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Biomedical subjects

F M Albanesi Filho

Publications and source records attributed to F M Albanesi Filho.

At least 19 recordsLinked to original sources
PubMed2001

Is female sex an independent predictor of in-hospital mortality in acute myocardial infarction?

OBJECTIVE: To assess whether female sex is a factor independently related to in-hospital mortality in acute myocardial infarction. METHODS: Of 600 consecutive patients (435 males and 165 females) with acute myocardial infarction, we studied 13 demographic and clinical variables obtained at the time of hospital admission through uni- and multivariate analysis, and analyzed their relation to in-hospital death. RESULTS: Females were older (p<0.001) and had a higher incidence of hypertension (p<0.001). Males were more frequently smokers (p<0.001). The remaining risk factors had a similar incidence among both sexes. All variables underwent uni- and multivariate analysis. Through univariate analysis, the following variables were found to be associated with in-hospital death: female sex (p<0.001), age >70 years (p<0.001), the presence of previous coronary artery disease (p=0.0004), previous myocardial infarction (p<0.001), infarction in the anterior wall (p=0.007), presence of left ventricular dysfunction (p<0.001), and the absence of thrombolytic therapy (p=0.04). Through the multivariate analysis of logistic regression, the following variables were associated with in-hospital mortality: female sex (p=0.001), age (p=0.008), the presence of previous myocardial infarction (p=0.02), and left ventricular dysfunction (p<0.001). CONCLUSION: After adjusting for all risk variables, female sex proved to be a variable independently related to in-hospital mortality in acute myocardial infarction.

Aged↗
PubMed2000

Cardiac tamponade in systemic lupus erythematosus. Report of four cases.

OBJECTIVE: To report and assess the incidence of cardiac tamponade in systemic lupus erythematosus as a cardiac manifestation of the disease. METHODS: We reviewed the medical records of 325 patients diagnosed with systemic lupus erythematosus according to the American Rheumatism Association and their complementary laboratory tests compatible with cardiac tamponade. RESULTS: In the 325 medical records reviewed, we found 108 patients with pericardial effusions corresponding to 33.2% of the total and 54% of the patients studied in the active phase of the disease. Clinical assessment and transthoracic echocardiogram allowed the clinical diagnosis of cardiac tamponade in only 4 (1.23%) patients, 3 of whom were females, white, with ages ranging from 25 to 44 years. The pericardial fluid was hemorrhagic or serosanguineous with high levels of FAN and positivity for LE cells. In the treatment, we successfully used pericardiocentesis associated with high doses of corticosteroids. In clinical and laboratory follow-up performed for a period of 3 years, neither recrudescence of the pericardial effusion nor evolution to constriction occurred. CONCLUSION: Even though rare (1.23%), cardiac tamponade in patients with systemic lupus erythematosus has a benign evolution when properly treated, according to our experience.

Adult↗
PubMed1999

Natural course of subsequent pregnancy after peripartum cardiomyopathy.

OBJECTIVE: To assess the effect of subsequent pregnancy after peripartum cardiomyopathy (PPCM) on maternal and fetal outcome. METHODS: Prospective study of 34 patients with the diagnosis of PPCM (mean age = 26 years). At the time of first diagnosis 5 were in NYHA functional class (FC) II for heart failure, one in FC III and 28 in FC IV. After clinical treatment, patients were advised to avoid new pregnancies and a follow-up was obtained. RESULTS: There were 12 (35.3%) subsequent pregnancies in patients (pt) aged 19 to 44 years (mean 32), divided into two groups: GI: 6 pts who had normalized their heart size and GII: 6 pts with persistent cardiomegaly. GI had initially mild clinical manifestations (3 were in FC II, 1 in FC II and 2 in FC IV) and complete recovery of cardiac function (FC I). A new pregnancy was well-tolerated in 5 (83.3%); 1 pt presented with preeclampsia, and progressed to FC II. Presently, 5 pt are in FC I and 1 in FC II. GII pts had more severe heart failure at the onset of PPCM (1 pt in FC II and 5 in FC IV); during follow-up, 4 pt were in FC I and 2 in FC II. A new pregnancy was well tolerated in all of them, but the eldest, who had had 2 pregnancies and had a progressive worsening of clinical status, dying 8 years after the last pregnancy and 13 years after the diagnosis of PPCM. The remaining 5 pt are still alive, 3 in FC I and 2 in FC II, with worsening of FC in 1. Subsequent pregnancies occurred 3-7 years after clinical treatment of PPCM and no fetal distress was observed. CONCLUSION: Subsequent pregnancies are well-tolerated after PPCM, but not devoid of risk. No fetal distress was observed. A minimum interval of 3 years after the recovery of function seems to be safe for subsequent pregnancies.

Adolescent↗
PubMed1998

[High resolution electrocardiogram in frequency domain. Use of statistical techniques of spectral correlation for identification of patients with sustained monomorphic ventricular tachycardia].

PURPOSE: To evaluate the diagnostic accuracy of monomorphic ventricular tachycardia (MVT), in patients with structural heart diseases and episodes of sustained MVT, using the signal-averaged ECG (SAECG) in the time (TD) and the frequency domain (FD) with statistical techniques of spectral correlation. METHODS: Twenty seven patients with at least one episode of sustained MVT, 30 patients with structural heart diseases and no evidence of ventricular arrhythmias and 80 subjects with no evidence of heart disease have been studied. SAECG was performed in all patients with the following parameters: duration of the filtered QRS, RMS 40 and LAS40 in TD and the mean and the standard deviation of both signal energy intersegmentar spectral correlation and energy frequency edge track in FD. RESULTS: The sensitivity(S) and positive predict value (PPV) of the SAECG in TD, in FD and combined analysis of both domains were: S = 59.3%, 63.0%, 81.5% and PPV = 80.0%, 81.0%, 84.6%, respectively. CONCLUSION: The combined analysis of SAECG in TD and in FD improves the diagnostic accuracy in patients with S sustained MVT.

Adult↗
PubMed1998

[Significance of alcohol abstinence in alcoholic cardiomyopathy with moderate left ventricular dysfunction].

PURPOSE: To evaluate the role of a 12 month alcohol abstinence period in patients with moderate left ventricular dysfunction treated with anticongestive therapy. METHODS: Prospective observational study with 20 patients with alcoholic cardiomyopathy (ACM), 9 (45%) in functional class (FC) II and 11 (55%) in FC III, 16 (80%) men, mostly black (55%), from 35 to 56 (x = 45) years old, heavy alcohol users (> 80 g ethanol for 51 to 112 (x = 88) months. At the beginning, all agreed to participate with psychotherapy and clinical evaluation. After 12 months, they were divided in G-I, formed by those who remained abstemious and G-II of non-abstemious. RESULTS: After 12 months, among the 11 (55%) who remained in psychotherapy, 8 were in G-I, among those who did not 9 (45%), only 2 (22.22%) remained abstemious (G-I). At the end of the evaluation period, both groups had the same number of patients. Comparing them, we observed: a) lower mean systolic and diastolic left ventricular diameters in G-I; b) more hospitalizations in G-II (3); c) more patients with stable or better clinical evaluation in G-I. CONCLUSION: Despite the initial will, only 50% reached abstinence. When it was reached, patients had a better evolution in left ventricular systolic diameter and abstinence should always be tried even in the presence of moderate left ventricular dysfunction.

Adult↗
PubMed1998

[Meningococcemia complicated by myocarditis].

We report a case of a 26-year old man with meningococcemia complicated with myocarditis (ventricular dysfunction and myocardial ischemia), that required treatment for heart failure. Regression of myocardial dysfunction was observed six months after the infection.

Adult↗
PubMed1998

[Apical hypertrophic cardiomyopathy associated with coronary artery disease].

A fifty-nine year old man, known to have hypertrophic cardiomyopathy, presented worsening of angina. Multivessel coronary artery disease was diagnosed, and he underwent myocardial revascularization (mammary and two safenous grafts were implanted) with good evolution and reduction of left atrium dimension.

Arterial Occlusive Diseases↗
PubMed1997

[Infective endocarditis in adolescents. Analysis of risk factors for hospital mortality].

PURPOSE: To study the epidemiological, clinical, therapeutic and evolutive aspects of endocarditis in a group of patients aging 12 to 20 years-old (mean 15.5). METHODS: Thirty-three consecutive patients (14 males, 19 females) admitted with infective endocarditis were retrospectively studied. RESULTS: Infective endocarditis mortality was 42%. Rheumatic heart disease was the predominant underlying condition in 63% of patients. Congenital heart disease (24%) and cardiac prosthesis (12%) were the other affections involved. The majority of patients (78%) were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p = 0.01). Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%). Multivariate analysis identified total leukocyte count above 10,000/mm3 and functional class, both at admission (p = 0.01 and p = 0.004, respectively), and the occurrence of embolic complications (p = 0.03) as independent predictors of in-hospital mortality. CONCLUSION: Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S. aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

Adolescent↗
PubMed1997

[Evaluation of a cardiac rehabilitation program. Analysis after ten years of follow-up].

PURPOSE: To study the benefits of the cardiac rehabilitation program (CRP) in patients with coronary artery disease (CAD). METHODS: Between 1986 and 1995 we studied 49 patients with CAD, participants of the CRP, 45 (91.83%) of them men. They were compared with a control group of 37 sedentary patients, 33 (89.18%) men. The main parameters analyzed were the duration of exercise, the maximal oxygen consumption (VO2 max), the metabolic equivalent (MET), the functional aerobic impairment (FAI) and the change in the classification of the cardiorespiratory capacity between two graded exercise tests (GTX). RESULTS: There were improvements in all parameters of the GTX analyzed in the two groups. The patients of the CRP presented a better functional capacity than the sedentary patients and, in relation to the duration of exercise, to the VO2 max and to the MET, the differences in the two groups achieved statistical significance (p < 0.05). We did not observe benefits, in relation to the physical conditioning, with a more prolonged permanence of the patients in the program (more than 24 months). There were no cardiovascular complications with the practice of the exercise in the period analyzed. CONCLUSION: The improvement in the duration of exercise, in the VO2 max and in the MET, the more negative variation in the FAI and the improvement in the classification of the cardiorespiratory capacity between the two GTX of the patients of the CRP demonstrate improvement in functional capacity significantly better than sedentary patients. The CRP analyzed was considered a therapeutic method safe and efficient after a coronary event.

Adult↗
PubMed1997

[Apical hypertrophic cardiomyopathy with right ventricular involvement].

We report right ventricular involvement in apical hypertrophic cardiomyopathy (HCMP) in two women and one man, aged from 19 to 44 years-old, who presented different signs from those with left ventricular disease (who have good clinical evolution), with signs and symptoms of severe diastolic restriction, showing great atrial enlargement and two with atrial fibrillation and death due to thromboembolism. The right ventricular involvement in apical HCMP leads to a worst prognosis than isolated left ventricular disease, does not have the typical electrocardiographic changes and presents with ventricular restriction and tricuspid regurgitation.

Adult↗
PubMed1997

[Depressed electrical atrial activity in hypertrophic and dilated cardiomyopathies. An electrocardiographic, vectorcardiographic and echocardiographic study].

PURPOSE: To evaluate the "normal" or low-voltage P wave of the 12-leads conventional electrocardiogram (ECG), in patients with serious electric ventricular disturbances in hypertrophic (HC) and dilated (DC) cardiomyopathies. METHODS: Twenty cases of cardiomyopathies, 11 HC and 9 DC, ages ranging from 23 to 73 (x = 41) years have been studied. The analysis of the P wave was performed with ECG, amplified ECG at 1 mv = 20 mm and speed-paper at 50 mm/sec (ECG2), and the Frank-system vector-cardiogram (VCG). Voltage, delays and shapes of the P wave were evaluated by ECG2 and amplified VCG with gain at 1 mv = 160 mm. All electrical data were correlated with dimension of the left atrium (LA), dimension of left ventricular diastolic diameter (LVDD), dimension of left ventricular systolic diameter (LVSD), interventricular septal thickness (IST), posterior wall thickness ((PWT) and ejection fraction (EF) of the left ventricle of bidimensional echocardiogram (ECHO). RESULTS: Changes in morphologies and delays on the the P wave were best observed only on ECG2 and VCG. The mean voltage of P wave on ECG was 0.1 mv and the mean duration of the P loop on VCG was 133.7 msec in HC and 145.2 msec in DC, with mean terminal delay of 49.2 msec and 46.8 msec, respectively, due to slow atrial depolarization. CONCLUSION: In HC and DC with severe electric ventricular changes, the low-voltage and increased duration of P wave, are attributed to intraatrial-block due to structural changes of the atrial myocardium.

Adult↗
PubMed1997

[Is the apical hypertrophic cardiomyopathy seen in one population in Rio de Janeiro city similar to that found in the East?].

PURPOSE: To investigate the differences between clinical aspects and evolution of apical hypertrophic cardiomyopathy (AHCM) seen in Rio de Janeiro and the Oriental form, which was the first described. METHODS: In 156 patients with AHCM diagnosed in our institution, there were 13 (8.34%) with the apical form of the disease, whose clinical settings, diagnostic procedures and evolution were studied. RESULTS: There were 8 males and 5 females, between 19 and 75 years old, all white. Electrocardiogram (EKG) showed giant T waves in precordial leads in 10 (76.92%), echocardiogram (ECHO) demonstrated apical hypertrophy in all, 10 (76.92%) had only in the left ventricle, 2 in right ventricle and one involving both. Cineangiography corroborated ECHO findings. Follow-up ranged from 6 to 294 months (x = 95.4). Two deaths occurred in patients with RV involvement, due to large atria, atrial fibrillation, tricuspid or mitral insufficiency and thromboembolism. Among the survivors, the patient with RV disease has diastolic restriction and the ones with LV involvement, 9 are asymptomatic using either propranolol (8) or amiodarone (1), and one uses no medication. CONCLUSION: A HCM seen in Rio de Janeiro is similar to that found in the Orient (Japan) regarding presentation, diagnosis and evolution; but in 3 patients we have found RV disease, not described in Japan, characterizing a distinct group with a worse evolution.

Adolescent↗
PubMed1997

[Obstructive ischemic involvement of the anterior descending coronary artery in asymmetrical septal form of hypertrophic cardiomyopathy].

PURPOSE: The significance of necrosis and fibrosis of the interventricular septum in hypertrophic cardiomyopathy (HCM) is controversial. The purpose of this study was then to evaluate the clinical impact of left anterior descending artery (LAD) disease in HCM. METHODS: Among 158 patients presenting with HCM, 6 (3.79%) had LAD disease. Mean age was 65.16 years (52 to 70), 4 were men and 4 had the obstructive form of HCM. All patients were submitted to complete clinical and laboratory evaluation. Mean time of the diagnosis was 141 months (ranging from 78 to 182) for HCM and 42 months (ranging from one day to 106 months) for LAD disease. RESULTS: Five patients had unstable angina and one had myocardial infarction. LAD disease (60 to 100% coronary narrowing) was present in all patients; one patient had single vessel disease and 5 multivessel disease. During follow-up, 3 patients had coronary artery bypass grafting (CABG), one with associated septal myectomy; one was submitted to coronary angioplasty and 2 were submitted to medical treatment. During a follow-up period ranging from 76 to 124 months after LAD disease diagnosis, one patient died. At the end of the study, a reduction of the thickness of the interventricular septum from 1.53 to 1.40 cm was observed and left ventricular outflow pressure gradient decreased from 56 to 16 mmHg. Left ventricular diastolic diameter increased from 4.55 to 4.85 cm and systolic diameter from 2.83 to 3.13 cm. Left atrium diameter was unchanged. CONCLUSION: LAD disease is well tolerated in the asymmetrical form of HCM and may contribute to septal fibrosis, improving cardiac function. It does not represent an adverse factor in the evolution of HCM.

Aged↗
PubMed1996

[Coronary fistula associated with severe pulmonary stenosis and cianosis].

A 17 year old male adolescent was admitted to the hospital due to dyspnea and cyanosis, since the age of 6 years. On physical examination, it was found a continuous murmur over the left esternal border at the 4th and 5th intercostal spaces suggesting a coronary fistula. A color-echocardiogram associated with an angiography confirmed the diagnosis of coronary fistula and severe pulmonary stenosis. The functional consequence was a right to left shunt with cyanosis. A surgical repair was performed with closure of the fistula at the point where it drained into the right ventricle plus a pulmonary commissurotomy. The patient had an uneventful recovery.

Adolescent↗
PubMed1995

Role of anthropometric indexes and blood pressure as determinants of left ventricular mass and geometry in adolescents. The Rio de Janeiro Study.

To evaluate left ventricular structural changes and their relationship to blood pressure and anthropometric indexes, we examined by echocardiography 108 adolescents aged 13 to 19 years. Subjects were divided into three groups according to blood pressure tracking during three moments of observation: group 1 (n = 27), > or = 95th percentile; group 2 (n = 37), < or = 50th percentile; and group 3 (n = 44), blood pressure not stable in the original percentile. Left ventricular mass index and the prevalence of altered left ventricular geometry were greater in group 1 (P < .05 and P < .02, respectively). Of all the anthropometric indexes, body surface area showed the best correlation with left ventricular mass (P < .00001). Left ventricular mass also correlated with systolic and diastolic pressures (P < .00001 and P < .003, respectively). Ventricular septal and posterior wall thicknesses and left ventricular diastolic diameter showed good correlations with body surface area (P < .00001). These variables also correlated with systolic pressure (P < .001). In a multiple regression model when body surface area was controlled, systolic pressure did not correlate significantly with left ventricular mass. In a similar model systolic pressure maintained a significant correlation with ventricular septal and posterior wall (P < .00001) thicknesses but not with left ventricular diastolic diameter (P > .05). We conclude that left ventricular structural changes can occur early after initial abnormalities of blood pressure. Considering that body surface area and systolic pressure were the best predictors of left ventricular alterations in adolescents, the usual way of correcting left ventricular mass by body surface area should be reviewed.

Adolescent↗
PubMed1995

[Echocardiography in the evaluation of cardiac involvement in seronegative spondylo-arthropathies].

To evaluate the involvement of the heart in patients with seronegative spondyloarthropathies by echodopplercardiography, 35 patients including 20 with ankylosing spondylitis, 10 with Reiter's syndrome and 5 with psoriatic arthritis (21 men and 14 women, with ages ranging from 17-68 years and averaging 38.5) were studied. Most were asymptomatic with respect to the cardiovascular system (65.71%) and 12 oligosymptomatic with palpitations as their main complaint. Each patient had an echocardiogram and electrocardiogram. A two-dimensional echocardiogram demonstrated alterations in 19 patients (54.29%), 28.58% asymptomatic and 25.71% symptomatic. This study revealed most of lesions (17/19-84.47%) followed by the Dopplerechocardiography (10/19-52.63%) and the one-dimensional echocardiography (9/19-47.36%). Abnormal aortic valves were found in 10 patients, in 7 thickenning and in 3 calcifications. The mitral valve was involved in 11 patients, in 8 thickenning, in 1 calcification and in 2 valve prolapse. In ankylosing spondylitis aortic valve disease was found in 8 patients. Dopplerechocardiography evidenced the presence of aortic regurgitation in 4 patients and mitral insufficiency in 3. The Q-T interval was increased in 19 patients, there was one first degree auriculoventricular block, one right branch block and one sinus bradicardia. Thus the echocardiogram is an excellent noninvasive method to disclose cardiac disturbances in patients with seronegative spondyloarthropaties.

Adolescent↗