ABSTRACT
Fundamento: As troponinas cardíacas são marcadores altamente sensíveis e específicos de lesão miocárdica. Esses marcadores foram detectados na insuficiência cardíaca (IC) e estão associadas com mau prognóstico. Objetivo: Avaliar a relação da troponina T (cTnT) e suas faixas de valores com o prognóstico na IC descompensada. Métodos: Estudaram-se 70 pacientes com piora da IC crônica que necessitaram de hospitalização. Na admissão, o modelo de Cox foi utilizado para avaliar as variáveis capazes de predizer o desfecho composto por morte ou re-hospitalização em razão de piora da IC durante um ano. Resultados: Durante o seguimento, ocorreram 44 mortes, 36 re-hospitalizações por IC e 56 desfechos compostos. Na análise multivariada, os preditores de eventos clínicos foram: cTnT (cTnT ≥ 0,100 ng/ml; hazard ratio (HR) 3,95 intervalo de confiança (IC) 95%: 1,64-9,49, p = 0,002), diâmetro diastólico final do ventrículo esquerdo (DDVE ≥70 mm; HR 1,92, IC95%: 1,06-3,47, p = 0,031) e sódio sérico (Na <135 mEq/l; HR 1,79, IC95%: 1,02-3,15, p = 0,044). Para avaliar a relação entre a elevação da cTnT e o prognóstico na IC descompensada, os pacientes foram estratificados em três grupos: cTnT-baixo (cTnT ≤ 0,020 ng/ml, n = 22), cTnT-intermediário (cTnT > 0,020 e < 0,100 ng/ml, n = 36) e cTnT-alto (cTnT ≥ 0,100 ng/ml, n = 12). As probabilidades de sobrevida e sobrevida livre de eventos foram: 54,2%, 31,5%, 16,7% (p = 0,020), e 36,4%, 11,5%, 8,3% (p = 0,005), respectivamente.Conclusão: A elevação da cTnT está associada com mau prognóstico na IC descompensada, e o grau dessa elevação pode facilitar a estratificação de risco.
Background: The cardiac troponins are highly sensitive and specific markers of myocardial injury. They have been detected in heart failure (HF) and are associated with a bad prognosis. Objective: To evaluate the association of cardiac troponin T (cTnT) and its ranges with prognosis in decompensated HF. Methods: A total of 70 patients with chronic HF worsening that needed hospitalization were studied. Cox model was used to evaluate the variables at admission capable of predicting the combined outcome that consisted of death or re-hospitalization due to HF worsening during a 1-year follow-up.Results: During the follow-up, there were 44 deaths, 36 re-hospitalizations due to HF and 56 combined outcomes. At the multivariate analysis, the predictors of clinical events were the cTnT (cTnT ≥0.100 ng/mL; hazard ratio [HR] 3.95 95% confidence interval [CI]: 1.64-9.49, p = 0.002), left ventricular end diastolic diameter (LVDD ≥70 mm; HR 1.92, 95%CI: 1.06-3.47, p = 0.031) and serum sodium (Na <135 mEq/L; HR 1.79, 95%CI: 1.02-3.15, p = 0.044). To evaluate the association between the cTnT increase and the prognosis in decompensated HF, the patients were stratified in three groups: low-cTnT (cTnT ≤0.020 ng/ml, n = 22), intermediate-cTnT (cTnT >0.020 and <0.100 ng/ml, n = 36), and high-cTnT (cTnT ≥0.100 ng/ml, n = 12). The probabilities of survival and event-free survival were 54.2%, 31.5%, 16.7% (p = 0.020) and 36.4%, 11.5%, 8.3% (p = 0.005), respectively. Conclusion: The increase in cTnT is associated with a bad prognosis in decompensated HF and the degree of this increase can help the risk stratification.
Fundamento: Las troponinas cardíacas son marcadores altamente sensibles y específicos de lesión miocárdica. Se las detectaron en la insuficiencia cardiaca (IC) y están asociadas con mal pronóstico. Objetivo: Evaluar la relación de la troponina T (cTnT) y sus franjas de valores con el pronóstico en la IC descompensada. Métodos: Se estudiaron a 70 pacientes con empeoramiento de la IC crónica que necesitaron hospitalización. Al ingreso, se empleó el modelo de Cox para evaluar las variables capaces de predecir el desenlace conformado por muerte o rehospitalización en razón de empeoramiento de la IC durante un año.Resultados: Durante el seguimiento, ocurrieron 44 muertes, 36 rehospitalizaciones por IC y 56 desenlaces compuestos. En el análisis multivariado, los predictores de eventos clínicos fueron: cTnT (cTnT ≥ 0,100 ng/ml; hazard ratio (HR) 3,95 intervalo de confianza (IC) 95%: 1,64-9,49, p = 0,002), diámetro diastólico final del ventrículo izquierdo (DDVI ≥70 mm; HR 1,92, IC95%: 1,06-3,47, p = 0,031) y sodio sérico (Na <135 mEq/l; HR 1,79, IC95%: 1,02-3,15, p = 0,044). Para avaluar la relación entre la elevación de la cTnT y el pronóstico en la IC descompensada, se dividieron a los pacientes en tres grupos: cTnT-bajo (cTnT ≤ 0,020 ng/ml, n = 22), cTnT-intermediario (cTnT > 0,020 y < 0,100 ng/ml, n = 36) y cTnT-alto (cTnT ≥ 0,100 ng/ml, n = 12). Las probabilidades de sobrevida y sobrevida libre de eventos fueron: 54,2%, 31,5%, 16,7% (p = 0,020), y 36,4%, 11,5%, 8,3% (p = 0,005), respectivamente. Conclusão: La elevación de la cTnT está asociada con mal pronóstico en la IC descompensada, y el grado de esa elevación puede facilitar la estratificación de riesgo.
Subject(s)
Female , Humans , Male , Middle Aged , Heart Failure/diagnosis , Troponin T/blood , Biomarkers/blood , Chronic Disease , Epidemiologic Methods , Heart Failure/complications , PrognosisABSTRACT
OBJECTIVE: To verify whether the serum levels of N-Terminal ProBNP fraction (ProBNP) allow us to identify with accuracy the clinical functional status of patients with heart failure (HF), because the clinical diagnosis of this syndrome is based basically on clinical data when the complementary tests have lower specificity. METHODS: Sixty-nine patients with a history of HF were studied. Their mean age of was 53.5 years and 78.3 percent were males. All underwent clinical and echocardiographic evaluations and a test to determine the serum dosage of ProBNP. According to clinical manifestation, patients were in the following functional classes (FC), 14 percent FC I, 40.6 percent FC II, 28.1 percent FC III, and 23.4 percent FC IV. The mean ejection fraction (EF) was 0.28. RESULTS: ProBNP did not differ according to age, sex, and cause of cardiopathy. No correlation existed between EF and the ProBNP serum level. ProBNP levels were significantly lower in patients in FC I than those in FC II (42 vs 326.7 pmol/L; P=0.0001), and in FC II than those in FC III (P=0.01). ProBNP levels did not differ statically between FC III and IV patients (888.1 vs 1082.8 pmol/L; P=0.25). ProBNP values greater than 100 pmol/L identify patients with decompensated HF with a sensitivity of 98 percent. CONCLUSION: ProBNP values over 100 pmol/L were indicative of HF, and patients with advanced HF had values over 270 pmol/L. A ProBNP dosage test was an excellent auxiliary in the clinical characterization of patients with HF