Background:Obstructive sleep apnoea (OSA) has been reported as a predictor of left ventricle (LV) diastolic dysfunction and left atrium (LA) remodelling. The aim of this study is to evaluate the impact of OSA treatment with a continuous positive airway pressure device (CPAP) on the LA volume and function, as well as on the LV diastolic function.Methods:In total, 56 OSA patients were studied. All patients underwent real-time three-dimensional (RT3DE) and two-dimensional echocardiogram with tissue Doppler evaluation in order to estimate LA volumes, function and LV diastolic performance. A total of 30 patients with an apnoea-hypopnoea index greater than 20 were randomly selected to receive sham CPAP (n = 15) or effective CPAP (n = 15) for 24 weeks. They underwent echo examination on three different occasions: at baseline, after 12 weeks and 24 weeks of CPAP or sham CPAP.Results:In the effective CPAP group we observed the following changes from the baseline to the 24-week echo evaluation: (a) a reduction in the E/E′ ratio (10.3 (1.9) to 7.9 (1.3), p = 0.03); (b) an increase in the LA passive emptying fraction (28.8% (11.9%) to 46.8% (9.3%), p = 0.01); and (c) a reduction in the LA active emptying fraction (42.7% (11.5%) to 25.7 (15.7), p<0.01). In the sham group, there were no changes from the baseline to the 24-week echo. We found a positive correlation between 24 week/baseline LA active emptying volume and 24 week/baseline E/E′ ratios (r = 0.40, p<0.05) and a negative correlation between 24 week/baseline LA passive emptying volume and 24 week/baseline E/E′ ratios (r = −0.53, p<0.05). No significant changes were found on LA total emptying fraction.Conclusion:CPAP improved LV diastolic function and LA passive emptying, but not LA structural variables in OSA patients.Trial registration number:NCT00768807.

Background: The major cause of death in the city of São Paulo (SP) is cardiac events. At its periphery, in-hospital mortality in acute myocardial infarction is estimated to range between 15% and 20% due to difficulties inherent in large metropoles.

CONTEXT AND OBJECTIVES: Early detection of reduced insulin sensitivity (IS) and insulin resistance (IR) is desirable. The aim here was to evaluate correlations of anthropometric indicators for identifying IR or IS and determine the cutoff points of the most effective indicators. DESIGN AND SETTING:Cross-sectional study in the city of São Paulo. METHODS:Sixty-one individuals with normal fasting plasma glucose (NFPG) and 43 overweight women were analyzed. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio, waist-to-height ratio (WHtR), conicity index and the HOMA-IS and HOMA-IR indices were determined.The correlations between the anthropometric indices and IS and IR were determined. ROC analysis was used to determine the areas under the curve (AUC) and cutoff points. RESUMO CONTEXTO E OBJETIVOS:A detecção precoce da redução na sensibilidade à insulina (SI) e resistência insulínica (RI) é desejável. O objetivo foi avaliar a correlação dos indicadores antropométricos em identificar a SI e RI, determinando os pontos de corte dos mais eficazes. TIPO DE ESTUDO E LOCAL: Estudo transversal na cidade de São Paulo.MÉTODOS: Analisou-se 61 indivíduos com glicemia de jejum normal (GJN) e 43 mulheres com sobrepeso. Determinou-se: índice de massa corporal (IMC), circunferência abdominal (CA), relação cintura quadril, relação cintura estatura (RCE), índice de conicidade e os índices HOMA-IS e HOMA-IR.As correlações entre os indicadores antropométricos e SI e RI foram determinadas. Análise ROC foi empregada com determinação das áreas abaixo da curva (AUC) e pontos de corte. CONCLUSÃO: Os indicadores mais promissores para indicar SI em indivíduos com GJN foram IMC, RCE e CA. Entre mulheres com sobrepeso, RCE demonstrou maior correlação com a RI.

OBJECTIVES:To correlate the importance of the ankle-brachial index in terms of cardiovascular morbimortality and the extent of coronary arterial disease amongst elderly patients without clinical manifestations of lower limb peripheral arterial disease.METHODS:We analyzed prospective data from 100 patients over 65 years of age with coronary arterial disease, as confirmed by coronary angiography, and with over 70% stenosis of at least one sub-epicardial coronary artery. We measured the ankle-brachial index immediately after coronary angiography, and a value of <0.9 was used to diagnose peripheral arterial disease.RESULTS:The patients' average age was 77.4 years. The most prevalent risk factor was hypertension (96%), and the median late follow-up appointment was 28.9 months. The ankle-brachial index was <0.9 in 47% of the patients, and a low index was more prevalent in patients with multiarterial coronary disease compared to patients with uniarterial disease in the same group. Using a bivariate analysis, only an ankle-brachial index of <0.9 was a strong predictive factor for cardiovascular events, thereby increasing all-cause deaths and fatal and non-fatal acute myocardial infarctions two- to three-fold.CONCLUSION:In elderly patients with documented coronary disease, a low ankle-brachial index (<0.9) was associated with the severity and extent of coronary arterial disease, and in late follow-up appointments, a low index was correlated with an increase in the occurrence of major cardiovascular events.

CONTEXT AND OBJECTIVE: Several studies have evaluated the role of low 25-hydroxyvitamin D (25OHD3) in the pathogenesis of type 2 diabetes (T2DM) and have presented controversial results. The metabolic processes that culminate in T2DM begin under prediabetic conditions. Our aim was to analyze the association between 25OHD3 and glucose metabolism in individuals who were free from but at elevated risk of diabetes. DESIGN AND SETTING: Cross-sectional study at a tertiary hospital. METHODS: Anthropometric and laboratory profiles were determined in patients with one or more of the following risk factors: hypertension; body mass index (BMI) ≥ 25 kg/m 2 ; waist circumference > 80 cm for women and > 94 cm for men; first-degree relatives with diabetes; women with large-for-gestational-age newborns or with gestational T2DM; HDL-cholesterol (high density lipoprotein) < 35 mg/dl; and triglycerides > 250 mg/dl. The patients were divided into two groups: one with prediabetes (abnormal fasting plasma glucose or oral glucose tolerance test) and the other with normal glucose (euglycemic). RESULTS: There was no statistically significant difference between the prediabetic group (n = 38) and euglycemic group (n = 15) regarding age (66.4 ± 10.6 versus 62.6 ± 9.1 years), gender (52.6 versus 73.3% female) and BMI (30.1 ± 4.61 versus 27.9 ± 4.7 kg/m 2 ). Low serum levels of 25OHD3 were found in both groups, without any statistically significant difference between them (29.1 ± 11.8 versus 26.87 ± 9.2 ng/dl). CONCLUSION: There was no association between 25OHD3 levels and the clinical or laboratorial variables analyzed.RESUMO CONTEXTO E OBJETIVO: Vários estudos já avaliaram o papel da 25-hidroxivitamina D (25OHD3) na patogênese do diabetes tipo 2 (DM2) e apresentaram resultados controversos. Os processos metabólicos que culminam no DM2 se iniciam no pré-diabetes. Nosso objetivo foi analisar a associação da 25OHD3 com o metabolismo glicêmico em indivíduos sem diagnóstico mas com alto risco para diabetes. TIPO DE ESTUDO E LOCAL: Estudo transversal em hospital terciário. MÉTODOS:Medidas antropométricas e laboratoriais foram determinadas em pacientes com um ou mais dos fatores de risco: hipertensão; índice de massa corpórea (IMC) ≥ 25 kg/m 2 ; circunferência abdominal > 80 cm no sexo feminino e > 94 cm no sexo masculino; parentes de primeiro grau com diabetes; mulheres com filho nascido grande para idade gestacional ou com DM2 na gravidez; colesterol HDL (high density lipoprotein) < 35 mg/dl e triglicerídeo > 250 mg/dl. Os pacientes foram divididos em dois grupos: um com pré-diabetes (glicemia de jejum ou teste de tolerância oral à glicose alterados) e outro com glicose normal (euglicêmicos). RESULTADOS: Entre pré-diabéticos (n = 38) e euglicêmicos (n = 15) não houve diferença estatística na idade (66,4 ± 10,6 versus 62,6 ± 9,1 anos), gênero (52,6 versus 73,3% feminino) e IMC (30,1 ± 4,61 versus 27,9 ± 4,7 kg/m 2 ). Baixos niveis séricos de 25OHD3 foram encontrados nos dois grupos, sem diferença estatística entre eles (29,1 ± 11,8 versu...