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Rocon C, Tabassian M, Tavares de Melo MD, de Araujo Filho JA, Grupi CJ, Parga Filho JR, Bocchi EA, D'hooge J, Salemi VMC. Biventricular imaging markers to predict outcomes in non-compaction cardiomyopathy: a machine learning study. ESC Heart Fail 2020; 7:2431-2439. [PMID: 32608172 PMCID: PMC7524220 DOI: 10.1002/ehf2.12795] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/27/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022] Open
Abstract
Aims Left ventricular non‐compaction cardiomyopathy (LVNC) is a genetic heart disease, with heart failure, arrhythmias, and embolic events as main clinical manifestations. The goal of this study was to analyse a large set of echocardiographic (echo) and cardiac magnetic resonance imaging (CMRI) parameters using machine learning (ML) techniques to find imaging predictors of clinical outcomes in a long‐term follow‐up of LVNC patients. Methods and results Patients with echo and/or CMRI criteria of LVNC, followed from January 2011 to December 2017 in the heart failure section of a tertiary referral cardiologic hospital, were enrolled in a retrospective study. Two‐dimensional colour Doppler echocardiography and subsequent CMRI were carried out. Twenty‐four hour Holter monitoring was also performed in all patients. Death, cardiac transplantation, heart failure hospitalization, aborted sudden cardiac death, complex ventricular arrhythmias (sustained and non‐sustained ventricular tachycardia), and embolisms (i.e. stroke, pulmonary thromboembolism and/or peripheral arterial embolism) were registered and were referred to as major adverse cardiovascular events (MACEs) in this study. Recruited for the study were 108 LVNC patients, aged 38.3 ± 15.5 years, 48.1% men, diagnosed by echo and CMRI criteria. They were followed for 5.8 ± 3.9 years, and MACEs were registered. CMRI and echo parameters were analysed via a supervised ML methodology. Forty‐seven (43.5%) patients had at least one MACE. The best performance of imaging variables was achieved by combining four parameters: left ventricular (LV) ejection fraction (by CMRI), right ventricular (RV) end‐systolic volume (by CMRI), RV systolic dysfunction (by echo), and RV lower diameter (by CMRI) with accuracy, sensitivity, and specificity rates of 75.5%, 77%, 75%, respectively. Conclusions Our findings show the importance of biventricular assessment to detect the severity of this cardiomyopathy and to plan for early clinical intervention. In addition, this study shows that even patients with normal LV function and negative late gadolinium enhancement had MACE. ML is a promising tool for analysing a large set of parameters to stratify and predict prognosis in LVNC patients.
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Affiliation(s)
- Camila Rocon
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Mahdi Tabassian
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Marcelo Dantas Tavares de Melo
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jose Arimateia de Araujo Filho
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Cesar José Grupi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jose Rodrigues Parga Filho
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Edimar Alcides Bocchi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
| | - Jan D'hooge
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Vera Maria Cury Salemi
- Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo, 05403-000, Brazil
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Oliveira ACG, Neves ILI, Sacilotto L, Olivetti NQS, Santos-Paul MAD, Montano TCP, Carvalho CMA, Wu TC, Grupi CJ, Barbosa SA, Pastore CA, Samesima N, Hachul DT, Scanavacca MI, Neves RS, Darrieux FCC. Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single-Center Study. J Am Heart Assoc 2019; 8:e012361. [PMID: 31319747 PMCID: PMC6761655 DOI: 10.1161/jaha.119.012361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Brugada syndrome and long-QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life-threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life-threatening arrhythmias in patients with channelopathies. Methods and Results We performed a randomized, double-blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty-eight-hour Holter monitoring was performed, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty-six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long-QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9±15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute (P=0.008). In patients with long-QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms (P=0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life-threatening arrhythmias occurred during dental treatment. Conclusions The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life-threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03182777.
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Affiliation(s)
- Ana Carolina Guimarães Oliveira
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Itamara Lucia Itagiba Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Luciana Sacilotto
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Natália Quintella Sangiorgi Olivetti
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Marcela Alves Dos Santos-Paul
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tânia Cristina Pedroso Montano
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cíntia Maria Alencar Carvalho
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Tan Chen Wu
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Cesar José Grupi
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Sílvio Alves Barbosa
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Carlos Alberto Pastore
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Nelson Samesima
- Unidade de Eletrocardiografia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Denise Tessariol Hachul
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Maurício Ibrahim Scanavacca
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Ricardo Simões Neves
- Unidade de Odontologia Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
| | - Francisco Carlos Costa Darrieux
- Nucleo Clinico-Cirurgico de Arritmias Cardiacas Instituto do Coracao Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de São Paulo Brazil
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Barbosa-Ferreira JM, Mady C, Ianni BM, Lopes HF, Ramires FJA, Salemi VMC, Grupi CJ, Hachul DT, Fernandes F. Dysregulation of Autonomic Nervous System in Chagas' Heart Disease Is Associated with Altered Adipocytokines Levels. PLoS One 2015; 10:e0131447. [PMID: 26147101 PMCID: PMC4493107 DOI: 10.1371/journal.pone.0131447] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 06/02/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chagas disease (CD) induces autonomic dysfunction and inflammatory activity, which may promote metabolic abnormalities. We studied metabolism and his correlation with Autonomic Nervous System (ANS) and inflammation in CD. METHODS AND RESULTS Sixty subjects were divided into 4 groups: control group (CG), IF (indeterminate form) group; ECG group (ECG abnormalities and normal left ventricular systolic function), and LVD group (left ventricular sistolic dysfunction). Levels of adiponectin, leptin, insulin, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-alpha) were assayed in serum samples by ELISA. ANS was assessed by heart rate variability in frequency domain in 24-hour Holter and postural tilt test (rest and orthostatic position). High frequency (HFr) component values were used to estimate parasympathetic activity and low frequency (LFr) component, sympathetic activity. Analyzes were made of the correlations of each of the metabolic parameters (leptin and adiponectin) with the inflammatory cytokines (interleukin-6 and TNF- alpha) and with the ANS assessment measurements. No significant differences were observed in leptin and insulin levels. Adiponectin was higher in ECG and LVD groups: [CG = 4766.5 (5529.5), IF = 4003.5 (2482.5), ECG = 8376.5 (8388.5), LVD = 8798 (4188.0) ng/mL, p<0.001)]. IL-6 and TNF-alpha were higher in LVD group: [IL-6: CG = 1.85 (6.41); IF = 1.58 (1.91); ECG = 1.0 (1.57); LVD= 31.44 (72.19) pg/ml; p = 0.001. TNF-alpha: CG = 22.57 (88.2); IF = 19.31 (33.16); ECG = 12.45 (3.07); LVD = 75.15 (278.57) pg/ml; p = 0.04]. Adiponectin levels had a positive association with the HFr component (r = 0.539; p = 0.038) and an inverse association with the LFr component (r = - 0.539; p = 0.038) in ECG group. Leptin levels had a negative association with the HFr component (r= - 0.632; p = 0.011) and a positive association with the LFr component (r = 0.632; p = 0.011) in LVD group. CONCLUSIONS We found increased adiponectin levels in Chagas' heart disease with systolic dysfunction and in patients with ECG abnormalities and normal systolic function at rest. Adipocytokines levels (adiponectin and leptin) were associated with ANS parameters in Chagas' heart disease.
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Affiliation(s)
- João Marcos Barbosa-Ferreira
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Charles Mady
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Barbara Maria Ianni
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Heno Ferreira Lopes
- Hypertension Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Universidade Nove de Julho—UNINOVE, São Paulo, Brazil
| | - Felix José Alvarez Ramires
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Maria Cury Salemi
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cesar José Grupi
- Electrocardiology Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Denise Tessariol Hachul
- Clinical Arrhythmia Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fábio Fernandes
- Cardiomyopathy Unit of the Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Lorga Filho A, Cintra FD, Lorga A, Grupi CJ, Pinho C, Moreira DAR, Sobral Filho DC, de Brito FS, Kruse JCL, Neto JS. Recommendations of the Brazilian Society of Cardiac Arrhythmias for holter monitoring services. Arq Bras Cardiol 2014; 101:101-5. [PMID: 24030077 PMCID: PMC3998161 DOI: 10.5935/abc.20130164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/24/2013] [Indexed: 11/20/2022] Open
Abstract
Background There are innumerous indicators to assure the quality of a service. However,
medical competence and the proper performance of a procedure determine its final
quality. The Brazilian Society of Cardiac Arrhythmias recommends minimum
parameters necessary to guarantee the excellence of ambulatory
electrocardiographic monitoring services. Objective To recommend minimum medical competences and the information required to issue a
Holter monitoring report. Methods This study was grounded in the concept of evidence-based medicine and, when
evidence was not available, the opinion of a writing committee was used to
formulate the recommendation. That committee consisted of professionals with
experience on the difficulties of the method and management in providing services
in that area. Results The professional responsible for the Holter monitoring analysis should know
cardiovascular pathologies and have consistent formation on electrocardiography,
including cardiac arrhythmias and their differential diagnoses. The report should
be written in a clear and objective way. The minimum parameters that comprise a
Holter report should include statistics of the exam, as well as quantification and
analysis of the rhythm disorders observed during monitoring. Conclusion Ambulatory electrocardiographic monitoring should be performed by professionals
knowledgeable about electrocardiographic analysis, whose report should comprise
the minimum parameters mentioned in this document.
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Affiliation(s)
| | - Fatima Dumas Cintra
- Mailing Address: Fatima Dumas Cintra, Alameda Taurus, 146, Residencial
Genesis I, Alphaville. Postal Code 06543-670, Santana de Parnaíba, SP - Brazil,
E-mail: ,
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Conceição-Souza GE, Pêgo-Fernandes PM, Cruz FDD, Guimarães GV, Bacal F, Vieira MLC, Grupi CJ, Giorgi MCP, Consolim-Colombo FM, Negrão CE, Rondon MUP, Moreira LFP, Bocchi EA. Left cardiac sympathetic denervation for treatment of symptomatic systolic heart failure patients: a pilot study. Eur J Heart Fail 2012; 14:1366-73. [PMID: 23099357 DOI: 10.1093/eurjhf/hfs132] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. METHODS AND RESULTS In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) ≤40%, sinus rhythm, and resting heart rate >65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 ± 6.6 to 33 ± 5.2 (P = 0.03); 6 min walking distance improved from 167 ± 35 to 198 ± 47 m (P = 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 ± 5 to 15 ± 7 (P = 0.06). The remaining analysed variables were unchanged. During 848 ± 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. CONCLUSIONS LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
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Antelmi I, Yamada AT, Hsin CN, TsuTsui JM, Grupi CJ, Mansur AJ. Influence of Parasympathetic Modulation in Doppler Mitral Inflow Velocity in Individuals without Heart Disease. J Am Soc Echocardiogr 2010; 23:762-5. [DOI: 10.1016/j.echo.2010.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Indexed: 10/19/2022]
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Neves ILI, Avila WS, Neves RS, Giorgi DMA, Santos JFKD, Oliveira Filho RM, Grupi CJ, Grinberg M, Ramires JAF. Maternal-fetal monitoring during dental procedure in patients with heart valve disease. Arq Bras Cardiol 2010; 93:463-742. [PMID: 20084307 DOI: 10.1590/s0066-782x2009001100005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2% with or without epinephrine 1:100,000 during restorative dental treatment. METHODS Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0%) patients, of which seven (41.8%) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION The use of 1.8mL of lidocaine 2% in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.
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Affiliation(s)
- Itamara Lucia Itagiba Neves
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
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Antelmi I, Chuang EY, Grupi CJ, Latorre MDRDDO, Mansur AJ. Heart rate recovery after treadmill electrocardiographic exercise stress test and 24-hour heart rate variability in healthy individuals. Arq Bras Cardiol 2009; 90:380-5. [PMID: 18592090 DOI: 10.1590/s0066-782x2008000600005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Accepted: 11/21/2007] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Heart rate recovery after treadmill electrocardiographic exercise stress test is modulated by the autonomic nervous system. Analysis of heart rate variability can provide useful information about autonomic control of the cardiovascular system. OBJECTIVE The aim of the study was to test the hypothesis of association between heart recovery after treadmill electrocardiographic exercise test and heart rate variability. METHODS We studied 485 healthy individuals aged 42+/- 12.1 (range 15-82) years, 281(57.9%) women, submitted to treadmill electrocardiographic exercise stress tests and heart rate variability evaluations over time (SDNN, SDANN, SDNNi, rMSSD, pNN50) and frequency (LF, HF, VLF, LF/HF ratio) domains in 24-hour ambulatory electrocardiographic monitoring. RESULTS Heart rate recovery was 30+/- 12 beats in the 1st minute and 52+/- 13 beats in the 2nd minute after exercise. Younger individuals recovered faster from the 2nd to the 5th minute after exercise (r= 0.19-0.35, P< 0.05). Recovery was faster in women than in men (4+/- 1.1 beats lower in the 1st minute, p<0.001; 5.7+/- 1.2 beats lower in the 2nd minute, p<0.01; 4.1+/- 1.1 beats lower in the 3rd minute, p<0.001). There was no significant correlation between heart rate recovery and heart rate variability in 1st and 2nd minutes after exercise. SDNN, SDANN, SDNNi, rMSSD, and pNN50 indices demonstrated a significant correlation with heart rate recovery only at the 3rd and 4th minutes. CONCLUSION The hypothesis of association between heart rate recovery and 24-hour heart rate variability in the first two minutes after exercise was not substantiated in this study. Heart rate recovery after exercise was associated with age and gender.
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Affiliation(s)
- Ivana Antelmi
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP - Brasil.
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Neves RS, Neves ILI, Giorgi DMA, Grupi CJ, César LAM, Hueb W, Grinberg M. Efeitos do uso da adrenalina na anestesia local odontológica em portador de coronariopatia. Arq Bras Cardiol 2007; 88:545-51. [PMID: 17589629 DOI: 10.1590/s0066-782x2007000500008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 02/13/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of vasoconstrictors for local anesthesia in patients with coronary heart disease is controversial in the literature, and there is concern regarding risk of cardiac decompensation. OBJECTIVE To evaluate electrocardiographic and blood pressure parameters during restorative dental procedure under local anesthesia with and without a vasoconstrictor in patients with coronary artery disease. METHODS Sixty-two patients were included in the study, ages ranging from 39 to 80 (mean 58.7 +/- 8.8), 51 (83.2%) of whom were male. Thirty patients were randomly assigned to receive 2% lidocaine with epinephrine (epinephrine group), and the remaining patients, 2% lidocaine without epinephrine (non-epinephrine group) for local anesthesia. All patients underwent 24-hour ambulatory blood pressure monitoring and dynamic electrocardiography. Three periods were considered in the study: 1) baseline--recordings obtained during the 60 minutes prior to the procedure; 2) procedure--recordings obtained from the beginning of anesthesia to the end of the procedure and 3) 24 hours. RESULTS There was an increase in blood pressure in both groups during the procedure, compared with baseline values; but when the two groups were compared no significant difference was detected between them. Heart rate remained unchanged in both groups. No ST-segment depression > 1 mm occurred either at baseline or during the procedure. Seven patients (12.5%) experienced more than ten arrhythmia episodes per hour during the procedure, four (13.8%) in the non-epinephrine group and three (11.1%) in the epinephrine group. CONCLUSION No difference was observed in blood pressure, heart rate, or evidence of ischemia and arrhythmias in either group. The use of vasoconstrictor has proved to be safe within the range of the present study.
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Araújo F, Antelmi I, Pereira AC, Latorre MDRDO, Grupi CJ, Krieger JE, Mansur AJ. Lower heart rate variability is associated with higher serum high-sensitivity C-reactive protein concentration in healthy individuals aged 46 years or more. Int J Cardiol 2006; 107:333-7. [PMID: 16503254 DOI: 10.1016/j.ijcard.2005.03.044] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 03/14/2005] [Accepted: 03/26/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND To test the hypothesis of an association between cardiac autonomic activity evaluated by heart rate variability and systemic inflammatory markers such as C-reactive protein, we studied the correlation of the indices of heart rate variability relative to serum high-sensitivity C-reactive protein (hs-CRP) in a healthy Brazilian population. METHODS Four hundred twenty-one healthy individuals aged 15-82 years (mean 40.4 years), 184 men (43.7%) and 237 women (56.3%) were enrolled between July 1998 and July 2001. The relationship between the log-transformed indices of the heart rate variability and the serum concentration of hs-CRP were analyzed stratified by age tertile using the Spearman correlation coefficient and multiple linear regression. RESULTS The log standard deviation of all normal sinus RR intervals over 24 h (SDNN) (r = -0.801; p = 0.024) was independently correlated with log hs-CRP in the individuals with age in the oldest tertile (> or = 46 years). In addition, the body mass index (BMI) was independently correlated with hs-CRP in all of the age groups. CONCLUSIONS In the healthy subjects aged 46 years or more the lower heart rate variability correlated with higher concentration of hs-CRP.
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Affiliation(s)
- Fernando Araújo
- Heart Institute (InCor), University of São Paulo Medical School, General Outpatient Clinics, Av. Dr. Enéas de Carvalho Aguiar, 44 05403-000 São Paulo SP, Brazil.
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Silva de Paula R, Antelmi I, Vincenzi MA, André CDS, Artes R, José Grupi C, José Mansur A. Influence of age, gender, and serum triglycerides on heart rate in a cohort of asymptomatic individuals without heart disease. Int J Cardiol 2006; 105:152-8. [PMID: 16243106 DOI: 10.1016/j.ijcard.2004.11.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2004] [Accepted: 11/13/2004] [Indexed: 10/25/2022]
Abstract
BACKGROUND Age, sex and blood lipids were demonstrated in epidemiological studies to influence heart rate measured on physical examination, on 12-lead electrocardiogram or with automatic devices for short-term measurements. We hypothesized that in healthy individuals, age, sex and other clinical variables may also influence heart rate measured on 24-h ambulatory electrocardiographic monitoring. METHODS We studied 625 asymptomatic individuals with normal clinical examination, aged 15 to 83 (mean 42, standard deviation 11.9) years, 276 (44.2%) men and 349 (55.8%) women. Heart rate was evaluated on 24 h ambulatory electrocardiographic monitoring. Variables selected in univariate analysis (chi(2) and Student t tests) were further submitted to multivariate analysis with canonical correlation to assess the strength of associations between heart rate and other variables, and multiple linear regression models to generate reference curves. RESULTS Age was the most significant influence on canonical variable of heart rate relative to other clinical and laboratory variables (0.55; p<0.01). There was an increase in the minimum heart rate and a decrease of maximum heart rate with increasing age in both genders. The increase was steeper in men and the decrease was steeper in women. Minimum heart rate increased with increasing serum triglycerides and decreased as estimated maximum oxygen consumption increased. CONCLUSIONS There was a narrower variation of heart rate with increasing age in both genders in healthy individuals. This variation was less pronounced in women. In addition, status of body haemostasis associated with peculiar metabolic conditions expressed in serum triglycerides levels may also be associated with heart rate.
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Affiliation(s)
- Rogério Silva de Paula
- Heart Institute (InCor), University of São Paulo Medical School, General Outpatient Clinics, Av. Dr. Enéas de Carvalho Aguiar, 44, São Paulo 05403-000, Brazil.
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12
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Takada JY, Solimene MC, da Luz PL, Grupi CJ, Giorgi DMA, Rigonatti SP, Rumi DO, Gowdak LHW, Ramires JAF. Assessment of the cardiovascular effects of electroconvulsive therapy in individuals older than 50 years. Braz J Med Biol Res 2005; 38:1349-57. [PMID: 16138218 DOI: 10.1590/s0100-879x2005000900009] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To evaluate the impact of electroconvulsive therapy on arterial blood pressure, heart rate, heart rate variability, and the occurrence of ischemia or arrhythmias, 38 (18 men) depressive patients free from systemic diseases, 50 to 83 years old (mean: 64.7 +/- 8.6) underwent electroconvulsive therapy. All patients were studied with simultaneous 24-h ambulatory blood pressure and Holter monitoring, starting 18 h before and continuing for 3 h after electroconvulsive therapy. Blood pressure, heart rate, heart rate variability, arrhythmias, and ischemic episodes were recorded. Before each session of electroconvulsive therapy, blood pressure and heart rate were in the normal range; supraventricular ectopic beats occurred in all patients and ventricular ectopic beats in 27/38; 2 patients had non-sustained ventricular tachycardia. After shock, systolic, mean and diastolic blood pressure increased 29, 25, and 24% (P < 0.001), respectively, and returned to baseline values within 1 h. Maximum, mean and minimum heart rate increased 56, 52, and 49% (P < 0.001), respectively, followed by a significant decrease within 5 min; heart rate gradually increased again thereafter and remained elevated for 1 h. Analysis of heart rate variability showed increased sympathetic activity during shock with a decrease in both sympathetic and parasympathetic drive afterwards. No serious adverse effects occurred; electroconvulsive therapy did not trigger any malignant arrhythmias or ischemia. In middle-aged and elderly people free from systemic diseases, electroconvulsive therapy caused transitory increases in blood pressure and heart rate and a decrease in heart rate variability but these changes were not associated with serious adverse clinical events.
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Affiliation(s)
- J Y Takada
- Departamento de Cardiologia, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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13
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Macedo AVS, Moffa PJ, Grupi CJ, Martinez Filho EE, Libby P, Gutierrez PS. [Fatal myocardial infarction in a 88-year-old woman]. Arq Bras Cardiol 2005; 85:139-46. [PMID: 16113856 DOI: 10.1590/s0066-782x2005001500014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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14
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Antelmi I, de Paula RS, Shinzato AR, Peres CA, Mansur AJ, Grupi CJ. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004; 93:381-5. [PMID: 14759400 DOI: 10.1016/j.amjcard.2003.09.065] [Citation(s) in RCA: 341] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2003] [Revised: 09/29/2003] [Accepted: 09/29/2003] [Indexed: 10/26/2022]
Abstract
We studied the time- and frequency-domain indexes of heart rate variability (HRV) in 653 patients without any evidence of heart disease relative to age, gender, heart rate, body mass index, and functional capacity. There was an inverse correlation of HRV with heart rate (p <0.001). HRV indexes decreased with increasing age, differed by gender, and were higher in patients with higher functional capacity. No correlation was noted between HRV and body mass index.
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Affiliation(s)
- Ivana Antelmi
- Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.
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15
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César LA, Ferreira JF, Grupi CJ, Pamplona D, Moretti MA, Pferfmann E, Ramires JA. Does a circadian variation occur in myocardial ischemia over 48 hours in patients with unstable angina? Arq Bras Cardiol 2000; 75:9-18. [PMID: 10983016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To study the incidence of and variation in myocardial ischemia over 48 hours in patients with unstable angina. METHODS Thirty-nine patients with unstable angina underwent long-term electrocardiography for 48 hours. The number of events and the period of time of ischemia (in minutes) were analyzed for the 48 hours, in two periods of 24 hours, and in periods of 4 hours. RESULTS We analyzed 1755.8 hours of monitoring tapes, and ischemic episodes were detected in 18 (46.2%) patients, corresponding to 173 ischemic episodes, allowing the evaluation of 1304 minutes of ischemia.only 4 of which were (2.2%) symptomatic, Considering the entire period of time of recording and the predetermined time intervals, we observed a higher number of ischemic episodes (38) and a longer duration of ischemia (315.4 minutes) between 11:00 am and 3:00 pm. However, no significant differences occurred among the values in the different intervals. CONCLUSION Long-term electrocardiography over 48 hours showed a high incidence (97.8%) of silent ischemic episodes in patients with unstable angina. No evidence of a circadian variation of myocardial ischemia in unstable angina was observed.
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Affiliation(s)
- L A César
- Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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16
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Abstract
PURPOSE To evaluate the contribution of the loop memory recorder in improving the diagnosis of symptoms related to cardiac arrhythmias. METHODS The study population was 64 patients whose Holter monitorization was inconclusive as to the diagnosis of symptoms related to cardiac arrhythmias. Each wore a patient-activated ambulatory electrocardiogram device for 15 days. The ECG recording during the occurrence of symptoms were sent to the ECG receiving center by phone. RESULTS Two patients did not conclude the study. The majority of the patients (85.5%) experienced symptoms in the fifteen days of monitorization, and in 62.2% of these patients electrocardiographic events were observed. The main symptoms experienced by these patients were: palpitation (67.7%), dizziness (32.3%), and syncope (29%). Other symptoms like breast pain, fatigue, indisposition and dyspnea were also noted in 30.6% of the patients. The main electrocardiographic disturbances observed were: sinus tachycardia (45.5%), isolated premature beats (30.3%), supraventricular tachycardia (21.2%), ventricular tachycardia (3%) and third degree AV block (3%). We also observed that the first symptomatic recording occurred mainly in the initial days of monitorization (69.4%) in the first 5 days). The percentage of diagnoses was 35.5% in patients whose Holter monitoring had been inconclusive. CONCLUSION The cardiac loop ECG recorder therefore achieved an important incremental diagnostic yield.
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Affiliation(s)
- C J Grupi
- Instituto do Coraçcao do Hospital das Clinicas--FMUSP
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17
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De Lima JJ, Lopes HF, Grupi CJ, Abensur H, Giorgi MC, Krieger EM, Pileggi F. Blood pressure influences the occurrence of complex ventricular arrhythmia in hemodialysis patients. Hypertension 1995; 26:1200-3. [PMID: 7498996 DOI: 10.1161/01.hyp.26.6.1200] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We investigated the relationship between blood pressure and the occurrence of complex ventricular arrhythmias (multiform, couplets, or runs) as assessed by 48-hour Holter monitoring in 74 stable long-term hemodialysis patients (44.5 +/- 12 years old; 54% men; 74% whites; dialysis duration, 51.3 +/- 36.1 months; systolic pressure, 146.6 +/- 19.3 mm Hg; diastolic pressure, 89.2 +/- 12.1 mm Hg; prevalence of arterial hypertension, 33.8%). Systolic and diastolic pressures represented the average of all predialysis determinations during the 3 months preceding the tests. Hemodialysis was performed midway through the Holter monitoring period. M-mode and bidimensional echocardiograms and myocardial perfusion tests were also obtained from all patients. Complex arrhythmias were observed in 37 individuals (50%). Univariate analysis showed that systolic pressure (P < .001), diastolic pressure (P < .05), age (P < .001), left ventricular posterior wall thickness (P < .01), left ventricular mass index (P < .05), and ischemic alterations on myocardial perfusion tests (P < .005) were significantly associated with complex arrhythmias. With the use of a multivariate model (stepwise logistic regression analysis) only systolic pressure (P < .01) and age (P < .05) were independently associated with complex arrhythmias. Sex; angina; dialysis duration; New York Heart Association functional class; use of digitalis; plasma levels of creatinine, sodium, potassium, calcium, and phosphate; hematocrit; left ventricular fractional shortening; left ventricular diastolic diameter; and ST segment deviation were not correlated with complex arrhythmias. The severity and frequency of complex arrhythmias were not influenced by hemodialysis. At follow-up (5 to 80 months) 5 patients had died of sudden death, 4 of whom were hypertensive and older than 45 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J J De Lima
- Hypertension Unit, Heart Institute, São Paulo, University Medical School, Brazil
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18
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Abstract
Electrocardiographic rhythm disturbance evaluation by Holter monitoring is increasingly becoming a useful methodologic tool for risk stratification as well as for therapeutic assessment in patients with Chagas' disease. Furthermore, late potential analyses, now being directly obtained from Holter recording has promising perspectives in enhancing identification of patients with high risk profiles for development of malignant ventricular arrhythmias. In addition, recently incorporated to Holter studies, heart rate variability analysis will certainly contribute to a better understanding of the characteristic autonomic nervous system disarray that commonly affects chagasic patients.
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Affiliation(s)
- C J Grupi
- Heart Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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19
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de Moraes AP, Moffa PJ, Sosa EA, Bellotti GM, Pastore CA, Lima EV, Chalela WA, Grupi CJ, Pileggi FJ. Signal-averaged electrocardiogram in chronic Chagas' heart disease. SAO PAULO MED J 1995; 113:851-7. [PMID: 8650486 DOI: 10.1590/s1516-31801995000200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
UNLABELLED The aim of the study was to register the prevalence of late potentials (LP) in patients with chronic Chagas' heart disease (CCD) and the relationship with sustained ventricular tachycardia (SVT). 192 patients (96 males), mean age 42.9 years, with CCD were studied through a Signal Averaged ECG using time domain analysis. According to presence or absence of bundle branch block (BBB) and SVT, four groups of patients were created: Group I (n = 72): without SVT (VT-) and without BBB (BBB-): Group II (n = 27): with SVT (VT+) and BBB-; Group III (n = 63): VT- and with BBB (BBB+); and Group IV (N = 30): VT+ and BBB+. The LP was admitted, with 40 Hz filter, in the groups without BBB using standard criteria of the method. In the group with BBB, the root-mean-square amplitude of the last 40 ms (RMS) < = 14 microV was considered as an indicator of LP. RESULTS In groups I and II, LP was present in 21 (78%) of the patients with SVT and in 22 (31%) of the patients with SVT (p < 0.001), with Sensitivity (S) 78%; Specificity (SP) 70% and Accuracy (Ac) 72%. LP was present in 30 (48%) of the patients without and 20 (67%) of the patients with SVT, in groups III and IV. p = 0.066, with S = 66%; SP = 52%; and Ac = 57%. In the follow-up, there were 4 deaths unrelated to arrhythmic events, all of them did not have LP. Eight (29.6%) of the patients from group II and 4 (13%) from group IV presented recurrence of SVT and 91.6% of these patients had LP. CONCLUSIONS LP occurred in 77.7% of patients with SVT and without BBB. In the groups with BBB, there was association of LP with SVT in 66.6% of the cases. The recurrence of SVT was patient in 21% of the cases from which 91.6% had LP.
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Affiliation(s)
- A P de Moraes
- Graphic Methods Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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20
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Cukier A, Vargas FS, Teixeira LR, Grupi CJ, Terra-Filho M, Carvalho-Pinto RM, Light RW. Arrhythmogenic effects of combined orally administered theophylline and albuterol in patients with chronic obstructive pulmonary disease. Braz J Med Biol Res 1994; 27:2869-77. [PMID: 7550007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
1. Studies in asthmatic subjects have reported conflicting results about the arrhythmogenic effects of beta agonist and theophylline. The purpose of the present study was to evaluate the effects of the combination of these drugs in patients with chronic obstructive pulmonary disease (COPD). 2. Twelve COPD patients (FEV1 = 1.2 +/- 0.3 L; PaO2 = 65.7 +/- 9.0 mmHg) were evaluated by 24-h Holter monitoring on three different days. The first evaluation was done after the patient had been without any treatment for at least 24 h, the second after sustained-release theophylline for one week and the third after oral beta agonist (albuterol) and theophylline for one week. 3. Mean serum level of theophylline was 1.9, 15.6 and 11.7 micrograms/ml, and mean heart rate was 78.3, 82.0 and 84.5 beats/min for the first, second and third period, respectively. Four patients showed more than 10 premature atrial contractions/h in the baseline Holter, and this rate did not increase after either treatment. Three patients had more than 10 premature ventricular contractions/h (PVC) at baseline, with no increase while receiving theophylline or the combination of theophylline and albuterol. However, one patient did have worsening of the arrhythmia while taking both drugs. There were 5 single PVCs/h at baseline and 150 single and 9 coupled PVCs/h plus 1 episode of non-sustained ventricular tachycardia during combined therapy. 4. We conclude that the combination of theophylline and a beta agonist (albuterol) may increase the premature ventricular contraction rate and the complexity of ectopic activity in COPD patients.
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Affiliation(s)
- A Cukier
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brasil
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21
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Grupi CJ, Moffa PJ, Sanches PC, Barbosa SA, Bellotti GM, Pileggi FJ. [Heart rate variability: significance and clinic application]. Rev Assoc Med Bras (1992) 1994; 40:129-36. [PMID: 7820151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- C J Grupi
- Setor de Holter da Divisão de Métodos Gráficos do Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo
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22
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Haertel LA, Moffa PJ, Grupi CJ, Camargo PA, Pereyra PA, Lima EV. [Intermittent ventricular pre-excitation in the presence of total atrioventricular block]. Arq Bras Cardiol 1993; 61:307-10. [PMID: 8147730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
An 8 year old child suffering from asthenia and complete atrioventricular block, probably congenital. During the tread-mill test there was a sudden electrocardiogram change to a ventricular preexcitation pattern. Besides this rare association, we emphasize the importance of the autonomic balance over the accessory pathway's electrophysiological properties. The appearance of a latent accessory pathway might be a substitutive mechanism to counterbalance the serious impairment of physiologic atrioventricular conduction.
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Affiliation(s)
- L A Haertel
- Instituto do Coração do Hospital das Clínicas-FMUSP, Blumenau, SC
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23
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Solimene MC, Ramires JA, Grupi CJ, Alfieri RG, Oliveira SF, Gama MN, Bellotti G, Pileggi F. [Silent ischemia after an uncomplicated myocardial infarct. A study in asymptomatic patients]. Arq Bras Cardiol 1992; 59:351-8. [PMID: 1340733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To verify the prognostic value of silent myocardial ischemia (SMI) after an uncomplicated myocardial infarction (MI). METHODS Forty asymptomatic patients were studied after a first uncomplicated MI. They were submitted to 48 hour ambulatory electrocardiographic monitoring and exercise-testing, during the 2nd and 8th weeks after the acute event. Thirty-nine patients were submitted to cardiac catheterization and coronary arteriography; one patient was submitted to necropsy. The electrocardiographic study identified 11 (27.5%) individuals with SMI (group A); the other 29 patients were considered group B. RESULTS Groups A and B were similar in relation to clinical characteristics, infarct site and ventricular function. Group A had significantly more extensive coronary artery disease when compared to group B. After a two-year follow-up, patients from group A had significantly more coronary events (36.3%) when compared to group B (3.4%). Kaplan-Meier analysis demonstrated a significantly higher cumulative probability of not experiencing a new coronary event for the group B patients. CONCLUSION SMI may have a prognostic value after uncomplicated MI, as in other clinical manifestations of coronary artery disease.
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Affiliation(s)
- M C Solimene
- Instituto do Coração do Hospital das Clínicas, FMUSP
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24
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Grupi CJ, Sosa EA, De Carvalho JF, Antonelli RH, Bellotti G, Pileggi F. [Spontaneous variability of ventricular extrasystole in chronic Chagas cardiopathy]. Arq Bras Cardiol 1991; 56:445-50. [PMID: 1726676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To study the spontaneous variability of single (VPCs) and coupled (CVPCs) in patients with chronic Chagas' disease (CCD). PATIENTS AND METHODS Twenty patients with CCD, 14 male, in class I and II NYHA, with frequent VPCs and VCPCs, free of drug therapy were studied. 21 hour Holter monitoring was done for 4 subsequent days. The data analysis assessed the variation in the frequency of VPCs and CVPCs between patients, seven hour periods one hour periods in a hierarchical model by a Poisson process. RESULTS a) the frequency of VPCs follows a circadian rhythm, closely related to the hourly variations of the mean heart rate; b) disregarding the heart rate influence on the variability of the ventricular arrhythmia, its behavior was at random and unpredictable; c) the minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous between antiarrhythmic effect and spontaneous variability was 121.86% for seven-hour, 58.42% for 21-hour and 38.45% for 42-hour electrocardiographic monitoring periods; d) the same approach for the VCPCs revealed values of 133.6%, 63.21% and 41.3% respectively. CONCLUSION The large variability of ventricular arrhythmia in CCD during a 24 hour period makes necessary observations always longer. The minimal percentual reduction in VPCs/h that discriminated between antiarrhythmic effect and spontaneous variability might be 58.42% for two 21-hour electrocardiography monitoring periods.
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Affiliation(s)
- C J Grupi
- Instituto do Coração, Hospital das Clínicas-FMUSP
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25
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Grupi CJ, Barbosa SA, Moffa PJ. [Syncope: diagnostic possibility and evaluation]. Arq Bras Cardiol 1991; 56:73-7. [PMID: 1872715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- C J Grupi
- Instituto do Coraçáo do Hospital das Clínicas-FMUSP, São Paulo
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