ABSTRACT: BACKGROUND: In acute coronary syndrome (ACS), admission hyperglycemia is associated with adverse cardiovascular events in diabetic and nondiabetic patients. OBJECTIVE: To assess the prognostic value of stress hyperglycemia for the in-hospital outcome of patients admitted due to ACS. METHODS: This study included 152 patients admitted to the chest pain unit of a tertiary hospital diagnosed with ACS, who had admission blood glucose data, from September 2005 to February 2010. Group I comprised patients with stress hyperglycemia, defined as admission blood glucose concentration > 126 mg/dL for nondiabetic individuals and admission blood glucose concentration > 200 mg/dL for diabetic individuals. Group II was formed by patients with admission blood glucose concentration lower than those established. The association of hyperglycemia and in-hospital outcome was assessed. RESULTS: Stress hyperglycemia associated with in-hospital complications, age increase and female sex. On multivariate analysis, only female sex (OR = 2.04; 95% CI: 1.03 - 4.06; p = 0.007) and in-hospital complications (OR = 3.65; 95% CI: 1.62 - 8.19; p = 0.002) associated independently with admission hyperglycemia. CONCLUSIONS: Stress hyperglycemia is an independent predictive factor for in-hospital complications after ACS in diabetic and nondiabetic patients. The results highlight the need to assess admission blood glucose concentration in all patients admitted due to ACS, including nondiabetic ones, aiming at identifying those at higher risk for complications.
Arquivos brasileiros de cardiologia 02/2013; 100(2):127-134. · 1.32 Impact Factor
ABSTRACT: Despite abundant evidence of increased morbidity and mortality, chronotropic incompetence (CI) is not a routine diagnosis well defined in protocols of cardiac evaluation and its clinical importance is still underestimated.
To evaluate the clinical and echocardiographic parameters associated with HF in non-elderly patients submitted to stress echocardiography (SE).
One thousand seven hundred ninety-eight patients with a mean age of 48.4 ± 7.5 years, who underwent SE between January/2000 and August/2009 were evaluated. Patients with chronotropic index smaller than 0.8 were considered chronotropic incompetent as compared to competent patients as to clinical and echocardiographic characteristics.
The duration of the exercise was 9.3 ± 2.4 minutes on average. Two hundred and seventy (15%) patients were chronotropic incompetent. The chronotropic index of this group was 0.7 ± 0.1 vs. 1.0 ± 0.1 for competent patients. Multivariate logistic regression analysis identified the following parameters as independently associated with HF: dyspnea on examination [odds ratio (OR) = 4.27, p <0.0001], previous chest pain on medical history (OR = 1.51; p = 0.0111), higher left ventricular mass rate in incompetent patients (LVMI) (OR = 1.16, p = 0.0001), metabolic equivalents (METs) (OR = 0.70, p = 0 , 0001), ST segment depression (OR = 0.58, p = 0.0003) and high systolic blood pressure (ΔSBP) (OR = 0.87, p = 0.0011). Myocardial ischemia was not associated with HF.
HF is associated with functional parameters, such as dyspnea on exertion, history of chest pain and lower METS. It is also associated with structural benchmark index of left ventricular mass. In addition, chronotropic incompetence does not appear to increase the chance of myocardial ischemia in non-elderly patients.
Arquivos brasileiros de cardiologia 04/2012; 98(5):413-20. · 1.32 Impact Factor
ABSTRACT: The literature lacks studies about the prognostic value of exercise stress echocardiography (ESE) in patients with complete left bundle branch block (LBBB) of the bundle of His.
To assess the prognostic value of ESE in patients with LBBB.
This is a retrospective cohort that evaluated 135 patients with LBBB, from January 2001 to October 2009, of which 37.8% were men, mean age 63.6 ± 11.5 years submitted to ESE according to Bruce protocol on a treadmill. Cox regression was used, considering these outcomes: death from all causes and from cardiac events, defined as acute myocardial infarction (AMI), percutaneous angioplasty (PA), coronary artery bypass grafting (CABG) and death from cardiac causes.
Positive ESE was observed in 42 patients (31%). The mean follow-up was 45.8 ± 4.7 months. During this period, there were 9 deaths from all causes and 9 cardiac events (3 deaths from cardiac causes, 3 myocardial infarctions, 2 PA and one CABG). The mortality rate from all causes during five years was 16.1% in the group with positive ESE and 2.5% in the group with negative test (p = 0.171), whereas the rate of cardiac events in the same period was 15.1% for the positive ESE and 1.6% in the group with negative test (p = 0.009).
ESE showed to be a predictor of cardiac events in patients with LBBB.
Arquivos brasileiros de cardiologia 12/2011; 97(6):478-84. · 1.32 Impact Factor