Biomarkers and prediction of anthracyclic cardiotoxicity in breast cancer.

Background: Chemotherapy with doxorubicin may lead to left ventricular dysfunction. There is a controversial recommendation that biomarkers can predict ventricular dysfunction, which is one of the most feared manifestations of anthracycline cardiotoxicity.

Objective: The aim of this study was to evaluate the behavior of biomarkers such as Troponin I, type B natriuretic peptide, creatine phosphokinase fraction MB, and myoglobin in predicting cardiotoxicity in a cohort of women with breast cancer undergoing chemotherapy with anthracycline.

Trends in Mortality Rates from Cardiovascular Disease and Cancer between 2000 and 2015 in the Most Populous Capital Cities of the Five Regions of Brazil.

Background: In many cities around the world, the mortality rate from cancer (CA) has exceeded that from disease of the circulatory system (DCS).

Objectives: To compare the mortality curves from DCS and CA in the most populous capital cities of the five regions of Brazil.

Methods: Data of mortality rates from DCS and CA between 2000 and 2015 were collected from the Mortality Information System of Manaus, Salvador, Goiania, Sao Paulo and Curitiba, and categorized by age range into early (30-69 years) and late (≥ 70 years), and by gender of the individuals.

Carotid chemoreflex and muscle metaboreflex interact to the regulation of ventilation in patients with heart failure with reduced ejection fraction.

Synergism among reflexes probably contributes to exercise hyperventilation in patients with heart failure with reduced ejection fraction (HFrEF). Thus, we investigated whether the carotid chemoreflex and the muscle metaboreflex interact to the regulation of ventilation ( ) in HFrEF. Ten patients accomplished 4-min cycling at 60% peak workload and then recovered for 2 min under either: (a) 21% O inhalation (tonic carotid chemoreflex activity) with legs' circulation free (inactive muscle metaboreflex); (b) 100% O inhalation (suppressed carotid chemoreflex activity) with legs' circulation occluded (muscle metaboreflex activation); (c) 21% O inhalation (tonic carotid chemoreflex activity) with legs' circulation occluded (muscle metaboreflex activation); or (d) 100% O inhalation (suppressed carotid chemoreflex activity) with legs' circulation free (inactive muscle metaboreflex) as control.

Transcutaneous electrical nerve stimulation attenuates cardiac sympathetic drive in heart failure: a MIBG myocardial scintigraphy randomized controlled trial.

Cardiac sympathetic overdrive provides inotropic support to the failing heart. However, as myocardial insult evolves, this compensatory response impairs contractile function and constitutes an independent mortality predictor and a primary target in the treatment of heart failure (HF). In this prospective, randomized, double-blind, controlled crossover trial, we proposed cervicothoracic transcutaneous electrical nerve stimulation (CTENS) as a nonpharmacological therapy on cardiac sympathetic activity in patients with HF.

Relationship of Electromechanical Dyssynchrony in Patients Submitted to CRT With LV Lead Implantation Guided by Gated Myocardial Perfusion Spect.

Background: Heart failure (HF) affects more than 5 million individuals in the United States, with more than 1 million hospital admissions per year. Cardiac resynchronization therapy (CRT) can benefit patients with advanced HF and prolonged QRS. A significant percentage of patients, however, does not respond to CRT.

Speckle Tracking and Transthyretin Amyloid Cardiomyopathy.

Background: Amyloidosis is a disease caused by deposits of insoluble fibrils in extracellular spaces. The most common type of familial amyloidosis is mediated by mutation of transthyretin, especially Val30Met. Symptoms and ejection fraction decrease may occur in cardiac amyloidosis only in case of poor prognosis.

Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery.

Background:: The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries.

Objectives:: To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk.

Methods:: A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study.

Cirrhotic Cardiomyopathy: Another Case of a Successful Approach to Treatment of Hepatorenal Syndrome.

Hepatorenal syndrome (HRS) is defined as a failure of renal function, potentially reversible, in patients with liver cirrhosis and ascites. Recently, a component of cardiomyopathy associated with HRS was described, but the use of positive inotropic medicine as part of the treatment of the acute phase has not been extensively evaluated. We report a second case in our hospital of a patient with HRS type I without previous heart disease, with secondary hemodynamic decompensation due to liver disease, in which the abnormalities in systolic function by speckle-tracking echocardiography were observed and could be reversed by the use of inotropes.

Cardiovascular effects of radiotherapy on the patient with cancer.

The incidence of cancer (CA) has increased globally and radiotherapy (RT) is a vital component in its treatment. Cardiovascular injuries induced by RT in the treatment of thoracic and cervical CA have been causing problems in clinical practice for decades, and are among the most serious adverse effects of radiation experienced by the growing number of cancer survivors. This article presentes a review on the Lilacs, Scielo and Pubmed databases of the main cardiovascular injuries, their mechanisms, clinical presentations, treatments and prevention proposals.

Two potentially fatal surprises in the preoperative assessment of an asymptomatic young adult.

Isolated left ventricular non-compaction is a rare disease classified as a primary genetic cardiomyopathy and is characterized by heart failure, systemic embolism and ventricular arrhythmias. The diagnosis is established by Doppler echocardiography. We report the case of an asymptomatic young adult, with no history of heart disease, who underwent preoperative assessment for low-risk orthopedic surgery.

Hypertension in patients with cancer.

There is a known association between chemotherapy and radiotherapy for treatment of cancer patients and development or worsening of hypertension. The aim of this article is to review this association. A literature search was conducted for articles reporting this association on the databases PubMed, SciELO and LILACS between 1993 and 2013.

Assessing strategies for heart failure with preserved ejection fraction at the outpatient clinic.

Background: Heart failure with preserved ejection fraction (HFPEF) is the most common form of heart failure (HF), its diagnosis being a challenge to the outpatient clinic practice.

Objective: To describe and compare two strategies derived from algorithms of the European Society of Cardiology Diastology Guidelines for the diagnosis of HFPEF.

Methods: Cross-sectional study with 166 consecutive ambulatory patients (67.

[Utility of B-type natriuretic peptide measurement in outpatients with heart failure with preserved ejection fraction].

Introduction: Heart failure with preserved ejection fraction (HFPEF) is a highly prevalent syndrome that is difficult to diagnose in outpatients. The measurement of B-type natriuretic peptide (BNP) may be useful in the diagnosis of HFPEF, but with a different cutoff from that used in the emergency room. The aim of this study was to identify the BNP cutoff for a diagnosis of HFPEF in outpatients.

Left atrium measurement in patients suspected of having heart failure with preserved ejection fraction.

Background: The pathophysiological model of heart failure (HF) with preserved ejection fraction (HFPEF) focuses on the presence of diastolic dysfunction, which causes left atrial (LA) structural and functional changes. The LA size, an indicator of the chronic elevation of the left ventricular (LV) filling pressure, can be used as a marker of the presence of HFPEF, and it is easily obtained.

Objective: To estimate the accuracy of measuring the LA size by using indexed LA volume and diameter (ILAV and ILAD, respectively) for diagnosing HFPEF in ambulatory patients.

Effects of short-term carvedilol on the cardiac sympathetic activity assessed by 123I-MIBG scintigraphy.

Background: Autonomic alterations in heart failure are associated with an increase in morbimortality. Several noninvasive methods have been employed to evaluate the sympathetic function, including the Meta-Iodobenzylguanidine (123I-MIBG) scintigraphy imaging of the heart.

Objective: to evaluate the cardiac sympathetic activity through 123I-MIBG scintigraphy, before and after three months of carvedilol therapy in patients with heart failure and left ventricular ejection fraction (LVEF) < 45%.

Evaluation of longitudinal systolic function in heart failure with normal ejection fraction.

Background: Heart failure with normal ejection fraction (HFNEF) is now the most prevailing model of HF in different epidemiological studies, and abnormalities in mild systolic function (subclinical) have been observed in those patients when the left ventricular contractility (LV) is evaluated in the longitudinal axis (S') by tissue Doppler echocardiography (TDE), even in normal LV ejection fraction.

Objective: To evaluate whether patients with HFNEF, according to the new criteria set out by the European Society of Cardiology, present changes in systolic function detected by S' measurement when compared with patients whose HFNEF has not been confirmed.

Methods: One hundred eighteen patients with signs or symptoms of HF underwent BNP measurement and TDE with measurements of longitudinal axis velocity during systole (S') and diastole (E') and measures of transmitral flow during diastole (E, A).

Study of vascular reactivity in HIV patients whether or not receiving protease inhibitor.

Background: A great number of HIV-infected patients using antiretroviral drugs develop endothelial dysfunction and atherothrombosis, which lead to a high medical and social burden. Thus, it is important to identify pathophysiological mechanisms involved with the endothelial function in these patients, so that early intervention can be made to avoid disease progression.

Objective: To evaluate endothelial function using endothelium-dependent and independent vasodilation in HIV-positive patients and in a control group.

Carotid artery structural and functional evaluation in relatives of type 2 diabetic patients.

Background: In Western countries type 2 diabetes mellitus (DM2) is the leading cause of morbidity and mortality, particularly from cardiovascular causes. Since a family history of diabetes, even in non-diabetic subjects, is regarded as an increased risk of coronary heart disease, the use of approved surrogate markers of early atherosclerosis, specially of ultrasonic measurements of the carotid arteries, is of vital importance.

Objective: To analyze the structural properties (intima-media thickness) and functional properties (distensibility measurement) of the carotid arteries in subjects with (FH+) a family history of type 2 diabetes, in comparison to subjects without (FH-) a family history of type 2 diabetes, both groups with no known cardiovascular risk factors.

Heart failure with preserved ejection fraction and systolic dysfunction in the community.

Background: In developed countries, heart failure with preserved ejection fraction (HFpEF) is more prevalent than heart failure with reduced ejection fraction (HFrEF) in the community. However, it has not been completely established if this fact is also observed within our community.

Objective: To determine the most prevalent form of heart failure (HFpEF or HFrEF) and whether the prevalence of HFpEF is higher in the community.