandes vasos; un caso de arteria coronaria izquierda originada en rama derecha de arteria pulmonar y 12 casos de arteria coronaria izquierda originada en arteria pulmonar tronco. Conclusiones: se destaca la importancia de una sospecha oportuna de la patología coronaria en el niño. El diagnóstico y tratamiento oportuno puede evitar la muerte. Esta fue la situación en el 35% de los pacientes presentados. En los casos de muerte súbita, se recomienda un estudio posmortem realizado por patólogo pediatra, con especial atención al corazón y las arterias coronarias. Summary Introduction: anomalies in coronary artery are very rare diseases in children. Due to their complexities they are frequent cause of sudden death. Objective: the aim of this study was to evaluate the cases of coronary diseases in children from the Policlínica de Cardiología del Hospital Pereira Rossell (PC-CHPR) and the Instituto de Cardiología Infantil (ICI) in the late 25 years, included cases of consultation. Method: a review of the files and clinical charts from PC-CHPR and ICI was performed. Cases with diagnosis of coronary disease were selected. Clinical presentation, diagnostic studies and follow up were analyzed. Results: 20 cases of disease of coronary artery were recorded. 2 cases of Kawasaki disease, one case of Williams syndrome with supravalvular aortic stenosis and coronary ostia stenosis; 2 cases of hypoplastic coronary artery; one case of left coronary artery originated in right sinus of Valsalva, with interarterial course; one case of occlusion of coronary artery after arterial switch operation in complete transposition of the great arteries; one case of abnormal left coronary artery from right pulmonary artery and 12 cases of abnormal left coronary artery pulmonary artery (ALCAPA). Conclusion: the importance of a prompt diagnosis is emphasized. On time interventions may prevent death. This was the case in 35% of the patients. In cases of sudden death, an autopsy performed by pediatric pathologist with special attention to coronary arteries is recommended.

Introduction: So far, HIV patients-tailored clinical guidelines, are based on the available recommendations for the general population plus on considering earlier initiation of antiretroviral therapy. This is a basic approach that although correct is likely amenable for optimization. A better understanding of the differences regarding pathogenesis, epidemiology and clinical characteristics of cardiovascular disease between HIV- 1-infected patients and uninfected individuals can help to design and develop prevention and clinical interventions to reduce cardiovascular disease risk among HIV-1-infected patients. Primary objective: The common main objective of the studies herein presented is to elucidate whether HIV-1-infected patients present with differences in cardiovascular risk relative to un-infected individuals. Secondary objetives: I. Epidemiologic. II. Clinical. III: Genetic. Results I. Two parallel case-control studies assessing the independent impact of smoking, diabetes and hypertension on the development of acute coronary syndrome in HIV-infected patients comparing with un-infected adults. Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, Blanco JL, Martínez-Rebollar M, Sánchez M, Mallolas J, Gatell JM, Domingo P, Martínez E. HIV Med. 2013 Jan;14(1):40-8. Conclusions: In this study, the first to our knowledge assessing PARs of common traditional cardiovascular risk factors in the HIV+ population, we found that: -The contribution of smoking to ACS in HIV-positive adults was almost twice as high as that in un- infected adults. - Smoking contributes to ACS in HIV-positive adults more than diabetes and hypertension do. These results support smoking cessation strategies as a priority when addresssing cardiovascular risk reduction in HIV-1-infected patients. II. A retrospective analysis of a prospective collected cohort of patients presenting with acute coronary syndrome (ACS) comparing the clinical presentation and short-term prognosis of ACS in those who were HIV-infected and those un-infected. Perelló R, Calvo M, Miró O, Castañeda M, Saubí N, Camón S, Foix A, Gatell JM, Masotti M, Mallolas J, Sánchez M, Martinez E. Eur J Intern Med. 2011 Oct;22(5):485-8. Conclusions: Comparing with un-infected adults, HIV-infected patients present ACS at younger ages with greater prevalence of traditional cardiovascular risk factors and less symptoms. HIV-1-infected patients present predominantly ST-elevation myocardial infarctions and were treated more frequently with percoutaneous coronary artery intervention. All theses differences lost their significance when controlling by age and gender. Short term prognosis was similar in both groups, HIV-infected and un-infected. III. Nested case-control study assessing the association of lipoprotein(a) genetic markers with traditional risk factors and with coronary heart disease in HIV-infected individuals. Egaña-Gorroño L, Martínez E, Escribà T, Calvo M, Gatell JM, Arnedo M. Front Immunol. 2012 Dec 6;3:367. Conclusions: No association was detected between myocardial infarction and KIV-2 copy-number variation and single- nucleotide polymorphisms in LPA. These two gentetic variants of LPA have not been identified as genetic markers of coronary heart disease in HIV-infected patients. Traditional cardiovascular risk factors and CD4 T-cell count did show significant association with myocardial infarction. IV. Systematic review of recent scientific evidence regarding HIV infection and body fat redistribution, lipidic and glucose metabolism and their implications in aging patients. Calvo M, Martinez E. Curr Opin HIV AIDS. 2014 Jul;9(4):332-9. Conclusions: Since chronic inflammation and microbial translocation will impact significantly metabolism despite sustained viral suppression in aging HIV- infected persons, new strategies will be required in this increasing group of patients to prevent frailty and comorbidities added to age-related ones. V. A systemic Review of the available scientific literature addressing smoking cessation in HIV-infected individuals. Calvo-Sánchez M, Martínez E. HIV Med. 2015 Apr;16(4):201-10. HIV-positive smokers exhibit greater motivation to quit but lower rates of smoking cessation and similar number of relapses than un-infected smokers with the available anti-smoking strategies. The regularity of their consultations, their trust on HIV physicians and their young mean age favor optimizing the achievable health benefits of smoking cessation. Smoking cessation strategies tailored for HIV patients are needed. VI. A systematic review of the pathogenic mechanisms and clinical implications of tobacco smoking and HIV infection. Calvo M, Laguno M, Martínez M, Martínez E. AIDS Rev. 2015 Jan-Mar;17(1):47-55. Tobacco smoking exerts greater impact on HIV-1-infected patients´ health than on uninfected smokers´ through cumulative and synergistic effects., Introducción: Hasta ahora las estrategias preventivas y terapéuticas de la enfermedad cardiovascular en pacientes con infección VIH presentes en las guías clínicas de VIH, se basan en las recomendaciones dirigidas a la población general junto a un inicio temprano de la terapia antirretroviral. Este acercamiento es aunque correcto, susceptible de ser optimizado. Entender mejor las características que diferencian en términos de patogénesis, epidemiología y clínica la enfermedad cardiovascular de pacientes VIH y no infectados, puede contribuir al diseño y desarrollo de intervenciones clínicas y preventivas para disminuir el riesgo de la enfermedad cardiovascular en pacientes VIH. Objetivo principal: El objetivo común principal de los estudios que se presentan a continuación es investigar las posibles diferencias en el riesgo cardiovascular de los pacientes infectados por VIH frente a pacientes no infectados e individuos sanos de la población general. Resultados I. Dos estudios casos-controles paralelos. Análisis de la contribución individual del tabaco, la diabetes y la hipertensión arterial en el desarrollo del síndrome coronario agudo en pacientes VIH frente a individuos no infectados. HIV Med. 2013 Jan;14(1):40-8. Calvo- Sánchez M et al. II. Análisis retrospectivo de una cohorte prospectiva de pacientes con síndrome coronario agudo (SCA) comparando su presentación clínica y pronóstico a corto plazo en pacientes VIH y no infectados. Eur J Intern Med. 2011 Oct;22(5):485-8. Perelló R, Calvo M, et al. III. Estudio casos-controles anidado que evalúa la asociación entre variantes genéticas de la lipoproteína (a) con factores de riesgo cardiovascular tradicionales y el riesgo de presentar infarto de miocardio en pacientes VIH. Egaña-Gorroño L, Martínez E, Escribà T, Calvo M, Gatell JM, Arnedo M. Front Immunol. 2012 Dec 6;3:367. IV. Revisión sistemática de la evidencia científica sobre redistribución de la grasa corporal, alteraciones metabólicas y su impacto en pacientes en edades avanzadas infectados por VIH. Calvo M, Martinez E. Curr Opin HIV AIDS. 2014 Jul;9(4):332-9. V. Revisión sistemática de la literatura científica sobre el abandono del consumo de tabaco en la población VIH. Calvo M, Martínez E. HIV Medicine 2014. VI. Revisión de los mecanismos fisiopatológicos e implicaciones clínicas del consumo de tabaco y la infección por VIH. Calvo M, Laguno M, Martínez M, Martínez E. AIDS Reviews 2014.

Background: Coronary artery disease (CAD) is a complex disease and the leading cause of death in the world. Populations of different ancestry do not always share the same risk markers. Natural selective processes may be the cause of some of the population differences detected for specific risk mutations. Objective: In this study, 384 single nucleotide polymorphisms (SNPs) located in four genomic regions associated with CAD (1p13, 1q41, 9p21 and 10q11) are analysed in a set of 19 populations from Europe, Middle East and North Africa and also in Asian and African samples from the 1000 Genomes Project. The aim of this survey is to explore for the first time whether the genetic variability in these genomic regions is better explained by demography or by natural selection. Results: The results indicate significant differences in the structure of genetic variation and in the LD patterns among populations that probably explain the population disparities found in markers of susceptibility to CAD. Conclusions: The results are consistent with potential signature of positive selection in the 9p21 region and of balancing selection in the 9p21 and 10q11. Specifically, in Europe three CAD risk markers in the 9p21 region (rs9632884, rs1537371 and rs1333042) show consistent signals of positive selection. The results of this study are consistent with a potential selective role of CAD in the configuration of genetic diversity in current human populations.

Altres ajuts: Fundació La Marató de TV3 07 (project 080810); Universitat de Barcelona (project ACESBELL 08) Collateral growth in patients with coronary artery disease (CAD) is highly heterogeneous. Although multiple factors are thought to play a role in collateral development, the contribution of genetic factors to coronary collateral circulation (CCC) is largely unknown. The goal of this study was to assess whether functional single nucleotide polymorphisms (SNPs) in genes involved in vascular growth are associated with CCC. 677 consecutive CAD patients were enrolled in the study and their CCC was assessed by the Rentrop method. 22 SNPs corresponding to 10 genes involved in postischemic neovascularization were genotyped and multivariate logistic regression models were adjusted using clinically relevant variables to estimate odds ratios and used to examine associations of allelic variants, genotypes and haplotypes with CCC. Statistical analysis showed that the HIF1A rs11549465 and rs2057482; VEGFA rs2010963, rs1570360, rs699947, rs3025039 and rs833061; KDR rs1870377, rs2305948 and rs2071559; CCL2 rs1024611, rs1024610, rs2857657 and rs2857654; NOS3 rs1799983; ICAM1 rs5498 and rs3093030; TGFB1 rs1800469; CD53 rs6679497; POSTN rs3829365 and rs1028728; and LGALS2 rs7291467 polymorphisms, as well as their haplotype combinations, were not associated with CCC (p < 0.05). We could not validate in our cohort the association of the NOS3 rs1799983, HIF1A rs11549465, VEGFA rs2010963 and rs699947, and LGALS2 rs7291467 variants with CCC reported by other authors. A validated SNP-based genome-wide association study is required to identify polymorphisms influencing CCC.

BACKGROUND: To evaluate the predictive value of carotid atherosclerotic disease (CAD) and intima-media thickness (IMT) on incident cardiovascular disease and mortality in hemodialysis patients. METHODS: Multicenter, observational, prospective study including 110 patients, followed-up to 6 years. Carotid doppler ultrasonographic findings were classified in 4 degrees of severity: 1) IMT 0.9 mm, 3) carotid plaque with stenosis 50%. The associations between IMT and CAD and cardiovascular events, total and cardiovascular mortality were assessed. RESULTS: 83% of the patients had atherosclerotic plaques (CAD degrees 3-4). During follow-up, 29.1% of patients experienced cardiovascular events, and 28.2% died, 38.7% of cardiovascular origin. The presence of plaques was associated with cardiovascular events (p = 0.03) while calcified plaques were associated with both cardiovascular events (p = 0.01), cardiovascular mortality (p = 0.03) and non-significantly with overall mortality (p = 0.08) in the survival analysis. Carotid IMT was not associated with outcomes. Cardiovascular events correlated with CAD severity (HR 2.27, 95% CI 1.13-4.54), age (HR 1.04, 1.01-1.06), previous cardiovascular disease (HR 1.75, 1.05-4.42), dyslipidemia (HR 2.25, 1.11-4.53), lipoprotein (a) (HR 1.01, 1.00-1.02), troponin I (HR 3.89, 1.07-14.18), fibrinogen levels (HR 1.38, 0.98-1.94) and antiplatelet therapy (HR 2.14, 1.04-4.4). In an age-adjusted multivariate model, cardiovascular events were independently associated with previous coronary artery disease (HR 3.29, 1.52-7.15) and lipoprotein (a) (HR 1.01, 1.00-1.02)./nCONCLUSIONS: The presence of carotid plaques and, especially, calcified plaques, are predictors of new cardiovascular events and cardiovascular mortality in hemodialysis patients, while IMT was not. The prognostic value of calcified plaques should be confirmed in future studies. This study was supported in part by the FISS project 03/0791 (a public grant from the Spanish Ministry of Health) ["Fondo de Investigación Sanitaria Instituto Carlos III, Ministerio de Sanidad y Consumo. FIS project 03/0791, http://www.isciii.es/ISCIII/es/contenidos/fd-investigacion/fd-financiacion/convocatorias-ayudas-accion-estrategica-salud.shtml].

Background The effects of dual antiplatelet therapy (DAPT) and triple therapy (TT: DAPT plus oral anticoagulation) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) regarding to CHA2DS2-VASc score remain undefined.We compare the effect of TT vs. DAPT in this setting regarding the CHA2DS2-VASc score. Methods and results In a prospective multicenter registry, 585 patients (75.2% male, 73.2 ± 8.2 years) with AF undergoing PCI were followed up during 1 year. Of them, 157 (26.8%) had a CHA2DS2-VASc=1, and 428 (73.2%) had a CHA2DS2-VASc ≥2. TT was prescribed in 51.6% with CHA2DS2-VASc=1 and in 55.5% with CHA2DS2-VASc ≥ 2. Patients with CHA2DS2-VASc=1 receiving TT had a similar thromboembolism rate to those on DAPT (1.2% vs. 1.3%, P=0.73), but more total (19.5% vs. 6.9%, P=0.01) and a tendency to more major (4.9% vs. 0%, P=0.06) bleeding. However, patients with CHA2DS2-VASc ≥ 2 receiving TT had a lower thromboembolism rate (1.7% vs. 5.3%, P=0.03) and a trend towards more bleeds (21.8% vs. 15.6%, P=0.06), with an excess of major bleeding (8.4% vs. 3.1%, P=0.01). Rates of major adverse cardiac events (MACE) in both CHA2DS2-VASc subgroups were similar, irrespective of treatment. In a Cox multivariate analysis, TT was associated to major bleeding, but not with MACE. Conclusions In patients with AF and CHA2DS2-VASc=1 undergoing PCI, the use of TT involves a high risk of bleeding without a significant benefit in preventing thromboembolism.

BackgroundSmall vessel disease (SMD) remains a major challenge because of the increased risk of restenosis. We sought to assess the efficacy and safety of a paclitaxel-eluting balloon (PEB) in patients with SMD. Methods and ResultsOne-hundred and four patients with native coronary lesions in small vessels treated by using a PEB were included in this prospective multicenter registry. In each case, after regular balloon dilatation, a larger PEB was inflated for a minimum of 45-60 seconds. Patients were 6510 years old, 43% diabetic, and 58% presented acutely. Angiographic success was 93% (7% bailout BMS implantation due to coronary dissection). The rate of major adverse cardiac events (MACE) at 12 months was 4.8% (1.9% cardiac death, 1.0% MI, and 2.9% TLR). One definite stent thrombosis was reported at 6 months in a patient with bailout BMS implantation. At 7 months, late loss was 0.31 +/- 0.2mm. Bail-out BMS after DEB use, was an independent predictor of MACE, HR 18.74, 95%CI (2.58-135.84) and TLR, HR 30.99, 95%CI (2.79-344.07). ConclusionThe use of this PEB for the treatment of SMD provides excellent 1-year outcomes with only 4.8% MACE. The need for a bailout BMS was a strong predictor of MACE and TLR. (J Interven Cardiol 2015;28:430-438)

BACKGROUND: Current guidelines for patients with moderate- or high-risk acute coronary syndromes recommend an early invasive approach with concomitant antithrombotic therapy, including aspirin, clopidogrel, unfractionated or low-molecular-weight heparin, and glycoprotein IIb/IIIa inhibitors. We evaluated the role of thrombin-specific anticoagulation with bivalirudin in such patients. METHODS: We assigned 13,819 patients with acute coronary syndromes to one of three antithrombotic regimens: unfractionated heparin or enoxaparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin alone. The primary end points were a composite ischemia end point (death, myocardial infarction, or unplanned revascularization for ischemia), major bleeding, and the net clinical outcome, defined as the combination of composite ischemia or major bleeding. RESULTS: Bivalirudin plus a glycoprotein IIb/IIIa inhibitor, as compared with heparin plus a glycoprotein IIb/IIIa inhibitor, was associated with noninferior 30-day rates of the composite ischemia end point (7.7% and 7.3%, respectively), major bleeding (5.3% and 5.7%), and the net clinical outcome end point (11.8% and 11.7%). Bivalirudin alone, as compared with heparin plus a glycoprotein IIb/IIIa inhibitor, was associated with a noninferior rate of the composite ischemia end point (7.8% and 7.3%, respectively; P=0.32; relative risk, 1.08; 95% confidence interval [CI], 0.93 to 1.24) and significantly reduced rates of major bleeding (3.0% vs. 5.7%; P

The oldest old population (>85 years of age) represents the faster growing segment of the elderly in developed countries. Cardioembolic infarction (CI) accounts for 14%-30% of all cerebral infarcts and is the most severe ischemic stroke subtype with the highest in-hospital mortality. Also, CI is associated with a low frequency of symptom-free patients at hospital discharge and presents a non-negligible risk of early embolic recurrence. Moreover, cardioembolic stroke is the acute cerebrovascular event most commonly found in very old subjects. However, some clinical aspects of the natural course of the disease in very old patients are still poorly defined. The present report presents an updated review of relevant aspects of CI related to clinical manifestations, biological characteristics, prognostic implications, and treatment strategies, which may contribute to improving the quality of care and outcome of acute cardioembolic stroke in very old patients. The most relevant aspects of CI are discussed based on the data published in the literature and the authors' experience in the management of stroke patients, collected from the hospital-based "Sagrat Cor Hospital of Barcelona Stroke Registry". The following aspects are commented on: epidemiologic data and risk factors, clinical characteristics, cardiac workup studies, special cardioembolic clinical features, outcome, thrombolytic therapy, antithrombotic treatment, and indications for future research lines. Cardioembolic stroke is an important topic in the frontier between cardiology and vascular neurology. The impact of CI on the patients' health and quality of life, health care systems, and society in general merits an in-depth review of current clinical issues, advances, and controversies.

An interesting aspect of infection with several infectious agents is the possible association with some diseases apparently not associated with infections. One of the most exciting examples of this is the association of cardiovascular diseases with infection involving several different infectious agents. Cytomegalovirus (CMV) is one of the chief candidates that have been studied. Several epidemiologic reports indicate a possible association of various forms of vascular disease with the presence and titer of viral antibodies. Other studies show the presence of virus, viral antigens or nucleic acid in atherosclerotic lesions. Studies in animal models and cell-culture studies present attractive mechanisms by which the virus may play a role in the etiology of these diseases. However, negative results have also been reported, and more research is needed before the final verdict on this exciting question is presented.

BACKGROUND: The direct-acting platelet P2Y12 receptor antagonist ticagrelor can reduce the incidence of major adverse cardiovascular events when administered at hospital admission to patients with ST-segment elevation myocardial infarction (STEMI). Whether prehospital administration of ticagrelor can improve coronary reperfusion and the clinical outcome is unknown.METHODS: We conducted an international, multicenter, randomized, double-blind study involving 1862 patients with ongoing STEMI of less than 6 hours' duration, comparing prehospital (in the ambulance) versus in-hospital (in the catheterization laboratory) treatment with ticagrelor. The coprimary end points were the proportion of patients who did not have a 70% or greater resolution of ST-segment elevation before percutaneous coronary intervention (PCI) and the proportion of patients who did not have Thrombolysis in Myocardial Infarction flow grade 3 in the infarct-related artery at initial angiography. Secondary end points included the rates of major adverse cardiovascular events and definite stent thrombosis at 30 days.RESULTS: The median time from randomization to angiography was 48 minutes, and the median time difference between the two treatment strategies was 31 minutes. The two coprimary end points did not differ significantly between the prehospital and in-hospital groups. The absence of ST-segment elevation resolution of 70% or greater after PCI (a secondary end point) was reported for 42.5% and 47.5% of the patients, respectively. The rates of major adverse cardiovascular events did not differ significantly between the two study groups. The rates of definite stent thrombosis were lower in the prehospital group than in the in-hospital group (0% vs. 0.8% in the first 24 hours; 0.2% vs. 1.2% at 30 days). Rates of major bleeding events were low and virtually identical in the two groups, regardless of the bleeding definition used.CONCLUSIONS: Prehospital administration of ticagrelor in patients with acute STEMI appeared to be safe but did not improve pre-PCI coronary reperfusion. (Funded by AstraZeneca; ATLANTIC ClinicalTrials.gov number, NCT01347580.).

As physicians, we often face patients with cardiovascular risk factors or different kinds of heart disease. We prescribe statins, ACE inhibitors or β-blockers, but also (should) encourage our patients to engage in regular physical activity to reduce cardiovascular disease burden. Physical exercise, as a part of cardiac rehabilitation or a primary prevention programme, is seemingly one of a kind. ‘For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration’.1 No other known therapy offers such advantageous characteristics. This even led some researchers to speculate, some 40 years ago, that marathon runners were immune to atherosclerosis.2 Running a marathon was quite unusual at that time, and cardiovascular adaptation to such a high load of exercise had been scarcely explored. Since then, the late 70s, the number of non-professional runners finishing a marathon has increased 20-fold, and current observational studies are jeopardising the notion of exercise as risk-free. Increased sudden death risk during exercise bouts is well established but extremely rare. An evolving core of evidence supports the hypothesis that regular exercise increases the risk of atrial fibrillation (AF), ventricular arrhythmias or even ischaemic heart disease.3 How do these findings fit with the well-known benefits of exercise? Two papers explore this subject4 ,5 and provide important insights. By assessing outcomes such as AF incidence4 and cardiovascular or total mortality,5 both groups elegantly suggest in two large cohorts that exercise intensity and duration are key players in this association. They describe a similar U-shaped or reverse J-shaped pattern for the dose–response effect of exercise: maximum cardiovascular benefits are obtained if performed at moderate doses, while these benefits are lost with (very) high-intensity and prolonged efforts. Both groups took previously collected data on exercise performance …

Fundamento: As patologias cardiovasculares são a maior causa de morbimortalidade nos países desenvolvidos e emergentes. Sua principal etiologia, a aterosclerose, é doença disseminada acometendo os territórios coronariano, cerebral e periférico. A doença arterial obstrutiva periférica (DAOP), além de suas consequências per se, sinaliza o acometimento do território coronariano. Portanto, seu melhor conhecimento permite tratamento adequado, retardando complicações locais e à distância, diminuindo o custo para o sistema de saúde. Objetivo: Este estudo estima a porcentagem de DAOP em nipo-brasileiros de Bauru (SP), reconhecidos pela alta prevalência de distúrbios metabólicos, como hipertensão arterial (43%), diabetes melito (33%) e hipercolesterolemia (60 %), e analisa a associação com biomarcadores de risco. Métodos: Este estudo transversal populacional avaliou 1.330 nipo-brasileiros de ambos os sexos com idade ≥ 30 anos que foram submetidos a exame físico completo, medidas antropométricas, exames laboratoriais e índice tornozelo-braço (ITB). Participantes com ITB ≤ 0,90 foram diagnosticados como portadores de DAOP. Após aplicação dos critérios de exclusão, 1.038 indivíduos integraram a análise. Empregou-se regressão de Poisson para análise das associações com DAOP. Resultados: A idade média foi 56,8 anos e a porcentagem de DAOP foi 21,1%, igual entre os sexos. DAOP associou-se com tabagismo (RP 2,16 [1,33-3,48]) e hipertensão arterial (RP 1,56 [1,12-2,22]). Conclusão: A porcentagem de DAOP nos nipo-brasileiros foi semelhante à de outras populações de perfil cardiometabólico desfavorável (US PARTNERS e POPADAD). A associação independente de DAOP com tabagismo e hipertensão, mas não com outros clássicos fatores de risco, pode depender das frequências muito elevadas dos distúrbios metabólicos nessa população. Background: Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. Objective: This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. Methods: This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. Results: The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). Conclusion: The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population.

Objectives To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P

Coronary artery disease (CAD) mortality and morbidity is present in the European continent in a four-fold gradient across populations, from the South (Spain and France) with the lowest CAD mortality, towards the North (Finland and UK). This observed gradient has not been fully explained by classical or single genetic risk factors, resulting in some cases in the so called Southern European or Mediterranean paradox. Here we approached population genetic risk estimates using genetic risk scores (GRS) constructed with single nucleotide polymorphisms (SNP) from nitric oxide synthases (NOS) genes. These SNPs appeared to be associated with myocardial infarction (MI) in 2165 cases and 2153 controls. The GRSs were computed in 34 general European populations. Although the contribution of these GRS was lower than 1% between cases and controls, the mean GRS per population was positively correlated with coronary incidence explaining 65-85% of the variation among populations (67% in women and 86% in men). This large contribution to CAD incidence variation among populations might be a result of colinearity with several other common genetic and environmental factors. These results are not consistent with the cardiovascular Mediterranean paradox for genetics and support a CAD genetic architecture mainly based on combinations of common genetic polymorphisms. Population genetic risk scores is a promising approach in public health interventions to develop lifestyle programs and prevent intermediate risk factors in certain subpopulations with specific genetic predisposition.

Treballs Finals de Grau d'Enginyeria Informàtica, Facultat de Matemàtiques, Universitat de Barcelona, Any: 2013, Director: Petia Radeva, En los últimos años, los avances tecnológicos, tanto en adquisición como en postprocesado de imágenes médicas, han sido muy numerosos. Esto implica que actualmente las imágenes del interior del cuerpo se guarden en formato digital y que se utilice la ayuda de herramientas computacionales para facilitar tanto la visualización como la interpretación de la información que éstas brindan. Actualmente existen dos modalidades de imágenes disponibles: anatómicas y funcionales. En este trabajo de fin de grado utilizaremos las imágenes anatómicas obtenidas por ultrasonidos. Concretamente trabajaremos sobre imágenes imágenes de ultrasonido intravascular (IVUS) que nos ofrecen la morfología de las estructuras vasculares. Nuestra intención es la de facilitar la tarea a los especialistas creando una herramienta fácil y rápida de utilizar para analizar la morfología de los vasos coronarios y escoger y aplicar la terapia más relevante.

Treballs Finals de Grau d'Enginyeria Informàtica, Facultat de Matemàtiques, Universitat de Barcelona, Any: 2013, Director: Petia Radeva, En los últimos años la medicina ha avanzado a una velocidad vertiginosa, en parte por nuevos descubrimientos y en parte causado por la evolución tecnológica. Esto hace que se presenten nuevos problemas, ya que ahora somos capaces de extraer gran cantidad de información, pero nos encontramos delante de un gran muro que hay que sortear. Este muro es la dificultad de tratar y obtener resultados de este volumen ingente de información. En nuestro caso, la tecnología IVUS ha supuesto un gran avance para la detección y el tratamiento de enfermedades de las arterias coronarias (EAC), pero también ha supuesto un reto cómo obtener la información, ya que, gracias a la tecnología IVUS tenemos que lidiar con una gran cantidad de imágenes. El objetivo de nuestro proyecto es crear una herramienta que ayude al profesional a tratar y procesar toda la información de la manera más cómoda y rápida posible para poder obtener el mejor resultado y diagnosticar o tratar al paciente.

Het Peilstationsproject Hart- en Vaatziekten is uitgevoerd van 1987-1991. In deze periode zijn ruim 36.000 mannen en vrouwen in de leeftijd van 20-59 jaar onderzocht op risicofactoren voor hart- en vaatziekten. Prevalentie van hypercholesterolemie was 16% voor mannen en 13% voor vrouwen, 21% van de mannen en 6% van de vrouwen had een verlaagd HDL-cholesterolgehalte. Acht procent van de mannen en 6% van de vrouwen had hypertensie en 7% van de mannen en 9% van de vrouwen had overgewicht. Veertig procent van de mannen en vrouwen rookte sigaretten, 10% van de mannen en 3% van de vrouwen waren zware drinkers. Ongeveer 1/3 deel van alle mannen en vrouwen was lichamelijk inactief. De prevalentie van hypercholesterolemie daalde over de studieperiode met 3% bij mannen en 2% bij vrouwen, de prevalentie van een verlaagd HDL-cholesterolgehalte nam toe met 9% bij mannen en 1% bij vrouwen. De prevalentie van hypertensie veranderde niet, maar de medicamenteuze behandeling van hypertensie daalde. De prevalentie van overgewicht en lichamelijke inactiviteit steeg wanneer werd gecorrigeerd voor veranderingen in opleidingsniveau over de studieperiode. Het percentage sigaretten rokers daalde met 3% bij mannen en 4% bij vrouwen, het percentage zware drinkers nam af met 3% bij mannen en vrouwen.

Background Cardiovascular diseases are the major cause of morbidity and mortality in developed and emerging countries. Their main etiology, atherosclerosis, is a disseminated disease that affects the coronary, cerebral and peripheral territories. The peripheral arterial disease (PAD), as well as its consequences, indicates the involvement of the coronary territory. Therefore, its better understanding enables proper treatment, delaying local and long-term complications, reducing the cost to the health system. Objective This study estimates the percentage of PAD in Japanese-Brazilians from Bauru (SP), recognized by the high prevalence of metabolic disorders such as hypertension (43%), diabetes mellitus (33%) and hypercholesterolemia (60%), and examines the association with risk biomarkers. Methods This cross-sectional population study evaluated 1,330 Japanese-Brazilians of both genders aged ≥ 30 who underwent a complete physical examination, anthropometric measurements, laboratory tests and ankle-brachial index (ABI). Participants with ABI ≤ 0.90 were diagnosed as having PAD. After applying the exclusion criteria, 1,038 individuals were part of the analysis. We used Poisson regression to analyze associations with PAD. Results The mean age was 56.8 years and the percentage of PAD was 21.1%, equal among the genders. PAD was associated with smoking (PR 2.16 [1.33 to 3.48]) and hypertension (PR 1.56 [1.12-2.22]). Conclusion The percentage of PAD in Japanese-Brazilians was similar to other populations of adverse cardiometabolic profile (US PARTNERS and POPADAD). The independent association of PAD with smoking and hypertension, but not with other classical risk factors, may depend on the very high frequencies of metabolic disorders in this population.

PART 1. EFECTE DE LA HIPÒXIA I FACTORS POINFLAMATORIS SOBRE EL REMODELAT CARDÍAC EN CARDIOMIÒCITS VENTRICULARS HUMANS. INTRODUCCIÓ. Els mecanismes moleculars pels quals la isquèmia miocardíaca es tradueix en remodelat ventricular i insuficiència cardíaca són poc coneguts. HIPÒTESI. La hipòxia i factors proinflamatoris són inductors específics de recanvi de matriu extracel•lular en els cardiomiòcits humans. MÈTODES. Cardiomiòcits ventriculars humans adults (cèl•lules AC16) van ser incubats en condicions de tensió reduïda d’oxigen, CoCl2 (activador del factor de transcripció induïble per hipòxia 1, HIF-1), rotenona (inhibidor de HIF-1), TNFα, IL1β, LPS o vehicle durant intervals de temps variables. Un cop completats els períodes d’incubació, van obtenir-se els sobrenadants i el RNA cel•lulars per determinar la secreció cel•lular i l’expressió gènica de factors relacionats amb el recanvi de matriu extracel•lular. RESULTATS. La hipòxia indueix la producció de PIIINP (propèptid aminoterminal del del procolàgen tipus III) i inhibeix la síntesi i producció de TIMP1 (inhibidor tissular de metaloproteinases tipus 1) en els cardiomiòcits. La IL1β estimula la producció de PIIINP, TIMP1 i àcid hialurònic en cardiomiòcits. CONCLUSIÓ. La hipòxia i la IL1β activen el remodelat de matriu extracel•lular en cardiomiòcits ventriculars humans. Els resultats suggereixen que la hipòxia i la IL1-β són factors contribuents a la dilatació ventricular i insuficiència cardíaca en la malaltia cardíaca isquèmica. PART 2. EFECTE DE LA HIPÒXIA SOBRE LA SECRECIÓ DEL PÈPTID NATRIURÈTIC TIPUS B (BNP) EN CARDIOMIÒCITS VENTRICULARS HUMANS. INTRODUCCIÓ. El principal estímul per la síntesi i secreció de BNP es la distensió de la paret cardíaca. Evidències recents suggereixen que la isquèmia cardíaca pot induir també la producció de BNP. HIPÒTESI. La tensió reduïda d’oxigen estimula directament l’expressió gènica i la secreció de BNP en cardiomiòcits ventriculars humans en absència d’estímuls hemodinàmics o neurohormonals. MÈTODES. Cardiomiòcits ventriculars adults (cèl•lules AC16) van ser incubats en condiciones normòxiques o hipòxiques amb o sense la presència de rotenona. L’acumulació de BNP, ANP i VEGF es va mesurar en els sobrenadants cel•lulars. L’expressió gènica d’aquests factors va determinar-se mitjançant PCR a temps real. L’activitat transcripcional de HIF-1 va determinar-se en extractes nuclears cel•lulars mitjançant un enziminmunoassaig lligat a la seqüència d’unió de HIF-1 al DNA. RESULTATS. L’activitat transcripcional de HIF-1 va induir-se en condicions hipòxiques. La hipòxia va estimular la secreció i l’expressió gènica de BNP i VEGF però no d’ANP en els cardiomiòcits. La inhibició de HIF-1 en condicions hipòxiques va disminuir la secreció de BNP i VEGF. CONCLUSIONS. La hipòxia indueix la síntesi i secreció de BNP en cardiomiòcits ventriculars humans a través d’un mecanisme depenent de l’activació transcripcional de HIF-1. PART 3. ESTUDI DE LA SIGNIFICACIÓ CLÍNICA DE LES CONCENTRACIONS PLASMÀTIQUES DE BNP A L’INGRÉS EN PACIENTS AMB SÍNDROME CORONÀRIA AGUDA (SCA). INTRODUCCIÓ. Els pacients SCA presenten concentracions plasmàtiques elevades de BNP atribuïdes a la distensió de la paret ventricular. Existeix poca informació sobre el valor clínic d’aquest marcador cardíac en pacients amb SCA i fracció d’ejecció ventricular esquerra (LVEF) preservada. La demostració que la hipòxia estimula directament la secreció de BNP en cardiomiòcits ventriculars permet formular la hipòtesi que els pacients amb SCA sense insuficiència cardíaca i/o disfunció ventricular presenten concentracions plasmàtiques de BNP elevades, en relació al grau d’hipòxia cel•lular. Mètodes. L’estudi es va realitzar en 1806 pacients amb SCA ingressats de forma consecutiva dins les primeres 24 hores posteriors a l’inici dels símptomes. Es va realitzar un seguiment durant un any de l’aparició d’esdeveniments adversos. RESULTATS. La concentració plasmàtica de BNP en els pacients amb SCA i LVEF preservada va ser superior a l’observada en un grup control d’individus sans. Durant el seguiment, l’aparició d’esdeveniments adversos va ser del 10,0% en els pacients amb LVEF reduïda i del 7,9% en els pacients amb LVEF preservada. Els pacients amb BNP>150 pg/ml van presentar una major probabilitat d’esdeveniments adversos. L’anàlisi estadístic multivariat mostra que la contribució de BNP en la predicció d’esdeveniments adversos es manté desprès d’ajustar en funció de la LVEF. CONCLUSIONS. Els pacients amb SCA i LVEF preservada presenten concentracions plasmàtiques de BNP elevades a l’ingrès, que constitueixen un factor predictor independent de presentar nous episodis de SCA i/o mortalitat., MOLECULAR MECHANISMS OF MYOCARDIAL SECRETION: VENTRICULAR REMODELING AND SECRETION OF B-TYPE NATRIURETIC PEPTIDE. The molecular mechanisms by which myocardial ischemia translates in ventricular remodeling and heart failure remain unclear. In the current thesis it was explored whether hypoxia and proinflammatory factors are specific inducers of matrix remodeling in cardiomyocytes. Adult human ventricular cardiomyocytes (AC16 cells) were incubated at normoxic or hypoxic conditions and stimulated with proinflammatory factors. Matrix remodeling and cellular secretion and gene expression of matrix remodeling factors were analyzed. Results show that hypoxia activates matrix remodeling and induces the production of PIIINP (procollagen III N-terminal propeptide) and inhibits the production of TIMP-1 (tissue inhibitor of metalloproteinase 1). IL1β stimulated the cardiac production of PIIINP, TIMP1 and hyaluronic acid. Results suggest that hypoxia and IL1β may contribute to ventricular dilation and heart failure in ischemic heart diseases. The effect of hypoxia on the cardiac secretion of B-type natriuretic peptid (BNP) was also evaluated. Hypoxia stimulated the protein release and mRNA levels of BNP and VEGF but not ANP in AC16 cells. The analysis of the transcriptional activity of the hypoxia-inducible factor 1 (HIF-1) in nuclear extracts showed that HIF-1 activity was induced under hypoxic conditions. The treatment of AC16 cells with the HIF-1 inhibitor rotenone in hypoxia inhibited BNP and VEGF release. In conclusion, data indicate that hypoxia induces the synthesis and secretion of BNP in human ventricular myocytes, likely through HIF-1-enhanced transcriptional activity. This observed direct effect of hypoxia on BNP secretion in human ventricular myocytes allowed hypothesizing that patients with acute coronary syndromes (ACS) without ventricular dysfunction or heart failure present high plasma levels of BNP related with their degree of cardiac hypoxia. Thus, prognostic significance of BNP plasma levels was evaluated in a cohort of 1806 consecutive patients with ACS admitted within the first 24 hours after the onset of symptoms. The follow up for adverse events was of one year. Plasma levels of BNP in ACS patients with preserved left ventricular ejection fraction (LVEF) were higher than in the control group without ACS. During follow-up, adverse events was 10.0 % in patients with reduced LVEF and 7.9 % in patients with preserved LVEF. Patients with BNP>150 pg/ml presented significantly higher probability of adverse events during follow up. Results show that ACS patients with preserved LVEF present higher BNP levels at admission, which constitute an independent predictor of presenting new ACS and mortality.

Summary Although approximately 50% of Down Syndrome (DS) patients have heart abnormalities, they exhibit an overprotection against cardiac abnormalities related with the connective tissue, for example a lower risk of coronary artery disease. A recent study reported a case of a person affected by DS who carried mutations in FBN1, the gene causative for a connective tissue disorder called Marfan Syndrome (MFS). The fact that the person did not have any cardiac alterations suggested compensation effects due to DS. This observation is supported by a previous DS meta-analysis at the molecular level where we have found an overall upregulation of FBN1 (which is usually downregulated in MFS). Additionally, that result was cross-validated with independent expression data from DS heart tissue. The aim of this work is to elucidate the role of FBN1 in DS and to establish a molecular link to MFS and MFS-related syndromes using a computational approach. To reach that, we conducted different analytical approaches over two DS studies (our previous meta-analysis and independent expression data from DS heart tissue) and revealed expression alterations in the FBN1 interaction network, in FBN1 co-expressed genes and FBN1-related pathways. After merging the significant results from different datasets with a Bayesian approach, we prioritized 85 genes that were able to distinguish control from DS cases. We further found evidence for several of these genes (47%), such as FBN1, DCN, and COL1A2, being dysregulated in MFS and MFS-related diseases. Consequently, we further encourage the scientific community to take into account FBN1 and its related network for the study of DS cardiovascular characteristics.

Samenvatting van rapport 528901011

In dit rapport wordt ingegaan op de ontwikkelingen in de epidemiologie, etiologie en mogelijkheden voor primaire, secundaire en tertiaire preventie van coronaire hartziekten (CHZ), hartfalen en cerebrovasculaire aandoeningen (CVA) door middel van leefstijlinterventie. Ondanks het feit dat het accent in dit rapport derhalve ligt op de leefstijldeterminanten, blijft ook kennis over de endogene determinanten van belang, aangezien het effect van leefstijlfactoren op het ontstaan en beloop van CHZ en CVA voornamelijk verloopt via de beinvloeding van deze endogene (intermediaire) determinanten. Met betrekking tot de primaire preventie van CHZ, hartfalen en CVA zijn roken, voeding, alcoholgebruik en lichamelijke activiteit belangrijke leefstijldeterminanten. Interventies, gericht op deze determinanten kunnen belangrijke endogene determinanten voor CHZ, hartfalen en CVA (met name serumcholesterol, overgewicht en bloeddruk) gunstig beinvloeden. Gezien de hoge prevalenties van roken, overmatig alcoholgebruik, lichamelijke (in)activiteit en de hoge vetconsumptie in Nederland, biedt interventie op deze determinanten in theorie goede mogelijkheden voor gezondheidswinst. In het verleden zijn programma's ten aanzien van preventie van CHZ en CVA met name gericht geweest op een van de (talrijke) determinanten voor deze aandoeningen. Uit de literatuur blijkt dat de beste resultaten met betrekking tot primaire preventie van CHZ en CVA worden gevonden in multifactoriele programma's, gericht op het verlagen van de niveau's van meerdere factoren tegelijkertijd. Een geintegreerde aanpak van preventie door middel van leefstijlinterventie biedt aanzienlijke mogelijkheden voor gezondheidswinst. Het mechanisme waarlangs omgevingsfactoren, zoals voedingsstoffen, de niveaus van deze endogene determinanten beinvloeden wordt bepaald door verschillende (waaronder genetische) factoren. Dit leidt tot een aanzienlijke variabiliteit in de respons op deze omgevingsfactoren. Het is wenselijk het inzicht in de aard en het effect van deze factoren te vergroten, aangezien dit kan bijdragen aan het opsporen van hoog-risico groepen. Aansluitend bij de consensus-bijeenkomsten ten aanzien van hypercholesterolemie en hypertensie kan worden aanbevolen bij personen met licht verhoogde determinantenniveaus in eerste instantie met behulp van voedingsaanpassingen (beperking van inneming van verzadigd vet, natrium en alcohol) en, indien nodig, gewichtsvermindering te trachten een reductie van de bloeddruk en/of het serumcholesterol te verkrijgen, alvorens over te gaan tot medicamenteuze behandeling. Naast gewichtsreductie past ook regelmatige lichamelijke activiteit in het behandelingsschema. Bij secundaire preventie van CVA en CHZ moet worden gedacht aan het zo vroeg mogelijk herkennen van symptomen bij personen met angina pectoris, TIA of een 'stil' hart- of herseninfarct. Hartfalen is een langzaam voortschrijdende aandoening, die vaak de nasleep is van een hartinfarct. Dit gegeven biedt aanknopingspunten voor secundaire preventie door vroegtijdige onderkenning, gevolgd door adequate behandeling. De bewijslast voor de relatie tussen leefstijlfactoren en het beloop van CHZ, CVA en hartzwakte is kleiner dan die voor het ontstaan van de ziekte, hoofdzakelijk ten gevolge van de (relatief) beperkte informatie over deze relatie in de wetenschappelijke literatuur. De leefstijldeterminanten die een rol spelen bij de etiologie van CHZ, CVA en hartfalen, zijn voor een belangrijk deel ook van belang bij het beloop van de aandoeningen en bieden dus mogelijkheden voor tertiaire preventie. Beinvloeding van het rookgedrag, het verlagen van het serumcholesterol-gehalte, het lichaamsgewicht en de bloeddruk door voedingsaanpassingen en het nastreven van een goede lichamelijke conditie door frequente lichamelijke activiteit, kan de kans op complicaties bij CHZ- en CVA-patienten, zoals een tweede hart- of herseninfarct, verlagen en kan zelfs tot regressie van het atherosclerose-proces leiden. Het huidige rookbeleid, gericht op beperking van het tabaksgebruik en bescherming van de jeugd en de niet-roker, is te vrijblijvend om tot werkelijk resultaat te leiden. Een preventiebeleid ten aanzien van roken zal in verschillende sectoren moeten doordringen om succes te behalen (facetbeleid). De eerstelijns-gezondheidszorg, GGD'en, industrie en wetgevende macht spelen in dat facetbeleid een belangrijke rol. Met betrekking tot het voedingsbeleid is een terughoudendheid merkbaar, waar het de intersectorale aanpak betreft. Dit resulteert tot op dit moment in een slechts traag nerbeterende betrokkenheid van de industrie en minimale vooruitgang in de richtlijnen/wetgeving, bijvoorbeeld ten aanzien van etikettering van voedingsmiddelen. Ook hier is facetbeleid wenselijk. Zo kan de hoge zoutconsumptie in Nederland alleen effectief worden beinvloed als medewerking wordt verkregen van de voedingsmiddelenindustrie, aangezien 85% van de geconsumeerde hoeveelheid zout reeds aanwezig is in het voedingsmiddel, en slechts 15% tijdens het bereiden of aan tafel wordt toegevoegd. Het is opvallend dat in het gezondheidsbeleid nauwelijks aandacht wordt besteed aan het reduceren van lichamelijke inactiviteit. De nieuwste inzichten op het gebied van deze determinant rechtvaardigen een meer stimulerend beleid ten aanzien van lichamelijke activiteit in ons land, waar naar schatting meer dan een derde van de bevolking lichamelijk inactief is in de vrije tijd. Aanbevolen wordt om tot een voorlichtingsplan voor lichamelijke activiteit te komen, vergelijkbaar met het Alcohol Voorlichtings Plan, dat op zowel nationaal als lokaal niveau activiteiten ontplooit, gericht op bewustwording van de problematiek en beinvloeding van de mentaliteit. In het overheidsbeleid ten aanzien van chronisch zieken wordt slechts zeer beperkt aandacht besteed aan de rol die leefstijlfactoren kunnen spelen bij het voorkomen van verergering van de ziekte en de goede mogelijkheden die daarmee ontstaan voor de verbetering van de kwaliteit van leven van de chronisch zieke. Een actiever overheidsbeleid lijkt daarom wenselijk, gezien de mogelijke gezondheidswinst (inclusief verbetering van de kwaliteit van leven) die met tertiaire preventie valt te behalen.

In dit rapport wordt ingegaan op de ontwikkelingen in de epidemiologie, etiologie en mogelijkheden voor primaire, secundaire en tertiaire preventie van coronaire hartziekten (CHZ), hartfalen en cerebrovasculaire aandoeningen (CVA) door middel van leefstijlinterventie. Ondanks het feit dat het accent in dit rapport derhalve ligt op de leefstijldeterminanten, blijft ook kennis over de endogene determinanten van belang, aangezien het effect van leefstijlfactoren op het ontstaan en beloop van CHZ en CVA voornamelijk verloopt via de beinvloeding van deze endogene (intermediaire) determinanten. Met betrekking tot de primaire preventie van CHZ, hartfalen en CVA zijn roken, voeding, alcoholgebruik en lichamelijke activiteit belangrijke leefstijldeterminanten. Interventies, gericht op deze determinanten kunnen belangrijke endogene determinanten voor CHZ, hartfalen en CVA (met name serumcholesterol, overgewicht en bloeddruk) gunstig beinvloeden. Gezien de hoge prevalenties van roken, overmatig alcoholgebruik, lichamelijke (in)activiteit en de hoge vetconsumptie in Nederland, biedt interventie op deze determinanten in theorie goede mogelijkheden voor gezondheidswinst. In het verleden zijn programma's ten aanzien van preventie van CHZ en CVA met name gericht geweest op een van de (talrijke) determinanten voor deze aandoeningen. Uit de literatuur blijkt dat de beste resultaten met betrekking tot primaire preventie van CHZ en CVA worden gevonden in multifactoriele programma's, gericht op het verlagen van de niveau's van meerdere factoren tegelijkertijd. Een geintegreerde aanpak van preventie door middel van leefstijlinterventie biedt aanzienlijke mogelijkheden voor gezondheidswinst. Het mechanisme waarlangs omgevingsfactoren, zoals voedingsstoffen, de niveaus van deze endogene determinanten beinvloeden wordt bepaald door verschillende (waaronder genetische) factoren. Dit leidt tot een aanzienlijke variabiliteit in de respons op deze omgevingsfactoren. Het is wenselijk het inzicht in de aard en het effect van deze factoren te vergroten, aangezien dit kan bijdragen aan het opsporen van hoog-risico groepen. Aansluitend bij de consensus-bijeenkomsten ten aanzien van hypercholesterolemie en hypertensie kan worden aanbevolen bij personen met licht verhoogde determinantenniveaus in eerste instantie met behulp van voedingsaanpassingen (beperking van inneming van verzadigd vet, natrium en alcohol) en, indien nodig, gewichtsvermindering te trachten een reductie van de bloeddruk en/of het serumcholesterol te verkrijgen, alvorens over te gaan tot medicamenteuze behandeling. Naast gewichtsreductie past ook regelmatige lichamelijke activiteit in het behandelingsschema. Bij secundaire preventie van CVA en CHZ moet worden gedacht aan het zo vroeg mogelijk herkennen van symptomen bij personen met angina pectoris, TIA of een 'stil' hart- of herseninfarct. Hartfalen is een langzaam voortschrijdende aandoening, die vaak de nasleep is van een hartinfarct. Dit gegeven biedt aanknopingspunten voor secundaire preventie door vroegtijdige onderkenning, gevolgd door adequate behandeling. De bewijslast voor de relatie tussen leefstijlfactoren en het beloop van CHZ, CVA en hartzwakte is kleiner dan die voor het ontstaan van de ziekte, hoofdzakelijk ten gevolge van de (relatief) beperkte informatie over deze relatie in de wetenschappelijke literatuur. De leefstijldeterminanten die een rol spelen bij de etiologie van CHZ, CVA en hartfalen, zijn voor een belangrijk deel ook van belang bij het beloop van de aandoeningen en bieden dus mogelijkheden voor tertiaire preventie. Beinvloeding van het rookgedrag, het verlagen van het serumcholesterol-gehalte, het lichaamsgewicht en de bloeddruk door voedingsaanpassingen en het nastreven van een goede lichamelijke conditie door frequente lichamelijke activiteit, kan de kans op complicaties bij CHZ- en CVA-patienten, zoals een tweede hart- of herseninfarct, verlagen en kan zelfs tot regressie van het atherosclerose-proces leiden. Het huidige rookbeleid, gericht op beperking van het tabaksgebruik en bescherming van de jeugd en de niet-roker, is te vrijblijvend om tot werkelijk resultaat te leiden. Een preventiebeleid ten aanzien van roken zal in verschillende sectoren moeten doordringen om succes te behalen (facetbeleid). De eerstelijns-gezondheidszorg, GGD'en, industrie en wetgevende macht spelen in dat facetbeleid een belangrijke rol. Met betrekking tot het voedingsbeleid is een terughoudendheid merkbaar, waar het de intersectorale aanpak betreft. Dit resulteert tot op dit moment in een slechts traag nerbeterende betrokkenheid van de industrie en minimale vooruitgang in de richtlijnen/wetgeving, bijvoorbeeld ten aanzien van etikettering van voedingsmiddelen. Ook hier is facetbeleid wenselijk. Zo kan de hoge zoutconsumptie in Nederland alleen effectief worden beinvloed als medewerking wordt verkregen van de voedingsmiddelenindustrie, aangezien 85% van de geconsumeerde hoeveelheid zout reeds aanwezig is in het voedingsmiddel, en slechts 15% tijdens het bereiden of aan tafel wordt toegevoegd. Het is opvallend dat in het gezondheidsbeleid nauwelijks aandacht wordt besteed aan het reduceren van lichamelijke inactiviteit. De nieuwste inzichten op het gebied van deze determinant rechtvaardigen een meer stimulerend beleid ten aanzien van lichamelijke activiteit in ons land, waar naar schatting meer dan een derde van de bevolking lichamelijk inactief is in de vrije tijd. Aanbevolen wordt om tot een voorlichtingsplan voor lichamelijke activiteit te komen, vergelijkbaar met het Alcohol Voorlichtings Plan, dat op zowel nationaal als lokaal niveau activiteiten ontplooit, gericht op bewustwording van de problematiek en beinvloeding van de mentaliteit. In het overheidsbeleid ten aanzien van chronisch zieken wordt slechts zeer beperkt aandacht besteed aan de rol die leefstijlfactoren kunnen spelen bij het voorkomen van verergering van de ziekte en de goede mogelijkheden die daarmee ontstaan voor de verbetering van de kwaliteit van leven van de chronisch zieke. Een actiever overheidsbeleid lijkt daarom wenselijk, gezien de mogelijke gezondheidswinst (inclusief verbetering van de kwaliteit van leven) die met tertiaire preventie valt te behalen.

Samenvatting van rapport 528901011

Los individuos forman parte de varios grupos a la vez, en primer lugar del familiar y en segundo de todos los demás. La capacidad de cuidado de familiares y profesionales sanitarios así como su credibilidad como promotores de la salud estarán relacionadas con sus creencias y conocimientos sobre la enfermedad. El objetivo fue conocer las creencias y percepciones de los familiares y personal sanitario con relación a las causas, consecuencias y manejo de los factores de riesgo de la enfermedad coronaria, en 4 Hospitales de la Provincia de Barcelona. Muestra: 57 familiares de pacientes ingresados por un primer evento coronario, 65 enfermeras y 38 médicos que estaban trabajando en un momento determinado en todos los turnos y servicios donde se atendían enfermos de cardiopatía isquémica. Para el análisis de datos se utilizó el programa SPSS Vs 9.0.1. Resultados. El 72 % de los familiares opinaban que el paciente realizaba una dieta grasa. No hacen suficiente ejercicio un 78%. Había vivido un suceso importante en los últimos tres años un 61%. Se sentían capaces de cuidar a su familiar un 66%. No se han observado diferencias entre las opiniones de enfermeras y médicos ni entre los diferentes hospitales. El paciente es el máximo responsable del control de su enfermedad.

Màster en Infermeria Cardiovascular, Universitat de Barcelona, Escola Universitària d'Infermeria, any: 2011-2012, Director: Joan Maria Estrada Masllorens. Tutora: Sandra Cabrera Jaime, La cardiopatía isquémica es aquella situación en la cual el corazón sufre una lesión, isquemia o necrosis causada por obstrucción de algún o algunos vasos coronarios, produciendo falta de irrigación y oxigenación de los mismos. Ésta enfermedad esta ocasionada por la arterioesclerosis de las arterias coronarias, que son las encargadas de proporcionar la sangre al miocardio. La arterioesclerosis coronaria es un proceso lento de formación de colágeno y acumulación de lípidos y células inflamatorias, causante de la estenosis. El tratamiento más común es antiagregantes, fármacos antianginosos como los nitratos, betabloqueantes, calcioantagonistas y la nitroglicerina sublingual si precisa

Coronary artery disease (CAD), also known as ischemic heart disease (IHD) and coronary heart disease (CHD), is caused by the narrowing (stenosis) of one or more coronary arteries, due to atherosclerosis, restricting blood flow and reducing the supply of oxygen to the heart muscle. Transient shortages in blood flow and oxygen lead to angina pectoris and chest pain, which may radiate to the left shoulder, arms, neck, back or jaw. Stable angina symptoms do not tend to progress in intensity over time. More seriously, the rupturing of an atherosclerotic plaque (causing a thrombotic occlusion) and stenosis of the vessel can result in acute myocardial infarction (AMI) due to a critical reduction in the blood supply to the heart muscle (myocardial ischemia). High levels of morbidity and mortality associated with this infarction are a consequence of ischemia. It is vital to promptly re-establish coronary blood flow after an infarction, because sustained ischemic damages and injuries to the heart muscle may lead to sudden death or heart failure. In addition to infarction, acute symptomatic manifestations of ischemic heart disease include unstable angina, and less common conditions such as cardiogenic shock and sudden death (Thygesen, 2007)...

In Spain a significant number of individuals die from atherosclerotic disease of the coronary and carotid arteries without having classic risk factors and prodromal symptoms. The diagonal ear lobe crease (DELC) has been characterized in the medical literature as a surrogate marker which can identify high risk patients having occult atherosclerosis. This topic however has not been examined in either the medical or dental literature emanating from Spain. The majority of clinical, angiography and postmortem reports support the premise that DELC is a valuable extravascular physical sign able to distinguish some patients at risk of succumbing to atherosclerosis of the coronary arteries. A minority of studies have however failed to support this hypothesis. More recently reports using B mode ultrasound have also linked DELC to atherosclerosis of the carotid artery and another report has related DELC to the presence of calcified carotid artery atheromas on panoramic radiographs. DELC is readily visible during head and neck cancer screening examinations. In conjunction with the patient’s medical history, vital signs, and panoramic radiograph, the DELC may assist in atherosclerotic risk assessment. Key words: Diagonal ear lobe crease, atherosclerosis disease, calcified carotid artery, atheromas, panoramic radiographs.

6 páginas., Ensuring the accuracy of dietary assessment instruments is paramount for interpreting diet-disease relationships. The present study assessed the relative and construct validity of the 14-point Mediterranean Diet Adherence Screener (MEDAS) used in the Prevención con Dieta Mediterránea (PREDIMED) study, a primary prevention nutrition-intervention trial. A validated FFQ and the MEDAS were administered to 7146 participants of the PREDIMED study. The MEDAS-derived PREDIMED score correlated significantly with the corresponding FFQ PREDIMED score (r = 0.52; intraclass correlation coefficient = 0.51) and in the anticipated directions with the dietary intakes reported on the FFQ. Using Bland Altman’s analysis, the average MEDAS Mediterranean diet score estimate was 105% of the FFQ PREDIMED score estimate. Limits of agreement ranged between 57 and 153%. Multiple linear regression analyses revealed that a higher PREDIMED score related directly (P < 0.001) to HDL-cholesterol (HDL-C) and inversely (P < 0.038) to BMI, waist circumference, TG, the TG:HDL-C ratio, fasting glucose, and the cholesterol:HDL-C ratio. The 10-y estimated coronary artery disease risk decreased as the PREDIMED score increased (P < 0.001). The MEDAS is a valid instrument for rapid estimation of adherence to the Mediterranean diet and may be useful in clinical practice., Supported by the Spanish Network RD06/0045/0000 [ISCIII, Sistema Nacional de Salud contract (CP06/00100, PI1001407] from Instituto de Salud Carlos III-FEDER, by grant CNIC06 from the Centro Nacional de Investigaciones Cardiovasculares, by grant ACOMP/2011/151 from the Valencia Goverment, by a joint contract of the Instituto de Salud Carlos III and the Health Department of the Catalan Government (Generalitat de Catalunya), CP 03/00115, and partially supported by the Generalitat of Catalunya (2005 SGR 00577). The CIBERobn is an initiative of the Instituto de Salud Carlos III, Spain.

Considerando que a prática de exercício físico com uma intensidade pelo menos moderada melhora a capacidade funcional (Maines et al., 1997; Clara et al., 2002; Olney et al., 2006), a qualidade de vida (Leal et al., 2005; Azevedo & Leal, 2009; Flynn et al., 2009) e diminui os fatores de risco coronários (Maines et al., 1997; Squires & Hamm, 2007; Perk, 2009; Pimenta, 2010), propõe-se com o presente estudo analisar o efeito do exercício físico supervisionado, em fase ambulatório precoce, realizada na comunidade, ao nível da recuperação de doentes cardíacos. Método: Aplicar-se-á um estudo experimental, em doentes cardíacos de ambos os sexos, entre os 28 e os 80 anos. Atribuir-se-á particular ênfase às alterações induzidas pela aplicação do programa de exercício físico nos parâmetros bioquímicos (colesterol total, C-LDL, C-HDL, triglicéridos e glicose), na composição corporal (peso, índice de massa corporal, perímetro da cintura), na capacidade funcional (consumo de oxigénio pico –V02 pico, equivalente metabólico, duplo produto), no nível de atividade física, na ingestão alimentar e na qualidade de vida. O estudo terá uma duração superior a três meses, comparando dois grupos, um grupo submetido ao exercício físico supervisionado (ES) e outro aos cuidados usuais (CU), os quais serão alvo de duas avaliações (inicial e final), avaliando-se a média e o desvio-padrão para todas as variáveis em estudo e recorrendo-se aos testes não paramétricos e paramétricos, para um nível de significância de p< .05. Resultados: Foram elegidos 52 doentes, sendo que 22 participaram no grupo cuidados usuais (CU) e 30 no grupo exercício físico supervisionado (ES), observando-se que o grupo ES apresentou melhorias mais acentuadas quando comparadas com o grupo CU, ao nível dos seguintes indicadores: dispêndio de kcal/semana (+697.22% vs +320.20%); PC (-3.19% vs +5.85%); CT (-23.92% vs -9.29%), C-LDL (-32.52% vs -8.92%); total de kcal/dia ingeridas (-33,31% vs -2.58%); VO2 pico (+30.88% vs -3.57%); qualidade de vida geral (+53.86% vs +2.96%). Conclusão: Concluindo que o exercício físico multicomponente, inserido na fase de ambulatório precoce na comunidade, potencia a recuperação de doentes cardíacos influenciando positivamente os fatores de risco de progressão da doença coronária, a capacidade funcional e a qualidade de vida fundamentais para que o doente possa, pelos seus próprios meios, retomar a sua vida na comunidade., Considering that the physical exercise with at least moderate intensity improves functional capacity (Maines et al., 1997; Clara et al., 2002; Olney et al., 2006), the quality of life (Leal et al., 2005; Leal & Azevedo, 2009; Flynn et al., 2009) and decreases coronary risk factors (Maines et al., 1997; Squires & Hamm, 2007; Perk, 2009; Pepper, 2010), this study proposes to examine the effect of supervised exercise in the early clinical phase held in the community, in the period of heart patients recovery. Method: This will be an experimental study of cardiac patients of both sexes, between 28 and 80 years old. In this study, special emphasis will be put on changes induced by application of physical exercise program in the biochemical parameters (total cholesterol, LDL-C, HDL-C, triglycerides and glucose), body composition (weight, body mass index, perimeter waist), functional capacity (peak oxygen consumption, metabolic equivalent, double product), level of physical activity, food intake and quality of life. The study will last over three months. Two groups undergoing supervised exercise (ES) and usual care (UC) will be compared, which will also be the subjects of two evaluations (initial and final), evaluating the mean and standard for all study variables and resorting to the non-parametric and parametric tests for a significance level of p, Orientador: Jorge Proença

In der vorliegenden prospektiven Kohortenstudie wurde der prognostische Wert verschiedener systemisch messbarer Inflammationsmarker alleine und in Kombination mit Plasmalipiden bei Patienten mit einer stabilen koronaren Herzerkrankung (KHK) untersucht. Von den initial 312 Patienten im Alter zwischen 40 und 68 Jahren mit angiographisch gesicherter und klinisch stabiler KHK, nahmen nach einer mittleren Follow-up-Zeit von 3,2 Jahren 300 Patienten an einer Nachuntersuchung teil. Bei allen Studienteilnehmern wurden zu Beginn der Studie verschiedene Entzündungsmarker und Lipoproteine im Plasma bestimmt. Bei 60 dieser 300 Patienten (20 %) wurde innerhalb der Nachbeobachtungszeit ein kardiovaskuläres Ereignis beobachtet. Die Inflammationsmarker mit den höchsten prädiktiven Werten in unserer Studie waren das C-reaktive Protein (CRP) und Interleukin-6 (IL-6). Bezüglich des IL-6 waren die Ausgangskonzentrationen bei Patienten mit einem späteren kardiovaskulären Ereignis signifikant höher als bei denen ohne ein späteres kardiovaskuläres Ereignis. In multivariaten Analysen hatten Patienten mit erhöhten Ausgangskonzentrationen dieser inflammatorischen Marker ein um 30 - 80 % erhöhtes Risiko für ein kardiovaskuläres Ereignis (4. Quartil gegen 1. Quartil). Durch die kombinierte Betrachtung von Biomarkern (Inflammationsmarker und Lipide) ließ sich ein um 80 - 110 % erhöhtes Risiko für ein späteres kardiovaskuläres Ereignis erkennen. Als Ergebnis der vorliegenden Studie zeigt sich somit, dass die gleichzeitige Betrachtung von Inflammationsmarkern und Markern des Lipidprofils die Risikostratifizierung hinsichtlich eines späteren kardiovaskulären Ereignisses bei Patienten mit einer stabilen koronaren Herzerkrankung möglicherweise verbessern kann.

FUNDAMENTO: O conhecimento sobre a doença arterial coronariana pode ser considerado o primeiro passo para reduzir o risco de complicações cardíacas. OBJETIVOS: Construir e validar um instrumento capaz de avaliar e descrever o conhecimento do paciente coronariano em programas de reabilitação cardíaca, com a finalidade de educação. MÉTODOS: Para construção, foi realizada análise de artigos e estudo de campo para a apresentação de itens a uma equipe multidisciplinar associada à reabilitação cardíaca. Após análise, foi gerada a versão testada em um estudo-piloto. O instrumento, nomeado CADE-Q (Questionário para Educação do Paciente Coronariano), foi aplicado em 155 pacientes com idade de 61 ± 9 anos (mín = 36 ; máx = 86), participantes de programas de reabilitação cardíaca. Dos 155 pacientes, 114 eram homens. A consistência interna foi verificada pelo coeficiente Alpha de Cronbach. A reprodutibilidade foi testada através do coeficiente de correlação intraclasse (CCIC) e a validade de construto por análise fatorial exploratória. Foi realizada análise comparando os escores totais em função de características da população e entre os grupos de reabilitação (privado e público). RESULTADOS: A versão final possui 19 questões com 4 alternativas, com 4 quadrantes de conhecimento. O Alpha de Cronbach foi de 0,68 e CCIC foi de 0,783. A análise fatorial revelou 6 fatores, abrangendo três áreas de conhecimento, o que demonstra a multifatoriedade do instrumento. A análise das características da população em função do escore total apresentou diferenças significativas em função das variáveis do nível socioeconômico (tipo de reabilitação, renda familiar e escolaridade). CONCLUSÃO: O instrumento CADE-Q apresenta validade e confiabilidade adequadas para sua utilização na população brasileira em futuras pesquisas. BACKGROUND: Being aware of the coronary artery disease can be considered the first step to reduce the risk of cardiac complications. OBJECTIVE: Building and validating a tool to assess and describe coronary patients' awareness in cardiac rehabilitation programs, with the purpose of education. METHODS: For the construction, we analyzed articles and field studies to submit items to multidisciplinary team associated to cardiac rehabilitation. After this analysis, we generated the version tested in a pilot study. The tool, named CADE-Q (Questionnaire for Coronary Patient Education) was applied in 155 patients aged 61 ± 9 (min = 36, max = 86) in response to cardiac rehabilitation programs. Out of the 155 patients, 114 were men. Internal consistency was measured by Cronbach's alpha coefficient. Reproducibility was tested by the intraclass correlation coefficient (ICC) and construct validity was performed by exploratory factor analysis. The analysis compared the total scores as a function population characteristics and rehabilitation groups (private and public). RESULTS: The final version has 19 questions with 4 alternatives, with 4 quadrants of awareness. Cronbach's alpha was 0.68 and ICC was 0.783. The factor analysis revealed 6 factors, covering three areas of awareness, which demonstrates the multifactorial nature of the instrument. The population characteristics as a function of the total score showed significant differences depending on the socioeconomic status variables (type of rehabilitation, household income and education level). CONCLUSION: CADE-Q has proper validity and reliability to be used in the Brazilian population in future research.

FUNDAMENTO: A prevalência de depressão em portadores de doença arterial coronariana (DAC) é alta. A escala de depressão geriátrica (EDG) é um instrumento amplamente usado para rastrear a depressão em idosos. No Brasil, as propriedades psicométricas da versão curta ainda não foram adequadamente exploradas. OBJETIVO: Avaliar as propriedades psicométricas da versão curta da EDG em portadores de DAC em ambulatório de cardiologia. MÉTODOS: Estudo transversal que avaliou 209 idosos (≥ 65 anos) com DAC utilizando a EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) e The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). A consistência interna da EDG-15 foi calculada pelo KR-20. Uma análise fatorial dessa escala foi conduzida. Escores da EDG-15 foram comparados com os diagnósticos de depressão (DSM-IV) para a validade de critérios. Na análise de validade concorrente, os mesmos escores foram correlacionados com os das escalas de depressão CAMDEX, Miniexame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e BOMFAQ. RESULTADOS: A depressão clínica foi diagnosticada em 35,71% da amostra avaliada de acordo com o DSM-IV. Para o diagnóstico de depressão maior ou distimia, o ponto de corte 5/6 apresentou acurácia moderada (AUROC = 0,84), sensibilidade de 79,92% e especificidade de 78,29%. A consistência interna foi de 0,80. Na análise fatorial, três fatores obtidos explicaram 52,72% da variância total observada. Os escores da EDG-15 correlacionaram-se com os da escala de depressão CAMDEX. CONCLUSÃO: No geral, a EDG-15 apresentou boa confiabilidade e validade (concorrente e de critério). Em settings cardiológicos, seu uso pode auxiliar no rastreamento de quadros depressivos de forma simples e rápida. BACKGROUND: The prevalence of depression in individuals with coronary artery disease (CAD) is high. The Geriatric Depression Scale (GDS) is a broadly used tool to screen for depression in elderly individuals. In Brazil, the psychometric properties of the short version have not been adequately assessed. OBJECTIVE: To evaluate the psychometric properties of the short version of the GDS in patients with CAD treated at a Cardiology Outpatient Clinic. METHODS: The present is a cross-sectional study that assessed 209 elderly individuals (≥ 65 years) with CAD using the GDS-15, the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), the Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) and The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The internal consistency of the GDS-15 was calculated through the KR-20. A factorial analysis of this scale was carried out. The GDS-15 scores were compared with the diagnoses of depression (DSM-IV) for the validity of criteria. At the analysis of concurrent validity, the same scores were correlated with those of the CAMDEX, mini-mental state examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and BOMFAQ depression scales. RESULTS: Clinical depression was diagnosed in 35.71% of the sample assessed according to the DSM-IV. For the diagnosis of major depression or dystimia, the cutoff 5/6 presented moderate accuracy (AUROC = 0.84), sensitivity of 79.92% and specificity of 78.29%. The internal consistency was 0.80. At the factorial analysis, three obtained factors explained 52.72% of the total variance that was observed. The GDS-15 scores correlated with those of the CAMDEX depression scale. CONCLUSION: In general, the GDS-15 presented good reliability and validity (concurrent and of criterion). In cardiologic settings, its use, which is simple and fast, can be utilized in the screening for depression. FUNDAMENTO: La prevalencia de depresión en portadores de enfermedad arterial coronaria (EAC) es alta. La escala de depresión geriátrica (EDG) es un instrumento ampliamente utilizado para rastrear la depresión en adultos mayores. En Brasil, las propiedades psicométricas de la versión corta aún no fueron adecuadamente estudiadas. OBJETIVO: Evaluar las propiedades psicométricas de la versión corta de la EDG en portadores de EAC en ambulatorio de cardiología. MÉTODOS: Estudio transversal que evaluó 209 adultos mayores (> 65 años) con EAC utilizando la EDG-15, Cumulative Illness Rating Scale for Geriatrics (CIRS), Brazilian OARS Multidimensional Function Assessment Questionnaire (BOMFAQ) y The Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). La consistencia interna de la EDG-15 fue calculada mediante el KR-20. Se llevó a cabo un análisis factorial de esa escala. Los escores de la EDG-15 fueron comparados con los diagnósticos de depresión (DSM-IV) para la validez de criterios. En el análisis de validez concurrente, los mismos escores fueron correlacionados con los de las escalas de depresión CAMDEX, Miniexamen del Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) y BOMFAQ. RESULTADOS: En un 35,71% de la muestra evaluada se diagnosticó depresión clínica, de acuerdo al DSM-IV. Para el diagnóstico de depresión mayor o distimia, el punto de corte 5/6 presentó precisión moderada (AUROC = 0,84), sensibilidad del 79,92% y especificidad del 78,29%. La consistencia interna fue de 0,80. En el análisis factorial, tres factores obtenidos explicaron el 52,72% de la variancia total observada. Los escores de la EDG-15 se correlacionaron con los de la escala de depresión CAMDEX. CONCLUSIÓN: En general, la EDG-15 presentó buena confiabilidad y validez (concurrente y de criterio). En settings cardiológicos, su uso puede auxiliar en el rastreo de cuadros depresivos de forma simple y rápida.

Congenital heart disease (CHD) is the most common birth abnormality and the etiology is unknown in the overwhelming majority of cases. ISLET1 (ISL1) is a transcription factor that marks cardiac progenitor cells and generates diverse multipotent cardiovascular cell lineages. The fundamental role of ISL1 in cardiac morphogenesis makes this an exceptional candidate gene to consider as a cause of complex congenital heart disease. We evaluated whether genetic variation in ISL1 fits the common variant-common disease hypothesis. A 2-stage case-control study examined 27 polymorphisms mapping to the ISL1 locus in 300 patients with complex congenital heart disease and 2,201 healthy pediatric controls. Eight genic and flanking ISL1 SNPs were significantly associated with complex congenital heart disease. A replication study analyzed these candidate SNPs in 1,044 new cases and 3,934 independent controls and confirmed that genetic variation in ISL1 is associated with risk of non-syndromic congenital heart disease. Our results demonstrate that two different ISL1 haplotypes contribute to risk of CHD in white and black/African American populations.