Rev Neurocienc 2013;21(4):600-603 revisão 600 RESUMOObjetivo. O objetivo deste trabalho foi revisar aspectos conceituais da Variabilidade da Frequência Cardíaca (VFC), seus dispositivos de mensuração, índices utilizados para sua análise e utilização clínica. Método. Uma revisão de literatura não sistemática realizada através de busca eletrônica conduzidas nas seguintes bases de dados: Medline/ PubMed, Lilacs, Ovid, Science Direct e Biomed Central acerca da utilização clínica da VFC. Resultados. A VFC compreende as oscilações entre os intervalos RR que refletem as modificações na frequência cardíaca em função da atuação conjunta das divisões simpática e parassimpática do sistema nervoso autônomo. Sua análise pode ser executada em função de dois parâmetros: domínio de tempo e domínio de frequência. O eletrocardiograma, conversores analógicos e cardiofrequencímetros são os principais instrumentos utilizados para obtenção de seus índices, onde a alta variabilidade indica boa adaptação fisiológica do organismo, enquanto que sua redução tem sido apontada como importante indicador para o surgimento de patologias ou de complicações em pacientes com doenças de base conhecidas. Conclusâo. O estudo da VFCvem se apresentando como importante ferramenta de avaliação do funcionamento do organismo em condições normais e patológicas proporcionando assim o desenvolvimento de ações pelos profissionais da saúde visando prevenção e/ou detecção de várias fisiopatologias.Unitermos. Frequência Cardíaca, Adaptação Fisiológica, Sistema Nervoso Autônomo.Citação. Lopes PFF, Oliveira MIB, Sousa AndréSM, Nascimento DLA, Silva CSS, Rebouças GM, Renee Felipe T, Albuquerque Filho NJB, Medeiros HJ. Aplicabilidade Clínica da Variabilidade da Frequência Cardíaca. ABSTRACTObjective. The purpose of this study was to review the conceptual aspects of Heart Rate Variability (HRV), its measurement devices, indexes used for analysis and clinical use. Method. A non-systematic literature review conducted through electronic search conducted in the following databases: Medline/PubMed, Lilacs, Ovid, Science Direct and BioMed Central about the clinical use of HRV. Results. HRV comprises oscillations between RR intervals that reflect the changes in heart rate due to the joint action of the sympathetic and parasympathetic divisions of the autonomic nervous system. The HRV's analysis can be performed by the basis of two parameters: the time domain and frequency domain. The electrocardiogram, heart monitors and analog converters are the main instruments used to obtain indices that allow the assessment of HRV, whose high variability indicates good physiological adaptation of the organism while its reduction has been identified as an important indicator for the emergence of pathologies or complications in patients with underlying diseases known. Conclusion. The study of HRV has been presented as an important tool for assessing the body functioning in normal and pathological conditions thus providing the development of actions by health professionals aiming preventio...
Objetivo. O objetivo deste trabalho foi revisar aspectos conceituais da Variabilidade da Frequência Cardíaca (VFC), seus dispositivos de mensuração, índices utilizados para sua análise e utilização clínica. Método. Uma revisão de literatura não sistemática realizada através de busca eletrônica conduzidas nas seguintes bases de dados: Medline/ PubMed, Lilacs, Ovid, Science Direct e Biomed Central acerca da utilização clínica da VFC. Resultados. A VFC compreende as oscilações entre os intervalos RR que refletem as modificações na frequência cardíaca em função da atuação conjunta das divisões simpática e parassimpática do sistema nervoso autônomo. Sua análise pode ser executada em função de dois parâmetros: domínio de tempo e domínio de frequência. O eletrocardiograma, conversores analógicos e cardiofrequencímetros são os principais instrumentos utilizados para obtenção de seus índices, onde a alta variabilidade indica boa adaptação fisiológica do organismo, enquanto que sua redução tem sido apontada como importante indicador para o surgimento de patologias ou de complicações em pacientes com doenças de base conhecidas. Conclusâo. O estudo da VFCvem se apresentando como importante ferramenta de avaliação do funcionamento do organismo em condições normais e patológicas proporcionando assim o desenvolvimento de ações pelos profissionais da saúde visando prevenção e/ou detecção de várias fisiopatologias.
Background Recently, the European Society of Cardiology issued new algorithms to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD), along with new age-specific thresholds to classify individuals as low-to-moderate, high, or very-high risk. The aim of this study was to compare the latest SCORE-2 model with the older SCORE (Systematic COronary Risk Evaluation) in their ability to identify individuals with high coronary artery calcium score (CACS), and assess the relationship between potential eligibility for statin therapy and CACS. Methods Individuals 40–69 years old without diabetes or known ASCVD were identified in a single center registry of patients undergoing CACS and coronary CT angiography for suspected coronary artery disease. SCORE and SCORE-2 were calculated and used with each patient's untreated LDL-C values to assess eligibility for statin therapy. High CACS was defined as an Agatston score ≥100. Results A total of 389 pts (46% men, mean age 58±8 years) were included, of which 15% (n=60) were active smokers. The mean systolic blood pressure and untreated LDL-C values were 136±17 mmHg and 155±65 mg/dL, respectively. The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 93%, 6% and 1% using the SCORE algorithm, and 42%, 44%, and 14% using SCORE-2, respectively. Overall, 218 patients (56%) would have their risk category revised upwards, while no patients would be downgraded. The median CACS was 5 (IQR 0–71 AU), with 166 patients (43%) having CACS = 0, and 81 (21%) presenting CACS values ≥100. SCORE and SCORE-2 showed similar discriminative power to identify patients with CACS ≥100 (C-statistic 0.77, 95% CI 0.71–0.82, vs. 0.75, 95% CI 0.69–0.80, P=0.109 for comparison]. The up-reclassification of risk conveyed by SCORE-2 affected patients across all categories of CACS (Fig. 1). The proportion of patients in whom statin therapy would generally be indicated was higher with the SCORE-2 criteria vs. the SCORE algorithm (61% vs. 29%, respectively, p<0.001). The broadening of potential indication for statin therapy spanned all categories of CACS, including patients with CACS = 0 (Fig. 2). Conclusion Even though the discriminative power of SCORE-2 is similar to the older SCORE, the introduction of age-specific thresholds results in the up-reclassification of risk in roughly half of the patients. The application of SCORE-2 will broaden statin eligibility overall, not only in patients with high atherosclerotic burden, but also in those with CACS = 0. These findings support the use of risk modifiers in selected patients to improve the effectiveness of statin therapy. Funding Acknowledgement Type of funding sources: None.
Introduction Recently, the European Society of Cardiology issued new algorithms (SCORE-2 and SCORE2-OP) to estimate the 10-year risk of atherosclerotic cardiovascular disease (ASCVD). CACS has been shown to reclassify a significant proportion of patients when applied on top of several scores, but data on its use with these new algorithms are lacking. The aim of this study was to assess the risk reassignment that can be attained by using CACS as a risk modifier of the SCORE-2 / SCORE2-OP classification, in patients referred for coronary CT angiography (CCTA). Methods Individuals without diabetes or known ASCVD were included in a single center registry of patients undergoing CCTA for suspected coronary artery disease (CAD). The 10-year risk of cardiovascular disease was calculated for each patient using SCORE-2 (ages 40–69) or SCORE2-OP (ages 70–89), and categorised as low-to-moderate, high, or very-high risk, according to guideline-recommended age-specific thresholds. CACS was considered to reclassify risk one level downward if = 0 in high or very-high risk patients, and reclassify risk upward if >100 (or >75th percentile) in those with low-to-moderate risk, or >1000 in those with high-risk. Results A total of 529 patients (43% men, mean age 63±10 years) were included, of which 13% (n=69) were active smokers. The mean systolic blood pressure and non-HDL-C values were 137±18 mmHg and 140±37 mg/dL, respectively. A total of 47 patients (9%) had obstructive CAD on CCTA, classifying them as very-high risk. In the remainder 482 patients without obstructive CAD, the median CACS was 8 (IQR 0–80 AU), with 194 patients (40%) having CACS = 0, and 111 (23%) presenting CACS values ≥100. The proportion of patients classified as low-to-moderate risk, high risk, and very high risk was 36%, 46% and 19% using the SCORE-2 / SCORE2-OP algorithm. Using CACS would reclassify 150 patients (31%): 107 patients (22%) downward, and 43 patients (9%) upward. The extent of risk reclassification conveyed by CACS was 33% in patients assessed with SCORE-2, and 25% with SCORE-2 OP (p=0.082). Overall, most of the risk reassignment (42%, n=93) would occur in patients originally classified as high-risk – Fig. 1. At the time of testing, 32% (n=61) of patients with CACS = 0 were being treated with statins, whereas 52% (n=58) of those with CACS ≥100 were not. Conclusion Even when the most recent SCORE-2 / SCORE-2 OP algorithms are used, risk refinement with CACS leads to the reclassification of nearly one third of the patients undergoing CCTA, mostly from downgrading risk. This opportunistic use of CACS may be employed to improve the allocation of primary prevention therapies. Funding Acknowledgement Type of funding sources: None.
Background According to the 2015 European Society of Cardiology's non-ST segment elevation acute coronary syndrome (NSTE-ACS) clinical practice guideline, fondaparinux is the parenteral anticoagulant with the most favorable efficacy/safety profile. Thus, it is recommended over enoxaparin, for instance, in that setting. However, its use and performance in a contemporary portuguese cohort has not been fully described. Purpose To assess fondaparinux utilization degree and to compare its in-hospital efficacy and safety profiles with those of enoxaparin, in a contemporary portuguese cohort of NSTE-ACS patients. Methods Patients consecutively admitted with NSTE-ACS, between October 2010 and January 2019, were retrospectively identified from a national registry of acute coronary syndromes and were further divided in two groups, as per parenteral anticoagulation strategy (fondaparinux vs. enoxaparin). Key exclusion criteria were specific contraindications to both agents, recent hemorrhagic stroke and indications for anticoagulation other than ACS. The primary efficacy endpoint was a composite of in-hospital reinfarction and mortality, whereas the primary safety endpoint was moderate-to-severe bleeding, as defined by the GUSTO criteria. Results A total of 5843 NSTE-ACS patients (mean age 65±13 years, 72.4% males) were included. Of these, 89.2% had a myocardial infarction, while the remaining 10.8% were diagnosed with unstable angina. The most frequent cardiovascular comorbidities were hypertension (71.3%), dyslipidemia (63.0%) and diabetes mellitus (31.7%). Fondaparinux was the anticoagulant of choice in 27.5% of patients, whereas the remainder were treated with enoxaparin. Compared with patients receiving enoxaparin, those in the fondaparinux group were younger, had less hypertension or diabetes mellitus and exhibited a less severe presentation; nonetheless, they had more often a previous history of coronary artery disease or hemorrhagic events. An invasive approach in terms of revascularization was adopted in 87.7% of the cohort (79.1% in the fondaparinux group vs. 90.9% in the enoxaparin group, p<0.001). The primary efficacy and safety endpoints occurred in 2.4% and 4.7% of patients, respectively. After adjustment for relevant covariates, the use of fondaparinux was independently associated with a lower rate of both the primary efficacy (OR 0.56 [0.32–0.95], p=0.034) and the primary safety endpoints (OR 0.37 [0.23–0.59], p<0.001). Conclusion In a contemporary portuguese cohort of NSTE-ACS patients, fondaparinux was underused but still independently associated with a lower risk of both a composite of in-hospital reinfarction or mortality event and major hemorrhage. Funding Acknowledgement Type of funding source: None
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.