Yes / Digital image processing used in modern cardiac interventional x-ray systems may have the potential to enhance image quality such that it allows for lower radiation doses. The aim of this research was to quantify the reduction in radiation dose facilitated by image processing alone for percutaneous coronary intervention (PCI) patient angiograms, without reducing the perceived image quality required to confidently make a diagnosis. Incremental amounts of image noise were added to five PCI patient angiograms, simulating the angiogram having been acquired at corresponding lower dose levels (by 10-89% dose reduction). Sixteen observers with relevant and experience scored the image quality of these angiograms in three states - with no image processing and with two different modern image processing algorithms applied; these algorithms are used on state-of-the-art and previous generation cardiac interventional x-ray systems. Ordinal regression allowing for random effects and the delta method were used to quantify the dose reduction allowed for by the processing algorithms, for equivalent image quality scores. The dose reductions [with 95% confidence interval] from the state-of-the-art and previous generation image processing relative to no processing were 24.9% [18.8- 31.0%] and 15.6% [9.4-21.9%] respectively. The dose reduction enabled by the state-of-the-art image processing relative to previous generation processing was 10.3% [4.4-16.2%]. This demonstrates that statistically significant dose reduction can be facilitated with no loss in perceived image quality using modern image enhancement; the most recent processing algorithm was more effective in preserving image quality at lower doses. / Philips Healthcare (the Netherlands).

A insuficiência cardíaca congestiva (ICC) é uma condição em que o coração não consegue bombear o sangue de acordo com as necessidades metabólicas dos tecidos. Quando a ICC entra em seu estágio final, já refratária ao tratamento medicamentoso, ou outras opções terapêuticas, o transplante cardíaco constitui-se em medida salvadora destes pacientes. Após o primeiro ano de evolução do procedimento, a doença vascular do enxerto (DVE) é a complicação mais temida nestes pacientes. Esta doença caracteriza-se por aterosclerose acelerada, com acometimento concêntrico do vaso, predominando nos terços médios e distais. Sintomas isquêmicos geralmente não estão presentes devido ao coração denervado destes pacientes. Daí a importância em se ter um método com boa acurácia e que possibilite o diagnóstico da DVE em seus estágios iniciais, que, muitas vezes, não é demonstrado pela cineangiocoronariografia (CINE). O nosso trabalho teve como objetivo avaliar se o diagnóstico da DVE pela tomografia computadorizada por múltiplos detectores (TCMD) foi preditor de eventos maiores, definimos como: morte súbita, infarto, angioplastia, queda da fração de ejeção e retransplante. Em nossa amostra, selecionamos 59 pacientes transplantados que tinham sido submetidos à TCMD por indicação clínica. Encontramos idade média de 49 anos ± 11,36 anos e tempo médio de transplante na realização da TCMD de 82,67 ± 36,38 meses. A prevalência de hipertensão (HAS) foi de 59,32%, dislipidemia (DLP) 57,63% e diabetes mellitus (DM) 33,90%. Em relação à etilogia da ICC dos receptores, em primeiro lugar, tivemos doença isquêmica com 38,98%, seguida por doença chagásica com 33,90% e por miocardiopatia dilatada idiopática com 13,56% da amostra. Desta população, um subgrupo de 41 pacientes, além de ter feito a TCMD, fez também a CINE. A comparação dos dois métodos mostrou sensibilidade de 100%, especificidade de 77,27%, valor preditivo positivo (VPP) de 46,34% e valor preditivo negativo (VPN) de 100%. Os resultados mostraram que a presença de DVE pela tomografia foi preditora de eventos maiores no seguimento destes pacientes com significância estatística p 0,001. Outras variáveis analisadas que também tiveram impacto significativo foram escore de cálcio positivo (p< 0,05), piora da classe funcional na evolução para classe II e III, e os receptores que tinham o diagnóstico prévio de miocardiopatia dilatada. Concluímos que a TCMD é um exame que tem boa acurácia diagnóstica na DVE, podendo a CINE ficar restrita aos casos duvidosos. Além disso, alterações deste exame são preditoras de eventos adversos. O escore de cálcio e a piora da classe funcional também foram preditores de eventos. / Congestive heart failure (CHD) is a condition characterized by the heart inot meeting the body oxygen demands. For end-stage CHD, refractory to medical treatment, heart transplant is a lifesaver treatment, but its late results may suffer a negative impact if there is allograft vasculopathy, the main reason of late adverse outcome in this population. This condition is is characterized by accelarated atherosclerosis with concentric disease predominant at the mid and distal segments of the coronary arteries. Ischemic symptoms seldom happen for the heart is denervated, and thus, it would be highly desirable to possess a test that could accuratelly foretell the presence of such abnormality. Furthermore, a possible gold standard, invasive coronary angiography (ICA) has been show to lack sensivity. The aim of this study was to evaluate if multidetector computed tomography( MDCT) could identify and thus to predict patients at higher risk of presenting late adverse events. Major events were considered as: sudden cardiac death (SCD), Hear attack, angioplasty, left ventricle impairment and retransplant. Consulting medical records we selected 59 heart transplant patients that underwent MDCT at least 7 years by clinical discretion. Mean age at the time of the exam was 49 ± 11.36 years. Mean post heart transplantantion time was 82.67 ± 36.38 months. Hypertension (HAS) prevalence was 59,32%, hyperlipidemia 57,63% and diabetes was 33,90%. Main pre-transplant CHD cause was ischemic heart disease in 38,98%, followed by Chaga\'s disease, 33.90% and idiopathic dilated cardiomyoapthy. We had 41 patients that also underwent ICA. Comparing both methods we found that MDCT had a sensibility of 100%, a specificity of 77,27%, a positive preditive value of 46,34% and a negative preditive value of 100%. The diagnosis of CAV done by MDCT was a predictor of major events at the follow-up (p=0,001). Other predictors that achieved statistical significance were positive calcium score (p<0,05), class functional (p<0,001) and dilated cardimyopathy dilated as the CHD cause (p=0,027). So we conclude that MDCT has a good accuracy on the diagnosis of CAV, and is a predictor of adverse events. Higher than zero calcium score, lower functional class and dilated cardiomyopathy also related to patient\'s follow-up.

Fundamentos: Este estudo tem o objetivo de comparar os resultados clínicos e angiográficos de pacientes com infarto agudo do miocárdio(IAM) tratados com implante de stent revestido com paclitaxel (SRP) versus stent convencional. Métodos e população do estudo: Um grupo de 30 pacientes com infarto agudo do miocárdio foi tratados com stent revestido com paclitaxel (TaxusTM). Um grupo controle com 30 pacientes foi tratado com stent convencional (Express2 TM).Resultados: Aos 6,9±1,2 meses, não ocorreu morte, reinfarto ou trombose intra-stent. Entretanto, pacientes tratados com stent farmacológico tiveram um risco menor de reintervenção (3.3%% vs. 33.3%; p=0.006). A perda luminal tardia foi de 0.2±0.2 mm no grupo de SRP vs. 0.6±0.6 mm (p=0.03) no controle e a reestenose binária foi de 3.3% (RVP)vs. 33.3%(controle) (p=0.006). O percentual médio de obstrução neointimal em pacientes do grupo farmacológico foi de 4,7%±6,8%. Conclusões: O SRP se mostrou seguro e efetivo aos 7 meses em pacientes com IAM / This study aimed to compare the clinical and angiographic outcomes of patients with acute myocardial infarction (AMI) treated with paclitaxel eluting stent (PES) versus conventional stent implantation. Methods and Study Population: A group of 30 patients admitted with AMI was treated with PES (TaxusTM). A control group comprised 30 patients with a similar bare stent (Express IITM). Results: Baseline and procedural characteristics were similar between the PES and control groups. At 6.9±1.2 months, there were no deaths, re-AMI, or stent thrombosis. However, patients treated with PES had a lower risk of repeat revascularization (3.3%% vs. 33.3%; p=0.006). The angiographic late loss was 0.2±0.2 mm vs. 0.6±0.6 mm (p=0.03) and the binary restenosis rate was 3.3% vs. 33.3% (p=0.006) in the PES vs. controls respectively. The average percent neointimal obstruction in patients treated with PES was 4.7±6.8 %. Conclusions: PES appeared safe and effective at 7 months in patients AMI

Bakgrund: Kranskärlssjukdom (CAD) är en hjärtsjukdom som kan diagnostiseras med icke-invasiva metoder, såsom myocardial perfusion imaging med single-photon emission computed tomography (SPECT), och genom invasiva metoder, såsom invasiv koronarangiografi (ICA). ICA är den golden standardmetod för att diagnostisera CAD. Men å andra sidan är ICA mer kostsam än SPECT och kan orsaka många komplikationer. Metoder och resultat: det är en retrospektiv kohortstudie. Studien analyserade 62 patienter som har genomgått både SPECT och ICA under 2018 vid Universitetssjukhuset Örebro (USÖ). Av dessa 62 utförde 56 patienter SPECT först. Analyseringen gjordes för att undersöka hur väl resultatet av ICA-sjukdomsdetektering och lokalisering kunde bestämmas av SPECT. Aktiv CAD definierades som närvaron av en behandling-krävande signifikant stenos vid ICA. SPECT-resultaten visade att 91% av fallen var patologiska och 9% var icke-patologiska. Sensitivitet, specificitet och noggrannhet för SPECT för detektering av aktiv CAD var 89%, 7% respektive 47% vid referens till ICA. Medan positiva prediktiva värden (PV +) och negativa prediktiva värden (PV-) var 48% respektive 40%. SPECT sensitivitet för lokalisering av defekter i referens till ICA var 35% för LAD-defekter, 68% för LCX-defekter och 92% för RCA-defekter. Slutsats: Resultatet skilde sig från den ursprungliga hypotesen. SPECT anses fortfarande vara effektiv för att identifiera patienter med aktiv CAD. Därför kan SPECT användas som initial undersökningsmetod för utvärdering av CAD hos patienter med låg till måttlig risk. SPECT var inte optimalt för att lokalisera defekterna.

<p>In unstable coronary artery disease (CAD) it still is a matter of debate which patients should undergo early revascularisation. In the FRISC II study (n=2457) an early invasive strategy was, compared to a primarily non-invasive strategy, associated with reduced mortality and myocardial infarction (MI) rates. However, in this heterogeneous group of patients, tools for an appropriate selection to revascularisation are needed.</p><p>From the FRISC II study we evaluated the prognosis, the angiographic extent of CAD and the effects of an early invasive strategy in relation to risk variables on admission.</p><p>The occurrence of ST depression and/or elevated levels of Troponin T were associated with a higher risk for death and MI, more severe CAD and also with a reduction of death or MI by the early invasive strategy.</p><p>Elevated levels of the inflammatory markers C-reactive protein (CRP) and interleukin-6 (Il-6) were associated with a higher mortality but an unchanged MI rate. Elevated levels of Il-6, but not CRP, identified patients with a large reduction of mortality by the invasive strategy.</p><p>Age ≥ 70 years, male gender, diabetes, previous MI, ST depression and elevated levels of troponin and markers of inflammation were independently associated with an adverse outcome. The FRISC-score was constructed using these 7 variables. At FRISC-score ≥ 5 an early invasive strategy markedly reduced mortality and MI, at FRISC–score 3-4 death/MI was reduced, whereas in patients with a FRISC-score 0-2 neither mortality nor death/MI was influenced.</p><p>In unstable CAD, a non-invasive strategy seems justified only for patients at low risk, i.e. FRISC score < 2. In patients with intermediate and high risk, i.e. FRISC-score ≥ 3, an early invasive strategy is recommended.</p>

In unstable coronary artery disease (CAD) it still is a matter of debate which patients should undergo early revascularisation. In the FRISC II study (n=2457) an early invasive strategy was, compared to a primarily non-invasive strategy, associated with reduced mortality and myocardial infarction (MI) rates. However, in this heterogeneous group of patients, tools for an appropriate selection to revascularisation are needed. From the FRISC II study we evaluated the prognosis, the angiographic extent of CAD and the effects of an early invasive strategy in relation to risk variables on admission. The occurrence of ST depression and/or elevated levels of Troponin T were associated with a higher risk for death and MI, more severe CAD and also with a reduction of death or MI by the early invasive strategy. Elevated levels of the inflammatory markers C-reactive protein (CRP) and interleukin-6 (Il-6) were associated with a higher mortality but an unchanged MI rate. Elevated levels of Il-6, but not CRP, identified patients with a large reduction of mortality by the invasive strategy. Age ≥ 70 years, male gender, diabetes, previous MI, ST depression and elevated levels of troponin and markers of inflammation were independently associated with an adverse outcome. The FRISC-score was constructed using these 7 variables. At FRISC-score ≥ 5 an early invasive strategy markedly reduced mortality and MI, at FRISC–score 3-4 death/MI was reduced, whereas in patients with a FRISC-score 0-2 neither mortality nor death/MI was influenced. In unstable CAD, a non-invasive strategy seems justified only for patients at low risk, i.e. FRISC score &lt; 2. In patients with intermediate and high risk, i.e. FRISC-score ≥ 3, an early invasive strategy is recommended.

Lipoprotein(a) (Lp(a)) consists of an LDL-like particle and the specific protein apo(a), which is very similar to plasminogen. Apo(a) contains repeated kringle structures and a serine protease domain, which cannot be activated by t-PA. Lp(a) is considered to be a predictor for atherosclerotic disease. It has been found incorporated in atherosclerotic plaques and inhibits in vitro fibrinolysis. Lp(a) was determined in 1527 randomly selected individuals participating in the Northern Sweden WHO-MONICA project. A weak but significant relation between Lp(a) and increasing age was found. Menopausal status was the strongest independent predictor of Lp(a) level in women. Fibrinogen was independently related to Lp(a) in both sexes. Only a minor fraction of Lp(a) variance could be explained for in a multiple regression model, which is in agreement with the contention that Lp(a) is highly genetically determined. Lp(a) was determined in 1571 patients investigated with coronary angiography because of suspected severe coronary artery disease (CAD). Patients with proven CAD at elective angiography had significantly higher Lp(a) than patients without significant CAD or healthy controls. Lp(a) was found to be an independent discriminator of CAD in both sexes. HLA-DR genotype 13 or 17 was found more frequently in 30 male patients with angiographic CAD at young age (&lt; 50 years) than in 30 age matched controls. These genotypes were common in patients with high Lp(a) levels, which indicates that Lp(a) may be related to immunological processes. The reaction of Lp(a) was investigated in 32 patients with acute myocardial infarction (AMI). Lp(a) increased during the first week, but the response was comparatively weak. Individual Lp(a) responses were heterogeneous and no correlations to infarct size or changes in the acute phase proteins were found. In a randomized cross-over study on 36 hypercholesterolaemic patients treated with simvastatin/placebo during 12+12 weeks Lp(a) did not change significantly, but patients with high Lp(a) levels at baseline tended to develop further increased Lp(a). To conclude, Lp(a) was found to be an independent predictor of angiographic CAD in both men and women. Lp(a) levels are primarily genetically determined and only a small fraction of Lp(a) variance could be explained by other factors in this study. Lp(a) may be related to HLA DR types and immunological processes involved in atherosclerotic disease. Lp(a) increased slightly during the first week of AMI, but was not related to changes in the acute-phase proteins. The effective LDL-lowering agent simvastatin did not influence Lp(a) significantly. / <p>Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 5 uppsatser.</p> / digitalisering@umu

Periodontite crônica e perda dentária tornaram-se ferramentas úteis para estudar a hipótese de que a infecção/inflamação aumenta o risco de doenças cardiovasculares. Tem se demonstrado que a periodontite e suas consequências (perdas dentárias) têm o poder de elevar os marcadores inflamatórios sistêmicos, incluindo a proteína C-reativa, a qual é uma proteína aguda plasmática que é reconhecida como um preditor de infarto e se encontra aumentada em infecções. Com base no entendimento que o processo inflamatório sistêmico é o fator ligante entre as duas condições, o objetivo deste estudo foi analisar a associação entre edentulismo, perda dentária e parâmetros clínicos de periodontite crônica com inflamação sistêmica medida através de níveis de proteína C-reativa. Este estudo transversal controlado faz parte de um macro-projeto do Instituto de Cardiologia do Rio Grande do Sul que num estudo tipo consórcio incluiu 130 pacientes que receberam indicação para realizar cineangiocoronariografia. Os pacientes selecionados foram examinados entre dezembro de 2016 e outubro de 2017 e passaram por exame periodontal completo constando de índice de placa visível (IPV), sangramento à sondagem (SS), perda de inserção (PI), profundidade de sondagem (PS) em todos os dentes presentes nos seis sítios e também coletado o número de dentes perdidos e coleta de exames sanguíneos. A amostra foi dividida em 2 grupos: edêntulos (24,6%) e dentados (75,3%), sendo que maioria era homens (67,7%), com idade média de 63,30(±10,7) brancos (80%), com educação fundamental (70%), sedentários (62%), diabéticos (52%), hipertensos (74%) e com pelo menos um evento cardiovascular anterior (52%). As médias ± desvio-padrão de PS foram de 3,36±1,25; para PIos valores foram de 5,42±1,85; IPV médio de 0,39±0,25; e SS médio de 0,34±0,23, com uma média de 13,44±7,95 dentes. No modelo de regressão logística observou-se o efeito independente da perda dentária após ajustada para fumo e sexo. Conclui-se que a perda dentária está associada a incremento do risco cardíaco medido por inflamação sistêmica. / Chronic periodontitis and tooth loss have become useful tools for studying the hypothesis that infection/inflammation increases the risk of cardiovascular disease. It has been shown that periodontitis and its consequences (tooth loss) have the power to elevate systemic inflammatory markers; one of these markers is C-reactive protein is an acute plasma protein that is recognized as a predictor of myocardial infarction and is increased in infections. Based on the understanding that the systemic inflammatory process is the linking factor between the two conditions the objective of this study was to analyze the association between edentulism, tooth loss and clinical parameters of chronic periodontitis with systemic inflammation measured through C-reactive protein levels. This controlled cross-sectional study is part of a macro-project of the Instituto de Cardiologia do Rio Grande do Sul, which in a consortium-type study included 130 patients who were indicated to perform coronary angiography. The selected patients were examined between December 2016 and October 2017 and underwent complete periodontal examination consisting of visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), in six sites per tooth of all teeth present in addition to blood tests. The sample was divided into 2 groups: edentulous (24,6%) and dentate (75,3%)individuals. The majority were men (67.7%), with mean age of 63.30 (± 10.7) whites (80%), hypertensive (74%) and with at least one previous cardiovascular event (52%). The means and standard deviation of PD were 3.36 ±1.25; for CAL mean values of 5.42 ±1,85; Mean VPI was of 0.39 ± 0.25; and BOP presented 0.34 ± 0.23 as mean, with a mean of 13.44 ± 7.95 teeth present. In logistic regression model, we observed the independent effect of tooth loss after adjustment for smoking and sex. It is concluded that tooth loss is associated with increased cardiac risk as measured by systemic inflammation.

Submitted by EMERSON DE ALBUQUERQUE SEIXAS null (emersondas@cardiol.br) on 2017-01-22T14:38:17Z No. of bitstreams: 1 Tese Doutorado apresentação final 17 Janeiro 2017 para repositório em PDF.pdf: 2272650 bytes, checksum: b1d116841eb237b23afc4bf970606f37 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2017-01-25T16:50:55Z (GMT) No. of bitstreams: 1 seixas_ea_dr_bot.pdf: 2272650 bytes, checksum: b1d116841eb237b23afc4bf970606f37 (MD5) / Made available in DSpace on 2017-01-25T16:50:55Z (GMT). No. of bitstreams: 1 seixas_ea_dr_bot.pdf: 2272650 bytes, checksum: b1d116841eb237b23afc4bf970606f37 (MD5) Previous issue date: 2016-12-09 / Introdução: as doenças cardiovasculares representam a maior causa de mortalidade nos pacientes renais crônicos antes e após o transplante renal, dentre elas a doença coronariana apresenta destaque especial. Preditores de risco tem sido usados no seu diagnóstico que é desafiador. Poucos trabalhos validaram preditores clínicos de seleção para exames invasivos para o diagnóstico de doença arterial coronariana (DAC) antes do transplante renal. Objetivo: avaliar a frequência e poder discriminatório de preditores clínicos da presença da doença arterial coronariana em pacientes renais crônicos em programa de diálise candidatos ao transplante renal, avaliar a performance da fórmula de Gowdak e colaboradores de risco de doença arterial coronariana e verificar a associação entre doença arterial coronariana e desfechos no grupo estudado. Métodos: foram analisadas as cinecoronariografias de candidatos ao transplante renal de dois centros de transplante renal do estado de São Paulo, realizadas entre março de 2008 e abril de 2013. Foi realizado estudo transversal para verificar o poder preditivo de parâmetros clínicos para a presença de doença coronária significativa (estenose ≥70% em uma ou mais artérias epicárdicas ou ≥ 50% no tronco da coronária esquerda). Adicionalmente, verificou-se o poder discriminatório de um escore clínico de risco previamente estabelecido (que leva em conta presença de diabetes melito (DM), idade e manifestações clínicas de doença cardiovascular). Foi realizado também estudo longitudinal observacional e traçaram-se curvas de sobrevida de acordo com o diagnóstico angiográfico para verificar a associação entre a presença de doença coronária e desfechos. Resultados: foram rastreados 128 pacientes, dos quais, 23 foram excluídos. A prevalência de ateromatose coronária de qualquer grau foi de 60/105 (57%) e ateromatose coronária significativa foi de 30/105 (29%) no total da casuística. Os 105 pacientes restantes realizaram coronariografia, dois foram excluídos por falha de registro dos desfechos, portanto 103 foram incluídos em análise longitudinal. Dos 105 pacientes, em seis, a análise dos dados clínicos se mostrou incompleta. Estes foram excluídos do estudo transversal que foi realizado com 99 pacientes. Análise de regressão logística univariada identificou presença de DM, angina e/ou infarto prévio, clínica de doença arterial periférica e dislipidemia como preditores de DAC. Regressão logística múltipla identificou apenas diabetes e angina e/ou infarto prévio como preditores independentes. O escore clínico previamente desenvolvido apresentou associação estreita com o diagnóstico de DAC, o que valida seu uso nos pacientes estudados. A mortalidade foi menor do que à esperada entre os pacientes em diálise. A presença de DAC foi associada à ocorrência de eventos cardiovasculares, porém não se associou à mortalidade. Conclusão: a DAC foi frequente em pacientes renais crônicos em programa de diálise candidatos ao transplante renal, pode ser identificada por dados clínicos e sua identificação por angiografia pode prever evento cardiovascular. / Introduction: cardiovascular diseases are major causes of mortality in chronic renal failure patients before and after renal transplantation. Among them, coronary disease presents a special emphasis. Predictors of risk for coronary artery disease has been used for its diagnosis. Few studies have validated clinical predictors to selection patients for invasive procedures for the diagnosis of coronary artery disease (CAD) before renal transplantation. Objective: this study evaluated the frequency and discriminatory power of clinical predictors of coronary artery disease in chronic renal failure patients undergoing dialysis who were renal transplant candidates, assessed a previously developed scoring system (Gowdak et al.) for coronary artery disease, and we also checked the association between coronary artery disease and outcomes of the study group. Methods: coronary angiographies conducted between March 2008 and April 2013 from candidates for renal transplantation from two transplant centers in São Paulo state were analyzed. Cross-sectional study was conducted to verify the predictive power of clinical parameters for the presence of significant coronary artery disease (≥70% stenosis in one or more epicardial artery or ≥ 50% in the left main coronary artery). In addition, the discriminating power of a previously established clinical risk score was assessed (which takes account of diabetes mellitus (DM), age and clinical manifestations of cardiovascular disease). It was also conducted observational longitudinal study and drew up survival curves according to the angiographic diagnosis to verify the association between the presence of coronary heart disease and outcomes. Results: we screened 128 patients, of which 23 were excluded. The prevalence of coronary atheromatosis of any grade was 60/105 (57%) and significant coronary atheromatosis was 30/105 (29%) in the total sample. The remaining 105 patients underwent coronary angiography, two were excluded because of recording outcomes failures, so 103 were included in the longitudinal analysis. Of the 105 patients, in six, the analysis of clinical data showed incomplete. These were excluded from the cross-sectional study that was conducted with 99 patients. Univariate logistic regression analysis identified the presence of DM, angina and / or previous infarction, clinical peripheral artery disease and hyperlipidemia as predictors of CAD. Multiple logistic regression identified only diabetes and angina and / or previous infarction as independent predictors. The previously developed scoring system showed a close association with the diagnosis of CAD, which validates its use in the patients studied. Mortality was lower than expected among patients on dialysis. The presence of CAD was associated with cardiovascular events and was not a predictor of mortality. Conclusion: the CAD was frequent in renal failure patients on dialysis candidates to kidney transplantation, can be identified by clinical data and identification by angiography can predict cardiovascular events.

Periodontite crônica e perda dentária tornaram-se ferramentas úteis para estudar a hipótese de que a infecção/inflamação aumenta o risco de doenças cardiovasculares. Tem se demonstrado que a periodontite e suas consequências (perdas dentárias) têm o poder de elevar os marcadores inflamatórios sistêmicos, incluindo a proteína C-reativa, a qual é uma proteína aguda plasmática que é reconhecida como um preditor de infarto e se encontra aumentada em infecções. Com base no entendimento que o processo inflamatório sistêmico é o fator ligante entre as duas condições, o objetivo deste estudo foi analisar a associação entre edentulismo, perda dentária e parâmetros clínicos de periodontite crônica com inflamação sistêmica medida através de níveis de proteína C-reativa. Este estudo transversal controlado faz parte de um macro-projeto do Instituto de Cardiologia do Rio Grande do Sul que num estudo tipo consórcio incluiu 130 pacientes que receberam indicação para realizar cineangiocoronariografia. Os pacientes selecionados foram examinados entre dezembro de 2016 e outubro de 2017 e passaram por exame periodontal completo constando de índice de placa visível (IPV), sangramento à sondagem (SS), perda de inserção (PI), profundidade de sondagem (PS) em todos os dentes presentes nos seis sítios e também coletado o número de dentes perdidos e coleta de exames sanguíneos. A amostra foi dividida em 2 grupos: edêntulos (24,6%) e dentados (75,3%), sendo que maioria era homens (67,7%), com idade média de 63,30(±10,7) brancos (80%), com educação fundamental (70%), sedentários (62%), diabéticos (52%), hipertensos (74%) e com pelo menos um evento cardiovascular anterior (52%). As médias ± desvio-padrão de PS foram de 3,36±1,25; para PIos valores foram de 5,42±1,85; IPV médio de 0,39±0,25; e SS médio de 0,34±0,23, com uma média de 13,44±7,95 dentes. No modelo de regressão logística observou-se o efeito independente da perda dentária após ajustada para fumo e sexo. Conclui-se que a perda dentária está associada a incremento do risco cardíaco medido por inflamação sistêmica. / Chronic periodontitis and tooth loss have become useful tools for studying the hypothesis that infection/inflammation increases the risk of cardiovascular disease. It has been shown that periodontitis and its consequences (tooth loss) have the power to elevate systemic inflammatory markers; one of these markers is C-reactive protein is an acute plasma protein that is recognized as a predictor of myocardial infarction and is increased in infections. Based on the understanding that the systemic inflammatory process is the linking factor between the two conditions the objective of this study was to analyze the association between edentulism, tooth loss and clinical parameters of chronic periodontitis with systemic inflammation measured through C-reactive protein levels. This controlled cross-sectional study is part of a macro-project of the Instituto de Cardiologia do Rio Grande do Sul, which in a consortium-type study included 130 patients who were indicated to perform coronary angiography. The selected patients were examined between December 2016 and October 2017 and underwent complete periodontal examination consisting of visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), in six sites per tooth of all teeth present in addition to blood tests. The sample was divided into 2 groups: edentulous (24,6%) and dentate (75,3%)individuals. The majority were men (67.7%), with mean age of 63.30 (± 10.7) whites (80%), hypertensive (74%) and with at least one previous cardiovascular event (52%). The means and standard deviation of PD were 3.36 ±1.25; for CAL mean values of 5.42 ±1,85; Mean VPI was of 0.39 ± 0.25; and BOP presented 0.34 ± 0.23 as mean, with a mean of 13.44 ± 7.95 teeth present. In logistic regression model, we observed the independent effect of tooth loss after adjustment for smoking and sex. It is concluded that tooth loss is associated with increased cardiac risk as measured by systemic inflammation.