We found no sustained arrhythmias and a lack of arrhythmia-related symptoms at baseline and after 1 year of SA treatment in a contemporary cohort of acromegaly patients that also present a low frequency of structural heart changes, indicating that these patients may have a lower frequency of heart disease than previously reported.

We demonstrated by CMRi, the gold-standard method, that patients with active acromegaly might have a lower prevalence of cardiac abnormalities than previously reported.

Acromegaly patients, despite presenting with a higher LVMi when analyzed by 2D echocardiography, did not present with impairment in the strain when compared to a control group; this finding indicates a low chance of evolution to systolic dysfunction and agrees with recent studies that show a lower frequency of cardiac disease in these patients.

The aims of this study are to determine the prevalence of coronary atherosclerosis in acromegalic patients and to investigate the relationship between the coronary artery calcium score (CS) and acromegaly status and clinical parameters [Framingham risk score (FRS)]. Fifty-six acromegalic patients and paired non-acromegalic volunteers were stratified according to the FRS into low-, intermediate-, and high-risk groups. CS was assessed using multidetector computed tomography. The patients were considered to have controlled or active acromegaly at the time they were submitted to evaluation. Sixty-six percent of acromegalic patients exhibited arterial hypertension, 36 % had diabetes mellitus, and 34 % had hypercholesterolemia. The median FRS and the median risk for cardiovascular event within the next 10 years were similar in the acromegalics and the controls. The median total CS and CS >75th percentile didn't differ significantly between these groups. In patients with controlled acromegaly, a low, intermediate, or high FRS risk was observed in 86, 14, and 0 %, respectively. In patients with active disease, a low, intermediate, or high FRS risk was verified in 94, 3, and 3 %, respectively, and differences between the controlled and active groups were not significant. Seventy-two percent of the patients had total CS = 0, and there were no differences between the controlled and active groups. The risk of coronary artery disease in acromegalic patients, determined according to FRS and CS, is low despite the high prevalence of metabolic abnormalities.

Acromegaly is a rare disease with many challenges in its management. In order to address these challenges, many clinical practice guidelines were recently published. They were based on the literature evidence, aiming at guiding primary care physicians, general endocrinologists and neuroendocrinologists. The majority of these guidelines were developed following the GRADE system that classifies the recommendations according to strength (weak or strong) and quality of the evidence that supports them. In this review, we discuss how the evidence-based guidelines are developed, how to interpret the different strengths of recommendations and discuss the clinical implications of the evidence-based guidelines in acromegaly, pointing its utility and limitations on the diagnosis, management of comorbidities and in the disease treatment.

Introduction: A disastrous disease, the COVID-19, continues its spread, this, coupled with its severity, led to a initial global lockdown. Early evidence identified Black counties where mortality risk was higher than in white counties, even more evident in Latin America. In Brazil, with multiple forms of social inequalities, where color/race takes high relevance in this debate, it is even more relevant in Rio de Janeiro. We aimed to analyze these socio economic factors and its correlation with COVID 19 mortality. Hypothesis: Patients hospitalized with COVID 19 with a high social vulnerable background would had greater in-hospital mortality Methods: Prospective study of 274 confirmed adult COVID 19 hospitalized patients in the UHCFF. Clinical features/blood chemistry information were obtained from the clinical record. Using the individual address, we correlated it with the Census Code Area (CCA), using a novel methodology, we geoprocessed each home on the Division map. Giving a high relevance to the socio-economic variables for inequity and vulnerability markers, also analyzing the fact to be transferred from another primary care institution, for its delay potential of advanced medical care. We performed a logistic regression, with in-hospital mortality as our primary outcome. Results: Patients living in low adequacy households(p=0.030) with high in-house individual agglomeration markers (p=0.017), and the fact to have been transferred from another primary care institution (p=0.047) presented high in-hospital mortality, with high ICU admission and Mechanical Ventilation rates. Conclusions: In hospital mortality due to COVID 19 was influenced by social individual background characteristics of vulnerability. Among other clinical parameters, these markers should be taken into account to predict the individual likelihood of complications related to the pandemic, prioritizing the attention and vaccination for those at higher risk should be paramount.