Abstract:
Background::Currently, there is no validated multivariate model to predict probability of obstructive coronary disease in patients with acute chest pain. Objective::To develop and validate a multivariate model to predict coronary artery disease (CAD) based on variables assessed at admission to the coronary care unit (CCU) due to acute chest pain. Methods::A total of 470 patients were studied, 370 utilized as the derivation sample and the subsequent 100 patients as the validation sample. As the reference standard, angiography was required to rule in CAD (stenosis ≥ 70%), while either angiography or a negative noninvasive test could be used to rule it out. As predictors, 13 baseline variables related to medical history, 14 characteristics of chest discomfort, and eight variables from physical examination or laboratory tests were tested. Results::The prevalence of CAD was 48%. By logistic regression, six variables remained independent predictors of CAD: age, male gender, relief with nitrate, signs of heart failure, positive electrocardiogram, and troponin. The area under the curve (AUC) of this final model was 0.80 (95% confidence interval [95%CI] = 0.75 - 0.84) in the derivation sample and 0.86 (95%CI = 0.79 - 0.93) in the validation sample. Hosmer-Lemeshow's test indicated good calibration in both samples (p = 0.98 and p = 0.23, respectively). Compared with a basic model containing electrocardiogram and troponin, the full model provided an AUC increment of 0.07 in both derivation (p = 0.0002) and validation (p = 0.039) samples. Integrated discrimination improvement was 0.09 in both derivation (p < 0.001) and validation (p < 0.0015) samples. Conclusion::A multivariate model was derived and validated as an accurate tool for estimating the pretest probability of CAD in patients with acute chest pain. Fundamento::Atualmente, não existe um modelo multivariado validado para predizer a probabilidade de doença coronariana obstrutiva em pacientes com dor torácica aguda. Objetivo::Desenvolver e validar um modelo multivariado para predizer doença arterial coronariana (DAC) com base em variáveis avaliadas à admissão na unidade coronariana (UC) devido a dor torácica aguda. Métodos::Foram estudados um total de 470 pacientes, 370 utilizados como amostra de derivação e os subsequentes 100 pacientes como amostra de validação. Como padrão de referência, a angiografia foi necessária para descartar DAC (estenose ≥ 70%), enquanto a angiografia ou um teste não invasivo negativo foi utilizado para confirmar a doença. Foram testadas como preditoras 13 variáveis basais relacionadas à história médica, 14 características de desconforto torácico e oito variáveis relacionadas ao exame físico ou testes laboratoriais. Resultados::A prevalência de DAC foi de 48%. Por regressão logística, seis variáveis permaneceram como preditoras independentes de DAC: idade, gênero masculino, alívio com nitrato, sinais de insuficiência cardíaca, e eletrocardiograma e troponina positivos. A área sob a curva (area under the curve, AUC) deste modelo final foi de 0,80 (intervalo de confiança de 95% [IC95%] = 0,75 - 0,84) na amostra de derivação e 0,86 (IC95% = 0,79 - 0,93) na amostra de validação. O teste de Hosmer-Lemeshow indicou uma boa calibração em ambas as amostras (p = 0,98 e p = 0,23, respectivamente). Em comparação com o modelo básico contendo eletrocardiograma e troponina, o modelo completo ofereceu um incremento na AUC de 0,07 tanto na amostra de derivação (p = 0,0002) quanto na de validação (p = 0,039). A melhoria na discriminação integrada foi de 0,09 nas amostras de derivação (p < 0,001) e validação (p < 0,0015). Conclusão::Um modelo multivariado foi derivado e validado como uma ferramenta acurada para estimar a probabilidade pré-teste de DAC em pacientes com dor torácica aguda.
journal_name
Arq Bras Cardioljournal_title
Arquivos brasileiros de cardiologiaauthors
Correia LCL,Cerqueira M,Carvalhal M,Ferreira F,Garcia G,Silva ABD,Sá N,Lopes F,Barcelos AC,Noya-Rabelo Mdoi
10.5935/abc.20170037subject
Has Abstractpub_date
2017-04-01 00:00:00pages
304-314issue
4eissn
0066-782Xissn
1678-4170pii
S0066-782X2017000400304journal_volume
108pub_type
杂志文章abstract:OBJECTIVE:To study electrophysiological characteristics that enable the identification and ablation of sites of chagasic tachycardia. METHODS:Thirty-one patients with chronic Chagas' heart disease and sustained ventricular tachycardia (SVT) underwent electrophysiological study to map and ablate that arrhythmia. Fiftee...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x1999000400006
更新日期:1999-04-01 00:00:00
abstract:PURPOSE:To study the quantitative and qualitative aspects of junctional rhythm (JR) during radiofrequency (RF) catheter ablation of slow pathway in atrioventricular nodal reentrant tachycardia. METHODS:Twenty five patients, 5 males, ages ranging from 15 to 76 years, with recurrent atrioventricular nodal reentrant tach...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章
doi:
更新日期:1995-07-01 00:00:00
abstract:Background::Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Brazil, and primary prevention care may be guided by risk stratification tools. The Framingham (FRS) and QRISK-2 (QRS) risk scores estimate 10-year overall cardiovascular risk in asymptomatic individuals, but the instrument of c...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.5935/abc.20170057
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that short periods of ischemia may increase the myocardial protection obtained with intermittent crossclamping of the aorta. METHODS:In the control group (18 patients), surgery was performed with systemic hypothermia at 32 degrees C and intermittent crossclamping of the aorta. Extracor...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1590/s0066-782x2001001000001
更新日期:2001-10-01 00:00:00
abstract::Central vein cannulation is used as routine for long-time treatment in paediatric intensive care units. The Sylastic catheter is now a days the most common used because of its non-thrombogenic effect. However, in the case here reported, fragmentation during its removal occurred in a eleven month baby. Non surgical rem...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:
更新日期:1989-11-01 00:00:00
abstract:PURPOSE:To evaluate the electrophysiological effects of intravenous propafenone in the anterograde and retrograde effective refractory period of the accessory pathways (AP), in patients with Wolff-Parkinson-White syndrome. METHODS:Forty symptomatic patients were studied. All patients were undergone to electrophysiolog...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章
doi:
更新日期:1993-07-01 00:00:00
abstract:BACKGROUND:There have been few studies on cardiovascular risk factors in adolescents with different degrees of obesity. OBJECTIVE:To evaluate metabolic effects associated with different degrees of obesity in adolescents and their impact on cardiovascular risks. METHODS:Cross-sectional study of 80 obese adolescents, d...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2010005000166
更新日期:2011-03-01 00:00:00
abstract:PURPOSE:The aim of this study was to analyse the effectiveness of patent ductus arteriosus (PDA) closure by the video-assisted thoracic surgery (VATS). METHODS:The technique was utilized in 6 newborn lambs firstly. Three to four small incisions (3 to 10mm) were used in each animal to permit the introduction of lung re...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract::The management of cardiac implantable electronic devices after death has become a source of controversy. There are no uniform recommendations for such management in Brazil; practices rely exclusively on institutional protocols and regional custom. When the cadaver is sent for cremation, it is recommended to remove the...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 信件
doi:10.36660/abc.20200447
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Studies have shown that pre/postnatal undernutrition leads to higher risk of non communicable diseases such as diabetes, hypertension and obesity in adulthood. OBJECTIVE:To determine whether overweight adolescents with mild stunting [height-for-age Z scores (HAZ) in the range <-1 to ≥ -2] have higher blood ...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2011005000115
更新日期:2012-01-01 00:00:00
abstract:OBJECTIVE:To determine the prevalence of cardiovascular disease (CVD) and traditional risk factors in patients with chronic renal failure undergoing evaluation for inclusion on the renal transplantation list. METHODS:One hundred ninety-five patients with dialytic chronic renal failure underwent clinical evaluation and...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2005000200012
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Aerobic exercise is an important ally in the fight against cardiovascular risk factors. However, the effects of high-intensity exercise on these factors are still poorly known. OBJECTIVE:To compare the effects of aerobic and anaerobic exercise protocols on cardiac risk factors. METHODS:22 individuals with ...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章,随机对照试验
doi:10.1590/s0066-782x2008001600003
更新日期:2008-10-01 00:00:00
abstract::A 78-year-old patient presented with shortness of breath after falling down. Transthoracic echocardiogram showed an extensive thrombus in the right atrium (RA), extensive thrombosis of the inferior vena cava (IVC), and abdominal aortic aneurysm (AAA). A magnetic resonance confirmed the thrombosis of the RA extending t...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.5935/abc.20160143
更新日期:2016-10-01 00:00:00
abstract:BACKGROUND:Heart failure is a severe complication associated with doxorubicin (DOX) use. Strain, assessed by two-dimensional speckle tracking (2D-STE), has been shown to be useful in identifying subclinical ventricular dysfunction. OBJECTIVES:a) To investigate the role of strain in the identification of subclinical ve...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.5935/abc.20140209
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Although the effects of salt intake reduction on casual blood pressure have been extensively studied in hypertensive individuals, data on reductions of added salt on arterial stiffness in both normotensive and prehypertensive subjects are scarce. OBJECTIVE:To evaluate the effects of progressive reduction in...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章
doi:10.36660/abc.20180426
更新日期:2020-05-01 00:00:00
abstract:PURPOSE:To analyse the performance of the artificial cardiac stimulation with the VVIR pacemaker whose sensor is adjusted by the variations of the autonomic nervous system in Chagas disease patients with deficiency of the conduction system. METHODS:Forty-seven Chagas disease patients have been studied, 28 male between...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 临床试验,杂志文章
doi:10.1590/s0066-782x1998001200004
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:Patients who underwent heart transplantation (HTX) experience a reduction in the elevation that is usual in systolic blood pressure during exercise testing. Of unknown origin, this phenomenon varies in frequency and intensity. The aim of this study was to analyze the relationship between systolic blood pressu...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2006001800013
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Prosthesis-patient mismatch (PPM) is associated with worse outcomes. OBJECTIVE:Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. METHODS:A total of 316 patients submitted to aortic valve replacement, wh...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.5935/abc.20190231
更新日期:2020-01-01 00:00:00
abstract::Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individu...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.5935/abc.20180249
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Sudden death is the leading cause of death in Chagas disease (CD), even in patients with preserved ejection fraction (EF), suggesting that destabilizing factors of the arrhythmogenic substrate (autonomic modulation) contribute to its occurrence. OBJECTIVE:To determine baroreflex sensitivity (BRS) in patient...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.5935/abc.20140066
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:Cardiovascular diseases (CVD) are the leading causes of death in our population. There was a progressive decrease in mortality due to CVD up to 2005. OBJECTIVE:To update the trends in mortality from cardiovascular diseases in Brazil and in the metropolitan region of São Paulo (MRSP) from 1990 to 2009. METH...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2012005000061
更新日期:2012-08-01 00:00:00
abstract:PURPOSE:In order to identify the reproducibility of head-up tilt test, a second test one week later in 22 patients with a positive first test, was performed. METHODS:The test was performed in a fasting state during the morning. The heart rate and blood pressure were monitored during 20 minutes in the supine position a...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND:The 22q11.2 deletion syndrome is the most frequent human microdeletion syndrome. The phenotype is highly variable, being characterized by conotruncal heart defect, facial dysmorphisms, velopharyngeal insufficiency, learning difficulties and mental retardation. OBJECTIVE:The objective of this study was to in...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2009000400010
更新日期:2009-04-01 00:00:00
abstract:BACKGROUND:High blood pressure is the major risk factor for cardiovascular disease. Low blood pressure control rates in Latin American populations emphasize the need for gathering evidence on effective therapies. OBJECTIVE:To evaluate the effects of dietary interventions on blood pressure in Latin American populations...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章,meta分析,评审
doi:10.5935/abc.20140037
更新日期:2014-04-01 00:00:00
abstract::We report the case of an 8-month-old female infant with Uhl's anomaly, who underwent successful cardiac transplantation. The clinical findings, complementary laboratory tests, anatomic findings, and differential diagnosis of the anomaly are discussed. ...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2001000700008
更新日期:2001-07-01 00:00:00
abstract::Beginning with a patient presenting with an atrial septal defect (ASD) of the secundum type, the genealogy was identified in four affected individuals who belonged to three successive generations of the same family. The defects were visually confirmed in all individuals and were found to be anatomically similar. No ot...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x1999000800009
更新日期:1999-08-01 00:00:00
abstract::We present a case of a 19-year old female with systemic pulmonary artery (PA) pressure due to a congenital ventricular septal defect (VSD) and atrial septal defect (ASD). She was pink at rest and cyanotic on exercise. Lung biopsy revealed grade IV pulmonary vascular changes. As a preliminary step PA was banded to incr...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:To quantify the percentage of contractility of different myocardial segments in patients with Chagas' disease by measuring myocardial strain and to assess the differences in the radial and longitudinal ventricular contractile function in the undetermined and dilated forms of chronic chagasic cardiomyopathy as...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2005000400003
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:To assess the relation between the evolution of cognitive performance and the prognosis of elderly patients after compensation of advanced heart failure. METHODS:Thirty-one patients older than 64 (68 +/- 7) years and admitted with New York Heart Association class IV heart failure and ejection fraction = 0.45...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.1590/s0066-782x2004000300005
更新日期:2004-03-01 00:00:00
abstract:BACKGROUND:Although team-based care is recommended for patients with hypertension, results of this intervention in a real-world setting are missing in the literature. OBJECTIVE:To report the results of a real-world long-term team-based care for hypertensive patients we conducted this study. METHODS:Data of hypertensi...
journal_title:Arquivos brasileiros de cardiologia
pub_type: 杂志文章
doi:10.36660/abc.20180384
更新日期:2020-08-28 00:00:00