RESUMO
BACKGROUND: Heart failure (HF) is a major public health problem with increasing prevalence worldwide. It is associated with high mortality and poor quality of life due to recurrent and costly hospital admissions. Several studies have been conducted to describe HF risk predictors in different races, countries and health systems. Nonetheless, understanding population-specific determinants of HF outcomes remains a great challenge. We aim to evaluate predictors of 1-year survival of individuals with systolic heart failure from the GENIUS-HF cohort. METHODS: We enrolled 700 consecutive patients with systolic heart failure from the SPA outpatient clinic of the Heart Institute, a tertiary health-center in Sao Paulo, Brazil. Inclusion criteria were age between 18 and 80 years old with heart failure diagnosis of different etiologies and left ventricular ejection fraction ≤50% in the previous 2 years of enrollment on the cohort. We recorded baseline demographic and clinical characteristics and followed-up patients at 6 months intervals by telephone interview. Study data were collected and data quality assurance by the Research Electronic Data Capture tools. Time to death was studied using Cox proportional hazards models adjusted for demographic, clinical and socioeconomic variables and medication use. RESULTS: We screened 2314 consecutive patients for eligibility and enrolled 700 participants. The overall mortality was 6.8% (47 patients); the composite outcome of death and hospitalization was 17.7% (123 patients) and 1% (7 patients) have been submitted to heart transplantation after one year of enrollment. After multivariate adjustment, baseline values of blood urea nitrogen (HR 1.017; CI 95% 1.008-1.027; p < 0.001), brain natriuretic peptide (HR 1.695; CI 95% 1.347-2.134; p < 0.001) and systolic blood pressure (HR 0.982;CI 95% 0.969-0.995; p = 0.008) were independently associated with death within 1 year. Kaplan Meier curves showed that ischemic patients have worse survival free of death and hospitalization compared to other etiologies. CONCLUSIONS: High levels of BUN and BNP and low systolic blood pressure were independent predictors of one-year overall mortality in our sample. TRIAL REGISTRATION: Current Controlled Trials NTC02043431, retrospectively registered at in January 23, 2014.
Assuntos
Insuficiência Cardíaca Sistólica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Pressão Sanguínea , Nitrogênio da Ureia Sanguínea , Brasil/epidemiologia , Doença Crônica , Progressão da Doença , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Cardíaca Sistólica/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Função Ventricular Esquerda , Adulto JovemRESUMO
Heart failure (HF) is associated with morbidity and mortality. Real-time three-dimensional echocardiography (RT3DE) may offer additional prognostic data in patients with HF. The study aimed to evaluate the prognostic value of real-time three-dimensional echocardiography (RT3DE). This is a prospective study that included 89 patients with HF and left ventricular ejection fraction (LVEF) < 0.50 who were followed for 48 months. Left atrium and ventricular volumes and functions were evaluated by RT3DE. TDI and two-dimensional echocardiography parameters were also obtained. The endpoint was a composite of death, heart transplantation and hospitalization for acute decompensated HF. The mean age was 55 ± 11 years, and the LVEF was 0.32 ± 0.10. The composite endpoint occurred in 49 patients (18 deaths, 30 hospitalizations, one heart transplant). Patients with outcomes had greater left atrial volume (40 ± 16 vs. 32 ± 12 mL/m2; p < 0.01) and right ventricle diameter (41 ± 9 vs. 37 ± 8 mm, p = 0.01), worse total emptying fraction of the left atrium (36 ± 13% vs. 41 ± 11%; p = 0.03), LVEF (0.30 ± 0.09 vs. 0.34 ± 0.11; p = 0.02), right ventricle fractional area change (34.8 ± 12.1% vs. 39.2 ± 11.3%; p = 0.04), and greater E/e' ratio (19 ± 9 vs. 16 ± 8; p = 0.04) and systolic pulmonary artery pressure (SPAP) (50 ± 15 vs. 36 ± 11 mmHg; p < 0.01). In multivariate analysis, LVEF (OR 4.6; CI 95% 1.2-17.6; p < 0.01) and SPAP (OR 12.5; CI 95% 1.8-86.9; p < 0.01) were independent predictors of patient outcomes. LVEF and the SPAP were independent predictors of outcomes in patients with HF.
Assuntos
Ecocardiografia Doppler em Cores , Ecocardiografia Tridimensional , Insuficiência Cardíaca Sistólica/diagnóstico por imagem , Hemodinâmica , Adulto , Idoso , Área Sob a Curva , Intervalo Livre de Doença , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Cardíaca Sistólica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Razão de Chances , Valor Preditivo dos Testes , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Fatores de Risco , Volume Sistólico , Fatores de Tempo , Função Ventricular EsquerdaRESUMO
Abstract Background: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. Objective: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). Methods: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVRwere calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. Results: 105 patients (average LVEF 26.0 ±7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). Conclusions: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
Resumo Fundamento: A hipertensão pulmonar está associada a mau prognóstico em insuficiência cardíaca. No entanto, o diagnóstico não-invasivo é desafiador na prática clínica. Objetivo: Avaliar a utilidade prognóstica da estimativa não-invasiva das resistências vasculares pulmonares (RVP) medidas através de ressonância magnética cardiovascular na previsão de desfechos cardiovasculares adversos em insuficiência cardíaca com fração de ejeção reduzida (ICFEr). Métodos: Registro prospectivo de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) < 40% internados recentemente por insuficiência cardíaca descompensada, durante três anos. As RVP foram calculadas com base na fração de ejeção do ventrículo esquerdo e velocidade média do fluxo na artéria pulmonar estimada por ressonância magnética cardíaca. Durante a evolução, reinternação por insuficiência cardíaca e mortalidade por todas as causas foram consideradas eventos adversos. Resultados: Foram incluídos 105 pacientes (FEVE média de 26,0 ± 7,7%, etiologia isquêmica em 43%). Os valores de RVP nos pacientes que apresentaram eventos adversos durante o seguimento em longo prazo foram mais altos (6,93 ± 1,9 versus 4,6 ± 1,7 unidades Wood estimadas (uWe), p < 0,001). Na análise de regressão multivariada de Cox, RVP ≥ 5 eWu (valor de corte segundo a curva ROC) mostrou-se independentemente associada a um maior risco de eventos adversos aos 9 meses de seguimento (RR = 2,98; IC 95% = 1,12-7,88; p < 0,03). Conclusões: Em pacientes com ICFEr, a presença de RVP ≥ 5,0 uW está associada a uma evolução clínica significativamente pior. A estimativa não-invasiva da RVP através de ressonância magnética cardíaca pode ser útil na estratificação de risco em ICFEr, independentemente da etiologia, presença de realce tardio pelo gadolínio ou FEVE.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Cardíaca Sistólica/diagnóstico , Imagem Cinética por Ressonância Magnética/normas , Resistência Vascular/fisiologia , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Análise de Sobrevida , Volume Sistólico/fisiologiaRESUMO
BACKGROUND: Pulmonary hypertension is associated with poor prognosis in heart failure. However, non-invasive diagnosis is still challenging in clinical practice. OBJECTIVE: We sought to assess the prognostic utility of non-invasive estimation of pulmonary vascular resistances (PVR) by cardiovascular magnetic resonance to predict adverse cardiovascular outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS: Prospective registry of patients with left ventricular ejection fraction (LVEF) < 40% and recently admitted for decompensated heart failure during three years. PVR were calculated based on right ventricular ejection fraction and average velocity of the pulmonary artery estimated during cardiac magnetic resonance. Readmission for heart failure and all-cause mortality were considered as adverse events at follow-up. RESULTS: 105 patients (average LVEF 26.0 ± 7.7%, ischemic etiology 43%) were included. Patients with adverse events at long-term follow-up had higher values of PVR (6.93 ± 1.9 vs. 4.6 ± 1.7 estimated Wood Units (eWu), p < 0.001). In multivariate Cox regression analysis, PVR ≥ 5 eWu(cutoff value according to ROC curve) was independently associated with increased risk of adverse events at 9 months follow-up (HR2.98; 95% CI 1.12-7.88; p < 0.03). CONCLUSIONS: In patients with HFrEF, the presence of PVR ≥ 5.0 Wu is associated with significantly worse clinical outcome at follow-up. Non-invasive estimation of PVR by cardiac magnetic resonance might be useful for risk stratification in HFrEF, irrespective of etiology, presence of late gadolinium enhancement or LVEF.
Assuntos
Insuficiência Cardíaca Sistólica/diagnóstico , Imagem Cinética por Ressonância Magnética/normas , Resistência Vascular/fisiologia , Idoso , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Volume Sistólico/fisiologia , Análise de SobrevidaRESUMO
There is wide consensus about the benefits of beta-blockers in systolic heart failure. However, it is not clear if one specific beta-blocker is superior to the others. Some guidelines favor three evidence-based beta-blockers (carvedilol, bisoprolol and metoprolol) that have proved to decrease mortality. Carvedilol might have different physiological properties, commonly referred as pleiotropic effects, but the clinical meaning of them is not clear. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified four systematic reviews including eight pertinent randomized controlled trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded there is little or no difference in hospitalization risk between carvedilol and bisoprolol or metoprolol, but carvedilol might decrease mortality compared to metoprolol or bisoprolol. It is uncertain whether nebivolol can be an alternative because the certainty of the evidence is very low.
Es indiscutido el beneficio de los betabloqueadores para pacientes con insuficiencia cardiaca con disfunción sistólica, sin embargo, no existe claridad sobre cuál de ellos es superior. Algunas guías clínicas han favorecido a tres de ellos (carvedilol, bisoprolol y metoprolol) por su probado beneficio en disminución de mortalidad. Carvedilol podría tener diversos efectos fisiológicos, normalmente llamados efectos pleiotrópicos, pero el real significado clínico de estos no está claro. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos cuatro revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados pertinentes. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Se concluye que existiría poca o nula diferencia entre los distintos betabloqueadores en cuanto a hospitalizaciones por cualquier causa, pero que carvedilol podría disminuir la mortalidad comparado con metoprolol o bisoprolol. Existe incertidumbre sobre si nebivolol podría ser una alternativa porque la certeza de la evidencia es muy baja.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Carbazóis/uso terapêutico , Insuficiência Cardíaca Sistólica/tratamento farmacológico , Propanolaminas/uso terapêutico , Carvedilol , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Hospitalização , Humanos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Fundamento: O ecocardiograma fornece dados importantes na avaliação cardiológica de pacientes em insuficiência cardíaca. A identificação de parâmetros ecocardiográficos na cardiopatia chagásica grave auxiliaria na implementação terapêutica e na avaliação prognóstica. Objetivo: Correlacionar parâmetros ecocardiográficos com desfecho mortalidade cardiovascular em pacientes com fração de ejeção < 35%. Métodos: Estudo de análise retrospectiva de parâmetros ecocardiográficos coletados prospectivamente e pré-especificados em 60 pacientes incluídos no Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias - braço cardiopatia chagásica. Os parâmetros foram: diâmetros e volumes diastólico e sistólico do ventrículo esquerdo, fração de ejeção, diâmetro do átrio esquerdo, volume do átrio esquerdo, volume indexado do átrio esquerdo, pressão sistólica da artéria pulmonar, integral da velocidade do fluxo aórtico, índice de performance miocárdica, taxa de aumento da pressão do ventrículo esquerdo, tempo de relaxamento isovolumétrico, velocidade das ondas E, A, Em, Am e Sm, tempo de desaceleração da onda E, relação E/A , E/Em e insuficiência mitral. Resultados: No seguimento médio de 24,18 meses, 27 pacientes faleceram. a fração de ejeção média era de 26,6 ± 5,34%. Na análise multivariada, foram incluídos os parâmetros de fração de ejeção (HR = 1,114; p = 0,3704), volume indexado do átrio esquerdo (HR = 1,033; p < 0,0001) e relação E/Em (HR = 0,95; p = 0,1261). O volume indexado do átrio esquerdo foi um fator de predição independente em ...
Background: Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. Objective: To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. Methods: Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. Results: In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). Conclusion: The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction. .
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Chagas/mortalidade , Doença de Chagas , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica , Doença de Chagas/fisiopatologia , Insuficiência Cardíaca Sistólica/fisiopatologia , Análise Multivariada , Prognóstico , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Taxa de Sobrevida , Volume Sistólico/fisiologia , Fatores de Tempo , Função Ventricular Esquerda/fisiologiaRESUMO
BACKGROUND: Echocardiography provides important information on the cardiac evaluation of patients with heart failure. The identification of echocardiographic parameters in severe Chagas heart disease would help implement treatment and assess prognosis. OBJECTIVE: To correlate echocardiographic parameters with the endpoint cardiovascular mortality in patients with ejection fraction < 35%. METHODS: Study with retrospective analysis of pre-specified echocardiographic parameters prospectively collected from 60 patients included in the Multicenter Randomized Trial of Cell Therapy in Patients with Heart Diseases (Estudo Multicêntrico Randomizado de Terapia Celular em Cardiopatias) - Chagas heart disease arm. The following parameters were collected: left ventricular systolic and diastolic diameters and volumes; ejection fraction; left atrial diameter; left atrial volume; indexed left atrial volume; systolic pulmonary artery pressure; integral of the aortic flow velocity; myocardial performance index; rate of increase of left ventricular pressure; isovolumic relaxation time; E, A, Em, Am and Sm wave velocities; E wave deceleration time; E/A and E/Em ratios; and mitral regurgitation. RESULTS: In the mean 24.18-month follow-up, 27 patients died. The mean ejection fraction was 26.6 ± 5.34%. In the multivariate analysis, the parameters ejection fraction (HR = 1.114; p = 0.3704), indexed left atrial volume (HR = 1.033; p < 0.0001) and E/Em ratio (HR = 0.95; p = 0.1261) were excluded. The indexed left atrial volume was an independent predictor in relation to the endpoint, and values > 70.71 mL/m2 were associated with a significant increase in mortality (log rank p < 0.0001). CONCLUSION: The indexed left atrial volume was the only independent predictor of mortality in this population of Chagasic patients with severe systolic dysfunction.
Assuntos
Doença de Chagas/diagnóstico por imagem , Doença de Chagas/mortalidade , Insuficiência Cardíaca Sistólica/diagnóstico por imagem , Insuficiência Cardíaca Sistólica/mortalidade , Adulto , Doença de Chagas/fisiopatologia , Feminino , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Volume Sistólico/fisiologia , Taxa de Sobrevida , Fatores de Tempo , Ultrassonografia , Função Ventricular Esquerda/fisiologiaRESUMO
BACKGROUND: The utility of longitudinal, circumferential, and radial strain and strain rate in determining prognosis in chronic heart failure is not well established. METHODS AND RESULTS: In 416 patients with chronic systolic heart failure, we performed speckle-tracking analyses of left ventricular longitudinal, circumferential, and radial strain and strain rate on archived echocardiography images (30 frames per second). Cox regression models were used to determine the associations between strain and strain rate and risk of all-cause mortality, cardiac transplantation, and ventricular-assist device placement. The area under the time-dependent ROC curve (AUC) was also calculated at 1 year and 5 years. Over a maximum follow-up of 8.9 years, there were 138 events (33.2%). In unadjusted models, all strain and strain rate parameters were associated with adverse outcomes (P<0.001). In multivariable models, all parameters with the exception of radial strain rate (P=0.11) remained independently associated, with patients in the lowest tertile of strain or strain rate parameter having a ≈ 2-fold increased risk of adverse outcomes compared with the reference group (P<0.05). Addition of strain to ejection fraction (EF) led to a significantly improved AUC at 1 year (0.697 versus 0.633, P=0.032) and 5 years (0.700 versus 0.638, P=0.001). In contrast, strain rate did not provide incremental prognostic value to EF alone. CONCLUSIONS: Longitudinal and circumferential strain and strain rate, and radial strain are associated with chronic heart failure prognosis. Strain provides incremental value to EF in the prediction of adverse outcomes, and with additional study may be a clinically relevant prognostic tool.
Assuntos
Ecocardiografia Doppler , Insuficiência Cardíaca Sistólica/diagnóstico por imagem , Contração Miocárdica , Volume Sistólico , Função Ventricular Esquerda , Idoso , Doença Crônica , Elasticidade , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Cardíaca Sistólica/terapia , Transplante de Coração , Coração Auxiliar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Estresse Mecânico , Fatores de Tempo , Estados UnidosRESUMO
AIMS: To evaluate the feasibility, safety, and potential beneficial effects of left cardiac sympathetic denervation (LCSD) in systolic heart failure (HF) patients. METHODS AND RESULTS: In this prospective, randomized pilot study, inclusion criteria were New York Heart Association (NYHA) functional class II or III, left ventricular ejection fraction (LVEF) ≤40%, sinus rhythm, and resting heart rate >65 b.p.m., despite optimal medical therapy (MT). Fifteen patients were randomly assigned either to MT alone or MT plus LCSD. The primary endpoint was safety, measured by mortality in the first month of follow-up and morbidity according to pre-specified criteria. Secondary endpoints were exercise capacity, quality of life, LVEF, muscle sympathetic nerve activity (MSNA), brain natriuretic peptide (BNP) levels and 24 h Holter mean heart rate before and after 6 months. We studied clinical effects in long-term follow-up. Ten patients underwent LCSD. There were no adverse events attributable to surgery. In the LCSD group, LVEF improved from 25 ± 6.6 to 33 ± 5.2 (P = 0.03); 6 min walking distance improved from 167 ± 35 to 198 ± 47 m (P = 0.02). Minnesota Living with Heart Failure Questionnaire (MLWHFQ) score physical dimension changed from 21 ± 5 to 15 ± 7 (P = 0.06). The remaining analysed variables were unchanged. During 848 ± 549 days of follow-up, in the MT group, three patients either died or underwent cardiac transplantation (CT), while in the LCSD group six were alive without CT. CONCLUSIONS: LCSD was feasible and seemed to be safe in systolic HF patients. Its beneficial effects warrant the development of a larger randomized trial. Trail registration: NCT01224899.
Assuntos
Insuficiência Cardíaca Sistólica/fisiopatologia , Insuficiência Cardíaca Sistólica/cirurgia , Simpatectomia/métodos , Adulto , Idoso , Determinação de Ponto Final , Feminino , Insuficiência Cardíaca Sistólica/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Resistência Física/fisiologia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Taxa de Sobrevida , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologiaRESUMO
FUNDAMENTO: A Hipertensão Arterial Sistêmica (HAS) é importante causa de Insuficiência Cardíaca sistólica Crônica (ICC) em países em desenvolvimento. Seria necessário conhecerem-se os fatores de predição de mortalidade para pacientes com essa condição clínica para melhor tratamento científico. OBJETIVO: Determinar os fatores de risco de mortalidade geral em pacientes com ICC secundária à HAS na era moderna do tratamento da ICC por disfunção sistólica do ventrículo esquerdo. MÉTODOS: Todos os pacientes rotineira e prospectivamente tratados na Clínica de Cardiomiopatia em nossa instituição de janeiro de 2000 a abril de 2008 com o diagnóstico de ICC secundária à HAS foram selecionados para o estudo. O modelo de riscos proporcionais de Cox foi utilizado para o estabelecimento de fatores de predição independentes de mortalidade geral. RESULTADOS: Cento e trinta pacientes foram estudados; 74 (57 por cento) eram homens. Trinta e um (24 por cento) pacientes faleceram; cinco (4 por cento) submeteram-se a transplante cardíaco; e 94 (72 por cento) estavam vivos ao final do estudo. A probabilidade de sobrevivência aos 12, 24, 36, 48 e 60 meses foi de 96 por cento, 93 por cento, 84 por cento, 79 por cento e 76 por cento, respectivamente. Idade (Razão de Riscos = 1,05, Intervalo de Confiança 95 por cento de 1,01 a 1,08, p = 0,01), dimensão diastólica do ventrículo esquerdo (Razão de Riscos = 1,08; Intervalo de Confiança 95 por cento de 1,02 a 1,09; p = 0,003) e terapia com betabloqueador (Razão de Riscos = 0,41; Intervalo de Confiança 95 por cento de 0,19 a 0,86; p = 0,02) foram os fatores de predição independentes de mortalidade geral. CONCLUSÃO: Idade, dimensão diastólica do ventrículo esquerdo e não uso de betabloqueador são fatores de predição independentes de mortalidade geral em pacientes com ICC sistólica secundária à HAS na população estudada.
BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57 percent) were male. Thirty one (24 percent) patients died, 5 (4 percent) underwent heart transplantation, and 94 (72 percent) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96 percent, 93 percent, 84 percent, 79 percent, and 76 percent, respectively. Age (Hazard Ratio=1,05, 95 percent Confidence Interval 95 percent 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95 percent Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95 percent Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.
BUNDAMENTO: La Hipertensión Arterial Sistémica (HAS) es importante causa de Insuficiencia Cardíaca sistólica Crónica (ICC) en países en desarrollo. Sería necesario conocer los factores de predicción de mortalidad para pacientes con esa condición clínica para mejor tratamiento científico. OBJETIVO: Determinar los factores de riesgo de mortalidad general en pacientes con ICC secundaria a la HAS en la era moderna del tratamiento de la ICC por disfunción sistólica del ventrículo izquierdo MÉTODOS: Todos los pacientes rutinaria y prospectivamente tratados en la Clínica de Cardiomiopatía en nuestra institución de enero de 2000 a abril de 2008 con diagnóstico de ICC secundaria a la HAS fueron seleccionados para el estudio. El modelo de riesgos proporcionales de Cox fue utilizado para el establecimiento de factores de predicción independientes de mortalidad general. RESULTADOS: Ciento treinta pacientes fueron estudiados; 74 (57 por ciento) eran hombres. Treinta y un (24 por ciento) pacientes fallecieron; cinco (4 por ciento) se sometieron a transplante cardíaco; y 94 (72 por ciento) estaban vivos al final del estudio. La probabilidad de supervivencia a los 12, 24, 36, 48 y 60 meses fue de 96 por ciento, 93 por ciento, 84 por ciento, 79 por ciento y 76 por ciento, respectivamente. Edad (Razón de Riesgos = 1,05, Intervalo de Confianza 95 por ciento de 1,01 a 1,08, p = 0,01), dimensión diastólica del ventrículo izquierdo (Razón de Riesgos = 1,08; Intervalo de Confianza 95 por ciento de 1,02 a 1,09; p = 0,003) y terapia con betabloqueante (Razón de Riesgos = 0,41; Intervalo de Confianza 95 por ciento de 0,19 a 0,86; p = 0,02) fueron los factores de predicción independientes de mortalidad general. CONCLUSIÓN: Edad, dimensión diastólica del ventrículo izquierdo y no uso de betabloqueante son factores de predicción independientes de mortalidad general en pacientes con ICC sistólica secundaria a la HAS en la población estudiada.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Insuficiência Cardíaca Sistólica/mortalidade , Hipertensão/complicações , Fatores Etários , Causas de Morte , Doença Crônica , Métodos Epidemiológicos , Insuficiência Cardíaca Sistólica/etiologia , Insuficiência Cardíaca Sistólica/patologia , Ventrículos do Coração/patologia , PrognósticoRESUMO
BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57%) were male. Thirty one (24%) patients died, 5 (4%) underwent heart transplantation, and 94 (72%) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96%, 93%, 84%, 79%, and 76%, respectively. Age (Hazard Ratio=1,05, 95% Confidence Interval 95% 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95% Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95% Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.
Assuntos
Insuficiência Cardíaca Sistólica/mortalidade , Hipertensão/complicações , Fatores Etários , Causas de Morte , Doença Crônica , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca Sistólica/etiologia , Insuficiência Cardíaca Sistólica/patologia , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
A ecocardiografia é um importante exame no diagnóstico de insuficiência cardíaca, avaliando as funções, sistólica e diastólica, comprometidas nesta síndrome...
Assuntos
Biomarcadores/sangue , Disfunção Ventricular Esquerda/diagnóstico , Ecocardiografia , Insuficiência Cardíaca Sistólica/mortalidadeRESUMO
The purpose of this study was to evaluate the prognostic significance of anemia on outcome of patients with chronic systolic heart failure secondary to Chagas' cardiomyopathy, as no previous study has previously addressed this question. One-hundred-eight-six patients followed for chronic systolic heart failure secondary to Chagas' cardiomyopathy at our Institution from January 2000 to December 2008 were studied. Forty-nine (26%) patients were found to have anemia; 37 (20%) were men and 12 (6%) were women. Mean hemoglobin level was 14.1±1.2g/L in patients with no anemia and 11.5±1.2g/L in patients with anemia. On a Cox proportional hazards multivariate analysis, anemia was a predictor of all-cause mortality neither in the univariate nor in the multivariate analysis. Mean serum sodium (Hazard ratio=0.92; Beta-coefficient=-0.09; 95% confidence interval 0.89-0.96; p value<0.005), and Beta-Blocker therapy (Hazard ratio=0.40; 95% confidence interval 0.26-0.61; p value<0.005) were retained as independent predictors of mortality for patients with Chagas' cardiomyopathy with chronic heart failure. Probability of survival for patients with anemia, however, was significantly lower in patients with anemia in comparison to patients with no anemia, mainly in patients with advanced heart failure. Anemia is not an independent predictor of all-cause mortality in patients with Chagas' cardiomyopathy with chronic systolic heart failure. Probability of survival is poorer in patients with anemia than in those without.
Assuntos
Anemia/diagnóstico , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/mortalidade , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/mortalidade , Adulto , Idoso , Doença Crônica , Feminino , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS: We sought to identify predictors of all-cause mortality for Chagas' disease patients with chronic systolic heart failure because they are virtually lacking in the current era of heart failure therapy. METHODS AND RESULTS: This study focus on 127 patients with the diagnosis of chronic systolic heart failure secondary to Chagas' cardiomyopathy. Mean follow up was 25+/-19 months. Sixty-three (50%) patients died during the study period. Cox regression analysis showed lack of B-blocking agent use (p=0.002, hazard ratio=0.30, 95% Confidence Interval 0.14 to 0.64), serum sodium levels (p=0.01, hazard ratio=0.93, 95% Confidence Interval 0.87 to 0.98), left ventricular ejection fraction (p=0.02, hazard ratio=0.96, 95% Confidence Interval 0.93 to 0.99), digoxin treatment (p=0.04, hazard ratio=8.47, 95% Confidence Interval 1.13 to 62.52) and New York Heart Association Class IV on admission (p=0.034, hazard ratio=1.92, 95% Confidence Interval 1.02 to 3.51) independent predictors of all-cause mortality. CONCLUSION: Lack of B-blocking agent use, serum sodium levels, left ventricular ejection fraction, digoxin treatment and New York Heart Association Class IV are independent predictors of all-cause mortality for patients with chronic heart failure secondary to Chagas' cardiomyopathy in the current era of heart failure therapy.