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Aims: Renal dysfunction is a powerful predictor of adverse outcomes in patients hospitalized for acute coronary syndrome. Three new glomerular filtration rate (GFR) estimating equations recently emerged, based on serum creatinine (CKD-EPI creat ), serum cystatin C (CKD-EPI cyst ) or a combination of both (CKD-EPI creat/cyst ), and they are currently recommended to confirm the presence of renal dysfunction. Our aim was to analyse the predictive value of these new estimated GFR (eGFR) equations regarding mid-term mortality in patients with acute coronary syndrome, and compare them with the traditional Modification of Diet in Renal Disease (MDRD-4) formula. Methods and results: 801 patients admitted for acute coronary syndrome (age 67.3±13.3 years, 68.5% male) and followed for 23.6±9.8 months were included. For each equation, patient risk stratification was performed based on eGFR values: high-risk group (eGFR<60ml/min per 1.73m 2 ) and low-risk group (eGFR⩾60ml/min per 1.73m 2 ). The predictive performances of these equations were compared using area under each receiver operating characteristic curves (AUCs). Overall risk stratification improvement was assessed by the net reclassification improvement index. The incidence of the primary endpoint was 18.1%. The CKD-EPI cyst equation had the highest overall discriminate performance regarding midterm mortality (AUC 0.782±0.20) and outperformed all other equations (ρ<0.001 in all comparisons). When compared with the MDRD-4 formula, the CKD-EPI cyst equation accurately reclassified a significant percentage of patients into more appropriate risk categories (net reclassification improvement index of 11.9% (p=0.003)). The CKD-EPI cyst equation added prognostic power to the Global Registry of Acute Coronary Events (GRACE) score in the prediction of mid-term mortality. Conclusion:The CKD-EPI cyst equation provides a novel and improved method for assessing the mid-term mortality risk in patients admitted for acute coronary syndrome, outperforming the most widely used formula (MDRD-4), and improving the predictive value of the GRACE score. These results reinforce the added value of cystatin C as a risk marker in these patients.

Transthoracic echocardiography has a pivotal role in the diagnosis of constrictive pericarditis (CP). In addition to the classic M-mode, two-dimensional and Doppler indices, newer methodologies designed to evaluate myocardial mechanics, such as two-dimensional speckle tracking echocardiography (2DSTE), provide additional diagnostic and clinical information in the context of CP. Research has demonstrated that cardiac mechanics can improve echocardiographic diagnostic accuracy of CP and aid in differentiating between constrictive and restrictive ventricular physiology. 2DSTE can also be used to assess the success of pericardiectomy and its impact on atrial and ventricular mechanics. In the course of this review, we describe cardiac mechanics in patients with CP and summarize the influence of pericardiectomy on atrial and ventricular mechanics assessed using 2DSTE.

Brugada syndrome, first described over 20 years ago, is characterized by a typical electrocardiographic pattern with coved-type ST-segment elevation in the right precordial leads and a high risk of sudden death in otherwise healthy young adults.The electrocardiographic pattern is sometimes intermittent, and fever is a possible trigger. The authors present the case of a 68-year-old woman who came to the emergency department with fever and syncope. A diagnosis of community-acquired pneumonia was made. The electrocardiogram performed when the patient had fever revealed a type 1 Brugada pattern, which disappeared after the fever subsided. After other causes of Brugada-like pattern were excluded, Brugada syndrome was diagnosed and a cardioverter-defibrillator was implanted.This case demonstrates that this entity can be diagnosed at more advanced ages and highlights the usefulness of electrocardiography in a febrile state. Síndrome de Brugada; Febre; Síncope Padrão de Brugada tipo 1 induzido pela febre Resumo A síndrome de Brugada, descrita há cerca de 20 anos, caracteriza-se eletrocardiograficamente por uma elevação convexa do segmento-ST nas derivações precordiais direitas e pelo elevado risco de morte súbita em jovens aparentemente saudáveis. Este padrão eletrocardiográfico é, por vezes, intermitente, sendo a febre um possível fator precipitante. Os autores apresentam o caso clínico de uma doente de 68 anos que recorre ao serviço de urgência por febre e síncope. Feito o diagnóstico de pneumonia adquirida na comunidade. O eletrocardiograma realizado em contexto de febre revelou um padrão de Brugada ଝ Please cite this article as: Madeira M, Caetano F, Providência R, et al. Padrão de Brugada tipo 1 induzido pela febre. Rev Port Cardiol. 2015. http://dx.287.e2 M. Madeira et al. tipo 1, que desapareceu após resolução do quadro febril. Excluídas outras causas de padrão Brugada-like foi confirmado o diagnóstico de síndrome de Brugada e realizada implantação de cardioversor-desfibrilhador.Este caso ilustra a possibilidade do diagnóstico desta entidade poder ser feito numa faixa etária já avançada e reforça a utilidade da realização de um eletrocardiograma em contexto febril.

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