Doenças Cardiovasculares e Diagnóstico

Hypertension is an important non-communicable disease in Africa. It is the most important cardiovascular risk factor. The effect of hypertension on left ventricle has been documented for long time, but sparse and consistent evidence shows an impact of hypertension on the right ventricle. The RV can be studied with many imaging and functional modalities. In clinical practice, echocardiography is the mainstay of evaluation of RV structure and function. Aim of this study was to analyze impact of presence and severity of systemic arterial hypertension (HTN) on right ventricular function measured by tissue Doppler echocardiography. For this aim we included sixty consecutive patients from outpatient clinics and thirty healthy age and sex matched individuals and made a full 2D and tissue doppler study for the RV and compared results for non-hypertensives, stage 1 and stage 2 hypertensives. Doppler data obtained at the tricuspid valve showed statistically significant results regarding E, E/A, DT and IVRT correlating the presence and degree of hypertension with RV diastolic function (p<0.001). The current study demonstrated that RV diastolic dysfunction not only is an early marker that is correlated to presence of systemic arterial hypertension but also showed it to be a marker of its severity and degree of control as conveyed by stage of hypertension.

Background: Precise myocardial tissue characterization in subjects with exercise-associated ventricular ectopy and prolonged QT interval but no obvious structural heart disease might facilitate further risk stratification. There is no data assessing QT intervals in patients with exercise-associated premature ventricular complexes (PVCs). Cardiovascular magnetic resonance (CMR) enables us to non-invasively assess myocardial scar and oedema. The purpose of our study was to assess the QT intervals in patients with exercise-associated premature ventricular complexes (PVCs).

Methods: We analyzed the QT and QTc intervals of the 162 consecutive patients with documented exerciseassociated PVCs but no history or evidence of coronary heart disease or cardiomyopathy we previously examined. Findings were compared with those from 182 new controls without exercise-associated PVCs matched for gender and age. Continuous 12-holder ECG during upright bicycle exercise test and ECG-triggered, T2-weighted, fast spin echo triple inversion recovery sequences and late gadolinium enhancement were obtained, as were LV function and dimensions.

Results: QT and QTc intervals were significantly prolonged in patients compared to controls (396.3 ± 33.5 ms vs. 385.9 ± 28.4 ms, p=0.002 and 431.7 ± 26.2 ms vs. 419.9 ± 26.6 ms, p=0.0001). Eighty five percent of patients with exercise-associated PVCs and prolonged QT intervals had structural abnormalities in the myocardium suggestive of acute or remote myocarditis or myopericarditis.

Conclusion: Patients with exercise-associated PVCs showed prolonged QT intervals compared to controls. As a long QT interval is predictive of increased risk for arrhythmias or sudden cardiac death these findings may supply a potential mechanism for explaining the increased risk of some patients with exercise-associated PVCs.

Background: We evaluated and compared short- (≤ 3 months) and mid-term (≥ 4 months) clinical outcomes and hemodynamic performances of the 19-mm Mosaic® and 19-mm TrifectaTM bioprostheses for aortic valve replacement.
Methods: 193 patients underwent aortic valve replacement: 37 received the 19-mm Mosaic® prosthesis (Group M) and 12 received the 19-mm TrifectaTM prosthesis (Group T). Pre- and postoperative echocardiographic parameters and New York Heart Association classes were evaluated in both groups. Results: Baseline characteristics and preoperative echocardiographic parameters were similar between the groups. The New York Heart Association class improved in both groups. The mean left ventricular-aortic pressure gradient was 22.6 mmHg ± 8.4 mmHg in Group M and 15.0 mmHg ± 6.2 mmHg in Group T. The left ventricular mass index was 99.6 ± 27.6 g/m2 and 99.0 ± 20.0 g/m2 respectively, with significant improvements in both groups. Left ventricular mass index regression during the mid-term period showed no significant difference between the groups, despite a higher-pressure gradient and smaller effective orifice area index in the Mosaic® group. Patient-prosthesis mismatch occurred in 20 patients in the Mosaic® group, with no significant differences in the postoperative left ventricular mass indices and New York Heart Association classes between the patientprosthesis mismatch and no patient-prosthesis mismatch subgroups in the Mosaic® group.
Conclusion: Compared with the 19-mm TrifectaTM bioprosthesis, the 19-mm Mosaic® bioprosthesis showed similar satisfactory improvement in the New York Heart Association class grade and reduction in the left ventricular mass index, despite a higher-pressure gradient and smaller effective orifice area index.

The case involved a 38-year-old man. By 30-year-old, he had undergone surgical resection of schwannoma four times and had been diagnosed with von Recklinghausen’s disease (neurofibromatosis type I; NF1). At 35 years old, invasion of the thoracic vertebral bodies due to NF1 was recognized along with exertional chest and back pain. In November 2014, he collapsed suddenly while walking and was urgently transported to our emergency room after the return of spontaneous circulation. Forrester subset IV heart failure was recognized, and chronic total occlusion was observed in both the right coronary and left circumflex arteries, while the culprit lesion for acute coronary syndrome was in the proximal left anterior descending artery (LAD). During emergent percutaneous coronary intervention (PCI) to the LAD, revascularization was difficult due to slow flow caused by unexpected multiple thrombi that disappeared immediately after argatroban injection. Although we finished PCI with thrombolysis in myocardial infarction grade 3 flow in the LAD, we could not save the patient because of worsening traumatic brain hemorrhage and decreased left ventricular function. Autopsy showed no subacute thrombosis of the drug-eluting stent deployed in the LAD. Autopsy also revealed severe atherosclerosis of multiple vessels, including the coronary vessels, representing a rare finding in typical NF1 patients.

The occurrence of coronary artery disease is rare in young and physically fit individual. Regular exercise reduced incidences of coronary atherosclerotic disease. However, there are reported cases of myocardial infarction and sudden death after heavy and prolonged exercise. We describe an apparent healthy young male marathon runner presented with acute myocardial infarction shortly after completion of the run. Coronary angiography revealed occlusive thrombus in the distal right coronary artery and thromboaspiration was performed. Repeated angiography showed complete resolution of thrombus. The relationship between physical activity and acute coronary thrombosis remain elusive.