Orientador: Haroldo Wilson Moreira / Banca: Evandro José Cesarino / Banca: Luiz Carlos de Mattos / Resumo: A haptoglobina é uma glicoproteína plasmática sintetizada principalmente pelo fígado com atividade antioxidante e imunomodulatória. Sua principal função é a formação de um complexo estável com a hemoglobina livre, prevenindo a excreção de ferro pelos rins e danos causados pelo efeito oxidativo do mesmo. O polimorfismo desta proteína é caracterizado por três genótipos principais: Hp1 / Hp1, Hp2 / Hp1 e Hp2 / Hp2, sendo que estes apresentam subtipos na dependência das recombinações entre os alelos Hp1F, Hp1S, Hp2FS, Hp2SF, Hp2FF e Hp2SS. Apesar de contraditório, vários autores tentam correlacionar esses tipos e subtipos com doenças, na tentativa de responsabilizar algum deles como facilitador ou conferir resistência quanto às mesmas. Os objetivos deste estudo foram verificar as freqüências desse polimorfismo, suas freqüências alélicas e possíveis correlações em portadores e não portadores de doença arterial coronariana, bem como em doadores de sangue, pertencentes a uma parcela da população paulista. Dessa forma foram analisados 125 pacientes com DAC, 69 com ausência de DAC e 124 doadores de sangue. O material genético foi extraído, amplificado e após restrição enzimática com Dra I permitiu identificar os tipos e subtipos da haptoglobina. Os resultados permitiram concluir que essa caracterização pela técnica aplicada mostrou ser rápida e de fácil realização. Os portadores de DAC e os doadores de sangue evidenciaram maior freqüência do Hp2 / Hp2 e aqueles com ausência de DAC do genótipo heterozigoto, não sendo observada diferenças estatísticas significativas entre eles. Essa mesma observação era verificada quando estratificávamos os grupos quanto aos sexos. A freqüência alélica do Hp2 se mostrou maior que o Hp1 para os três grupos analisados. A distribuição dos subtipos da haptoglobina revelou que o prevalente...(Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Haptoglobin is a glycoprotein synthesized by liver with antioxidant and immunomodulatory properties. Its main function is the formation of a stable complex with free hemoglobin, preventing iron loss and damage caused by oxidative effects. The polymorphism of this protein is characterized by three main genotypes: Hp1 / Hp1, Hp2 / Hp1 e Hp2 / Hp2, and these have subtypes in dependence of the recombination among the alleles Hp1F, Hp1S, Hp2FS, Hp2SF, Hp2FF e Hp2SS. Despite contradictory, the authors try to associated types and subtypes with diseases, attempt to hold responsible for someone or to permit resistance to them. The purposes of our study were to find the frequencies of this polymorphism, their allelic frequencies and possible associations in patients with coronary artery disease and patients without coronary artery disease, as well as in blood donors, from one fraction of Brazilian population. We have analyzed 125 patients with CAD, 69 patients without CAD and 124 blood donors. Genomic DNA was extracted, amplified and after enzyme restriction with Dra I we could identify types and subtypes of haptoglobin. With the results we conclude that this applied technique is fast and it's easy to carry out. Patients with CAD and blood donors evidenced higher frequencies for Hp2 / Hp2 and patients without CAD from heterozygous genotypes, weren't observed significant statistical differences among them. The same observation was verified when we stratified the groups regarding genders. The allelic frequency of Hp2 was shown higher than Hp1 for the three groups analyzed. The distribution of haptoglobin subtypes revealed that the prevalent for all groups were represented by Hp2FS / Hp2FS, followed by Hp2FS / Hp1F in patients with CAD and without CAD and Hp2FF / Hp2FF in blood donors. The third in expression was represented by Hp1S / Hp1S in patients with CAD, Hp2FS / Hp1S in patients without...(Complete abstract click electronic access below) / Mestre

Abstract Several studies have shown that altered cardiovascular autonomic regulation is associated with hypertension, diabetes, aging, angiographic severity of coronary artery disease (CAD), and increased mortality after acute myocardial infarction (AMI). The purpose of this study was to assess the temporal changes and prognostic significance of various measures of heart rate (HR) behaviour and their possible associations to coronary risk variables, and the progression of CAD in different populations. This study comprised five patient populations. The first consisted of 305 patients with recent coronary artery bypass graft surgery (CABG) and lipid abnormalities, the second of 109 male patients with recent CABG, the third of 53 type II diabetic patients with CAD, the fourth of 600 patients with recent AMI, and the fifth of 41 elderly subjects. HR variability and non-linear measures of HR dynamics were analysed. Among the patients with prior CABG, a significant correlation existed between the baseline HR variability (standard deviation of N-N intervals, SDNN) and the progression of CAD (r = 0.26, p < 0.001)). In the longitudinal study of patients with prior CABG, only the fractal indexes of HR dynamics, such as the power law slope (β) and the short-term fractal exponent (α1), decreased significantly. In diabetic patients, SDNN decreased significantly (p < 0.001) during the three-year period. The reduction of SDNN was related to cholesterol, triglyceride, and glucose levels, and also to progression of CAD (r = 0.36, p < 0.01). In the longitudinal follow-up study of patients with recent AMI, reduced fractal indices (α1 and β), and reduced HR turbulence predicted cardiac death when measured at the convalescent phase after AMI. Reduced β and turbulence slope predicted cardiac death when measured at 12 months after AMI. In the elderly population, β (p < 0.001) and α1 (p < 0.01) reduced significantly. Low-frequency power spectra were the only traditional measure of HR variability that decreased significantly during the 16-year period. HR variability is associated with many risk factors of atherosclerosis and with progression of CAD among patients with ischemic heart disease. Fractal HR dynamics are more sensitively able to detect age-related changes in cardiovascular autonomic regulation. Altered fractal HR dynamics and HR turbulence are associated with increased mortality after AMI.

oam1998@outlook.com / Background: Obstructive sleep apnea (OSA) is associated with increased mortality, for which impaired functional capacity (IFC) has been established as a surrogate. We sought to assess whether IFC is associated with increased mortality in patients with OSA and whether IFC is predictive of increased mortality after accounting for coronary artery disease. Methods: Patients with OSA who underwent both polysomnography testing and exercise stress echocardiogram were selected. Records were reviewed retrospectively for demographics, comorbidities, stress echocardiographic parameters, and polysomnography data. Univariable and multivariable logistic regression analysis was used to evaluate the association between IFC and overall mortality. We then evaluated the variables associated with IFC in the overall population and in the subgroup with normal Duke treadmill score (DTS). Results: In our cohort, 404 (26%) patients had IFC. The best predictors of IFC were female sex, history of smoking, ejection fraction less than 55, increased body mass index, presence of comorbidities, abnormal exercise echocardiogram, abnormal heart rate recovery, and abnormal DTS. Compared with those without IFC, patients with IFC were 5.1 times more likely to die (odds ratio [OR], 5.1; 95% confidence interval [CI], 2.5–10.5; P , 0.0001) by univariate analysis and 2.7 times more likely to die (OR, 2.7; 95% CI, 1.2–6.1; P = 0.02) by multivariate analysis, when accounting for heart rate recovery, DTS, and sleep apnea severity. Among those without coronary artery disease, patients with IFC were at significantly increased risk of mortality (OR, 4.3; 95% CI, 1.35–13.79; P = 0.0088) compared with those with preserved functional capacity. Conclusions: In our OSA population, IFC was a strong predictor of increased mortality. Among those with normal DTS, IFC identified a cohort at increased risk of mortality.

M.Phil. (Biokinetics) / Although coronary artery bypass graft (CABG) is well-established worldwide as a safe, effective operation for the treatment of coronary artery disease (CAD), it is an invasive procedure that often leaves patients feeling very anxious about the recovery process. The post-surgery phase should not only entail exercise intervention, but should also be paralleled with education and counselling to encourage patients to become responsible for the management of their own health and to achieve good functional capacity and quality of life (QoL). This prospective longitudinal study was aimed at achieving return to health and wellness in a group of CABG patients (n=18) with a mean age of 65 years. Four questionnaires were administered at the pre- and post-test, including Stone’s Heart Disease Risk Factor Questionnaire (1984), Paffenbarger Physical Activity Questionnaire (1978), Hawkes and Nowak Nutrition Knowledge Questionnaire (1998) and the Quality of Life Questionnaire. Morphological variables, biological and physiological fitness parameters, and health-related fitness were also assessed at the pre- and post-test. Prescribed exercise and lifestyle modifications were employed over twelve weeks, with emphasis on healthier nutrition and improved mental health. The level of significance was set at 5% (p ≤ 0.05) and 1% (p ≤ 0.0167). The findings in this study reflected significant improvements in heart disease risk, kilocalorie expenditure, nutrition knowledge, physical and mental QoL, waist circumference, body fat percentage, resting and recovery systolic blood pressure, aerobic endurance, flexibility, agility and dynamic balance, and lower-body strength. However, no significant changes were found in distance walked per day, body weight, body mass index, resting heart rate, resting diastolic blood pressure, blood cholesterol, maximum heart rate, maximum systolic and diastolic blood pressure, rating of perceived exertion, recovery heart rate, and recovery diastolic blood pressure. In addition, a deleterious change was found in blood glucose. Significant improvements were noted in the QoL and nutrition knowledge of this group of participants. The role limitations due to physical health reflected the most prominent improvement, indicating that the intervention positively influenced overall health, wellness, and activities of daily living. This study concluded that cardiac rehabilitation encompassing exercise intervention, nutrition guidelines, and psychosocial advice has been successful in improving the QoL of patients who have undergone CABG surgery.

Magister Artium (Sport, Recreation and Exercise Science) - MA(SRES) / Over 45% of firefighter deaths are due to a sudden cardiac event caused by underlying coronary artery disease (CAD) risk factors that can be prevented through adequate CAD risk factor screening and management. The aim of the study was to determine the prevalence of CAD risk factors in firefighters in the City of Cape Town and the relationship between the various CAD risk factors. This study used a quantitative cross-sectional, descriptive and correlational design. A total of 124 full-time firefighters of the City of Cape Town (CoCT) Fire and Rescue Service were conveniently recruited to participate in the study, including males and females of all ethnicities. Coronary artery disease risk factor information was obtained with a CAD risk factor assessment form, including, past medical history, smoking status, physical activity behaviour, ethnicity/race, age and gender.

No description available.

A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation.

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome, cardiogenic shock, and sudden cardiac death in women of reproductive age who have no traditional risk factors for coronary artery disease. The etiology, prognosis, and treatment of SCAD remain poorly defined. Coronary angiography is the gold standard for diagnosis. Management includes medical therapy and revascularization procedures using percutaneous intervention and coronary artery bypass grafting. Possible mechanisms of SCAD include rupture of atherosclerotic plaque or vasa vasorum, hemorrhage between the outer media and external lamina with intramedial hematoma expansion, and compression of the vessel lumen. We report a case of SCAD in a 39-year-old woman presenting with ST-elevation myocardial infarction midway through her menstrual cycle. Her medications included fenfluramine for obesity and hydrochlorothiazide, amlodipine, and atenolol for hypertension.

A 67-year-old male patient received a coronary artery bypass graft. Less than 2 months afterward, he presented with recurrent exacerbations of congestive heart failure. His response to a standard treatment regimen for heart failure was partly successful, but a few days after discharge he was readmitted for worsening dyspnea and edema. Doppler echocardiography suggested the hemodynamics of constrictive pericarditis. Magnetic resonance imaging showed thickened pericardium with exudates in the pericardial space. Cardiac catheterization confirmed the diagnosis, showing equalization of diastolic pressures of the left and right ventricles. The patient underwent subtotal pericardiectomy with resolution of the pericardial disease, but he died from respiratory insufficiency.

It is widely accepted that sleep disturbances occur in patients recovering from coronary artery bypass graft (CABG) surgery. This sleep disturbance, at least in theory, might retard or limit the return of functionality and exacerbate psychological states known to increase use of health care services and adversely affect prognosis. This study explored possible relations between sleep, self-rated aerobic physical capacity and physical activity in a sample of patients who underwent CABG surgery. Secondary analysis investigated the possible concurrent influences of post-CABG health complaints and depression on sleep function. Measures included the Pittsburgh Sleep Quality Questionnaire; the Veterans Specific Activity Questionnaire; the Paffenbarger Physical Activity Questionnaire; the Health Complaint Scale and the Beck Depression Inventory, Version II. The physical measure of body composition was also used. Fifty-five subjects completed baseline questionnaires for all measures just prior to surgery, excluding the Paffenbarger Physical Activity Questionnaire. Follow-up evaluations were repeated at 3 mo post-CABG for the same measures and the patients were also asked to report their patterns of post-surgical physical activity involvement. Correlation coefficients were calculated to determine whether a correlation existed between the measures. Significant correlations were found between pre-surgical and post-surgical sleep score, sleep subscales, functional capacity, depression and health complaints (p < 0.05). Post-CABG sleep and physical activity did not exhibit a significant correlation. A number of secondary analyses were performed in an effort to isolate possible influences of confounding factors, such as depression, body mass index > 27, and a ventricular ejection fraction (EF) < 30. In the low EF subgroup, overall sleep score and self-rated functional capacity were strongly correlated before surgery was performed (r = -0.85; p < 0.01). Stepwise regression equations were constructed to predict sleep outcome before and after surgery. Somatic health complaints, depression, and skinfold measures were found to be predictors for pre-surgical sleep (R2 = 0.52), as well as post-surgical sleep (R2 = 0.78). Fitness measures of functional capacity and physical activity were not a significant predictor of sleep. The findings of this study suggest that a modest correlation exists between functional capacity and sleep in CABG patients; however, predictors including health complaints, depression and skinfold measures serve as better indicators for sleep outcome before and after CABG surgery. / Master of Science