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INTRODUÇÃO: O treinamento físico é essencial para indivíduos saudáveis e cardiopatas. Segundo a Sociedade Brasileira de Cardiologia, a reabilitação cardiovascular para pacientes com insuficiência cardíaca crônica (ICC) estável, em classe funcional II-III da New York Heart Association, resulta em melhora da qualidade de vida e capacidade funcional e tem sido classe de recomendação I e nível de evidência A. Diferentes estratégias de treinamento físico são capazes de aumentar a aptidão física e cardiovascular, dentre as mais utilizadas estão o Treinamento Contínuo de Moderada Intensidade (MCT) e o Treinamento Intervalado de Alta Intensidade (HIIT). Estudos anteriores compararam os efeitos do HIIT com o MCT, em indivíduos saudáveis, porém, poucos demonstraram seus efeitos em cardiopatas, assim, o objetivo deste estudo foi avaliar a eficácia do HIIT no treinamento de pacientes com ICC. MÉTODOS: A seleção foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde e Cochrane Library de agosto de 2018 a fevereiro de 2019 utilizando os descritores: Insuficiência Cardíaca e Treinamento Intervalado de Alta Intensidade. Os critérios de inclusão consistiu em pesquisas que fossem ensaios clínicos randomizados em seres humanos, publicados em revistas indexadas, que apresentassem avaliações de intervenções e efeitos do HIIT em pacientes com ICC com duração mínima de 4 semanas. RESULTADOS: Na busca inicial foram acessados um total de 178 estudos e foram eleitos os 19 que preencheram os critérios de elegibilidade. Estes incluíram um total de 824 pacientes (83,6% homens, 16,4% mulheres) com ICC de etiologias diversas. Nossos achados salientam que até o presente momento, o HIIT se apresenta como uma estratégia de treinamento físico bem tolerado e seguro para pacientes com ICC (com e sem redução da Fração de Ejeção Ventricular Esquerda). Neste sentido, nossa revisão sistemática evidenciou efeitos significativos na melhoria dos parâmetros de aptidão física/ capacidade cardiorrespiratória, eficiência metabólica e ventilatória, porém, na análise global sem apresentar superioridade sobre o MCT. O HIIT permite aos pacientes se exercitarem com maior potência e similar tolerância do MCT, além de reverter a miopatia esquelética, contribuindo para induzir a hipertrofia muscular nessa população. CONCLUSÃO: O HIIT mostrou ser um método de treinamento seguro em pacientes com ICC, no entanto, até os últimos estudos não foi possível provar a sua superioridade sobre o MCT, sendo necessários novos estudos sobre o HIIT nesta população de grande relevância e implicância clínica. (AU)

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BACKGROUND: Heart rate recovery (HRR) has been shown to predict cardiovascular disease mortality. HRR is delayed in hypertension, but its association with prehypertension (PHT) has not been well studied. METHODS: The study population consisted of 683 asymptomatic individuals (90% men, aged 47±7.9 years). HRR was defined as peak heart rate minus heart rate after a 2-minute rest. PHT was categorized into stage I (systolic blood pressure (SBP) 120-129mm Hg or diastolic BP (DBP) 80-84mm Hg) or stage II (SBP 130-139mm Hg or DBP 85-89mm Hg). Logistic regression was used to generate odds ratios (ORs) for the relationship between HRR and PHT. RESULTS: The mean HRR was lower in the PHT groups than in those who were normotensive (60 bpm and 58 bpm in stages I and II PHT vs. 65 bpm in normal BP; P <0.01). Persons with PHT were more likely to be in the lowest quartile of HRR compared with those with normal BP (adjusted OR, 3.80 and 95% confidence interval [CI], 1.06, 13.56 for stage II PHT and adjusted OR, 3.01 and 95% CI 1.05, 8.66 for stage I PHT). In a fully adjusted model, HRR was still significantly associated with both stages of PHT. CONCLUSION: Among asymptomatic patients undergoing stress testing, delayed HRR was independently associated with early and late stages of PHT. Further studies are needed to determine the usefulness of measuring HRR in the prevention and management of hypertension.

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Obesity demonstrates a direct relation with cardiovascular risk and all-cause mortality, while cardiorespiratory fitness demonstrates an inverse relation. In clinical practice, several cardiometabolic (CM) risk factors are commonly measured to gauge cardiovascular risk, but the interaction between fitness and obesity with regard to CM risk has not been fully explored. In this study, 2,634 Brazilian adults referred for employer-sponsored heath exams were assessed. Obesity was defined as body mass index >30 kg/m(2) or waist circumference >102 cm in men or >88 cm in women when body mass index was 25 to 30 kg/m(2). Fitness was quantified by stage achieved on an Ellestad treadmill stress test, with those completing stage 4 considered fit. Hepatic steatosis was determined by ultrasound. CM risk factors were compared after stratifying patients into 4 groups: fit and normal weight, fit and obese, unfit and normal weight, and unfit and obese. Approximately 22% of patients were obese; 12% were unfit. Fitness and obesity were moderately correlated (ρ = 0.38 to 0.50). The sample included 6.5% unfit and normal-weight subjects and 16% fit and obese subjects. In overweight and obese patients, fitness was negatively associated with CM risk (p <0.01 for all values). In fit patients, increasing body mass index was positively associated with CM risk (p <0.01 for all values). In instances of discordance between fitness and obesity, obesity was the stronger determinant of CM risk. In conclusion, fitness and obesity are independently associated with CM risk. The effects of fitness and obesity are additive, but obesity is more strongly associated with CM risk when fitness and obesity are discordant. These findings underscore the need for weight loss in obese patients and suggest an unmeasured benefit of fitness.

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BACKGROUND: It is advisable that the intensity of the exercises for rehabilitation of patients with coronary artery disease does not cause myocardial ischemia. OBJECTIVE: Compare the capacity of myocardial tomographic scintigraphy with the electrocardiogram capacity in ischemia detection during rehabilitation session. METHODS: Twenty six patients with coronary artery disease, undergoing the rehabilitation program and with previous scintigraphy, with transient hypo-uptake have been administered a new injection of MIBI-Tc-99m during a training session when they were also monitored with dynamic electrocardiography. The rest scintigraphies, after ergometric treadmill test and rehabilitation session, were assessed in a semi-quantitative way using scores from 0 to 4 to classify each one of the chosen segments (0 = normal; 1 = discrete hypo-uptake; 2 = moderate; 3 = intense; 4 = lack of uptake). RESULTS: The means of the total scores found were: at rest = 12.9; after treadmill test = 19.3; after rehabilitation session = 15.1. There were statistically significant differences among them. An individual assessment showed that in 14 cases (53.8 %) hypo-uptake to some degree was identified during rehabilitation and in 12 cases (46.6%) it was not. Monitoring with the Holter system didn't show in any of the cases a ST segment depression equal or greater than 1mm. CONCLUSION: The exercises prescribed for patients with coronary artery disease, according to recommendations found in the literature, may trigger myocardial ischemia, assessed by scintigraphy during a rehabilitation session.

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FUNDAMENTO: Recomenda-se que a intensidade dos exercícios na reabilitação de coronariopatas não deva produzir isquemia miocárdica. OBJETIVO: Comparar a capacidade da cintilografia tomográfica do miocárdio com a do eletrocardiograma na detecção de isquemia durante sessão de reabilitação. MÉTODOS: Vinte e seis pacientes coronariopatas, em programa de reabilitação e com cintilografia prévia com hipocaptação transitória, receberam nova injeção de MIBI-Tc-99m durante uma sessão de treinamento, quando também foram monitorizados pela eletrocardiografia dinâmica. As cintilografias de repouso, após teste ergométrico em esteira e após sessão de reabilitação, foram analisadas de forma semiquantitativa utilizando-se um escore, de 0 a 4, classificando cada um dos segmentos escolhidos (0 = normal; 1 = hipocaptação discreta; 2 = moderada; 3 = intensa; 4 = ausência da captação). RESULTADOS: As médias dos somatórios dos escores encontrados foram: repouso = 12,9; após teste em esteira = 19,3; após sessão de reabilitação = 15,1. Houve diferenças estatisticamente significativas entre elas. Uma análise individual mostrou que em 14 casos (53,8 por cento) foi identificado algum grau de hipocaptação durante a reabilitação, e em 12 (46,6 por cento), não. Monitorização com sistema Holter não revelou, em nenhum caso, depressão do segmento ST, igual ou maior do que 1 mm. CONCLUSÃO: Exercícios prescritos em doentes coronariopatas, conforme recomendações da literatura, podem desencadear isquemia miocárdica, avaliada pela cintilografia, durante sessão de reabilitação.

BACKGROUND: It is advisable that the intensity of the exercises for rehabilitation of patients with coronary artery disease does not cause myocardial ischemia. OBJECTIVE: Compare the capacity of myocardial tomographic scintigraphy with the electrocardiogram capacity in ischemia detection during rehabilitation session. METHODS: Twenty six patients with coronary artery disease, undergoing the rehabilitation program and with previous scintigraphy, with transient hypo-uptake have been administered a new injection of MIBI-Tc-99m during a training session when they were also monitored with dynamic electrocardiography. The rest scintigraphies, after ergometric treadmill test and rehabilitation session, were assessed in a semi-quantitative way using scores from 0 to 4 to classify each one of the chosen segments (0 = normal; 1 = discrete hypo-uptake; 2 = moderate; 3 = intense; 4 = lack of uptake). RESULTS: The means of the total scores found were: at rest = 12.9; after treadmill test = 19.3; after rehabilitation session = 15.1. There were statistically significant differences among them. An individual assessment showed that in 14 cases (53.8 percent) hypo-uptake to some degree was identified during rehabilitation and in 12 cases (46.6 percent) it was not. Monitoring with the Holter system didn't show in any of the cases a ST segment depression equal or greater than 1mm. CONCLUSION: The exercises prescribed for patients with coronary artery disease, according to recommendations found in the literature, may trigger myocardial ischemia, assessed by scintigraphy during a rehabilitation session.

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The objective of this study was to evaluate whether uric acid (UA) levels were associated with coronary artery calcium (CAC) in white men asymptomatic for coronary heart disease. We also evaluated whether this relation was dependent or not on the presence of the metabolic syndrome (MS). The study population consisted of 371 asymptomatic Brazilian men (48 +/- 7 years of age) who underwent a routine evaluation. The average 10-year total risk of coronary heart disease calculated by Framingham risk score was 10.8 +/- 7.8%. The age-adjusted prevalence of CAC in patients with a high UA level (fourth quartile > or =7.1 mg/dl, n = 91) was significantly higher than that in those with a normal UA level (58% vs 44%, p = 0.02). With respect to age, smoking, physical activity, and components of MS-adjusted analyses, a high UA level was independently associated with the presence of CAC (p = 0.043) and with increasing levels of CAC (p = 0.028). Prevalence of MS showed a graded increase according to serum UA values. In patients with the MS, after adjusting for age, smoking, physical activity, and white blood cell count, high levels of UA were strongly associated with the presence of any CAC (odds ratio 3.47, 95% confidence interval 1.26 to 9.53, p = 0.01) and with increasing levels of CAC (odds ratio 2.74, 95% confidence interval 1.15 to 6.50, p = 0.02). Conversely, there was no significant association of high UA levels in patients without the MS. However, the interaction between high UA level and the MS did not achieve statistical significance for the presence of CAC (p = 0.11) or higher levels of CAC (p = 0.16). In conclusion, our study suggests that, among asymptomatic moderate-risk men, high UA levels were independently associated with CAC in subjects with the MS.

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OBJECTIVE: To correlate myocardial perfusion scintigraphy (MPS) with Tc-99m-MIBI and adenosine infusion using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). METHODS: Seventy patients with coronary artery disease (CAD) referred for myocardial perfusion scintigraphy (MPS) with MIBI and adenosine were studied. Clinical, electrocardiographic (ECG), and scintigraphic findings were correlated with variables of visual and quantitative angiographic analysis, as well as to those of IVUS. RESULTS: The mean age of patients was 60.6 years, and 39 were male. Coronary angiography showed percentage of diameter stenosis (% DS) of 49.94% in 105 arteries, 83 of which were re-evaluated by QCA (79%), mean of 44.20%, p<0.05. ST-segment depression during adenosine infusion was associated with higher degrees of % DS (55.0% vs. 47.8%), p<0.05). Scintigraphic ischemia was correlated with greater cross-sectional area of lumen obstruction by IVUS (% CSA). Clinical, ECG, and IVUS findings were considered together and expressed as global ischemic versus non-ischemic responses. Ischemia was associated with lower values of minimal lumen diameter (MLD) and minimal lumen area (MLA) determined by QCA and IVUS. CONCLUSION: Tc-99m-MIBI and adenosine myocardial SPECT is correlated with % CSA on IVUS, perfusion images considered. Global results assessment showed association between lumen diameter and area at obstructed sites as determined by QCA and IVUS.

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OBJETIVO: Estabelecer a correlação da cintilografia de perfusão do miocárdio (CPM) com Tecnécio 99m-MIBI (MIBI) e injeção de adenosina, empregando a angiografia coronária quantitativa (ACQ) e o ultra-som intracoronário (UIC) como comparação. MÉTODOS: Estudo de 70 pacientes com doença arterial coronária (DAC), encaminhados à CPM com MIBI e adenosina. As manifestações clínicas, do eletrocardiograma (ECG) e os resultados das imagens foram correlacionadas às variáveis da análise visual e quantitativa da angiografia, bem como ao UIC. RESULTADOS: A média de idades foi de 60,6 anos, com 39 pacientes do sexo masculino. A angiografia coronária evidenciou estenose do diâmetro da luz (E por cento) de 49,94 por cento em 105 artérias, com reavaliação à ACQ em 83 artérias (79 por cento) e média de 44,20 por cento, p<0,05. Infradesnível de ST durante adenosina associou-se a maiores graus de E por cento (55,0 por cento vs 47,8 por cento), p<0,05). A isquemia cintilográfica correlacionou-se a maior área porcentual de obstrução da luz pelo UIC (AO por cento). Os achados clínicos, do ECG e das imagens foram considerados em conjunto e expressos como respostas globais isquêmicas versus não-isquêmicas . A isquemia associou-se a menores valores do diâmetro mínimo da luz (DML) e da área mínima da luz (AML), obtidos à ACQ e ao UIC. CONCLUSAO: A cintilografia do miocárdio com 99mTc-MIBI e adenosina correlaciona-se à AO por cento ao UIC, considerando-se as imagens de perfusão. Na avaliação dos resultados globais da prova observa-se associação com os diâmetros e as áreas da luz nos locais de obstrução, obtidos à ACQ e ao UIC.

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OBJETIVO: Verificar a sensibilidade e a especificidade do hormônio natriurético do tipo B (BNP) para identificar pacientes ambulatoriais, com insuficiência mitral crônica grave, sintomáticos e assintomáticos. MÉTODOS: Um grupo de pacientes com insuficiência mitral foi examinado e submetido à eletrocardiografia, telerradiografia de tórax, coletas de sangue venoso e ecocardiograma transtorácico. Por meio da análise de variáveis ecocardiográficas, 62 pacientes apresentavam refluxo mitral discreto e moderado (G I) e 34 refluxo mitral grave (G II). A capacidade discriminante do BNP em detectar pacientes com insuficiência mitral grave foi avaliada pela construção de curvas ROC. RESULTADOS: Entre os 96 doentes, 71 (73 por cento) eram mulheres e as idades variaram entre 15 e 63 (média de 31,7) anos. Os valores de BNP variaram de 0,00 pg/ml a 193 pg/ml. Os doentes do G I tiveram um valor médio de BNP de 18,10 ± 0,74 pg/ml e os do G II de 50,54 ± 1,46 pg/ml, (p=0,001). O valor de corte para identificar insuficiência mitral grave foi de 15,40 pg/ml, para o melhor balanço entre a sensibilidade e a especificidade, respectivamente de 0,73 e 0,74. O valor de corte para identificar pacientes sintomáticos e com insuficiência mitral grave foi de 28,40 pg/ml, para o melhor balanço entre a sensibilidade e a especificidade, respectivamente de 0,78 e 0,83. CONCLUSÃO: Os valores de BNP capazes de indentificar doentes com insuficiência mitral grave assintomáticos e sintomáticos são menores do que os 100 pg/ml considerados para o diagnóstico de insuficiência cardíaca.

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