ABSTRACT
Fundamentos: A insuficiência cardíaca de etiologia chagásica (ICCh) parece ter maior mortalidade que a de outrascom disfunção sistólica. O teste cardiopulmonar de exercício (TCPE) é uma ferramenta de avaliação prognósticaainda pouco estudada na cardiopatia chagásica.Objetivo: Avaliar se o TCPE pode discriminar as diferenças prognósticas da ICCh em comparação às de etiologianão chagásica (ICNCh) e verificar quais das suas variáveis são preditoras independentes de mau prognóstico.Métodos: Análise retrospectiva de 21 pacientes com ICCh e 76 pacientes com ICNCh encaminhados ao TCPE, eseguidos quanto à sua mortalidade em dois anos.Resultados: No seguimento, houve óbito de 5 pacientes no grupo chagásico (GC) e 25 no grupo não chagásico(GNC). A curva de Kaplan-Meier não mostrou diferença na curva de sobrevida entre os grupos (p=0,43). Aregressão logística encontrou a potência circulatória como uma variável preditora independente para óbito paraambos os grupos, com uma razão de risco para o GC de 17,3 (IC95% 1,39-217,0; p=0,027) e no GNC de 4,8(IC95% 1,59-14,6; p=0,005). A curva ROC para esta variável encontrou uma área de 0,91 (IC95% 0,78-1,00; p=0,006)com um valor de corte ≤1 280 mmHg.mL.kg-1.min-1 no GC e uma área de 0,75 (IC95% 0,64-0,86; p<0,0001) com umvalor de corte de ≤1 245 mmHg.mL.kg-1.min-1 no GNC.Conclusão: A potência circulatória foi a variável associada à morte em ambos os grupos, e deve ser mais amplamenteutilizada como indicador de prognóstico na insuficiência cardíaca.
Background: Chagas heart failure (CHF) seems to have higher mortality than other systolic dysfunction conditions. Cardiopulmonaryexercise testing (CPET) is a prognostic assessment tool that is still little studied in Chagas heart disease.Objective: To assess whether CPET can discriminate the prognostic differences of CHF compared to non-Chagas heart failures(NCHF) and determine which of its variables are independent predictors of poor prognosis.Methods: Retrospective analysis of 21 patients with CHF and 76 patients with NCHF referred to CPET and followed up formortality in two years.Results: During follow-up, 5 patients died in the Chagas group (CG) and 25 in the non-Chagas group (NCG). The Kaplan-Meiercurve showed no difference in the survival curve between groups (p=0.43). Logistic regression found the circulatory power as anindependent predictor of death for both groups, with a hazard ratio for the CG of 17.3 (95% CI 1.39-217.0; p=0.027) and for theNCG of 4.8 (95% CI 1.59-14.6; p=0.005). The ROC curve for this variable found an area of 0.91 (95% CI 0.78-1.00; p=0.006) witha cutoff value ≤1280 mmHg.mL.kg-1.min-1 in the CG and an area of 0.75 (95% CI 0.64-0.86; p<0.0001) with a cutoff value of≤1245 mmHg.mL.kg-1.min-1 in the NCG.Conclusion: Circulatory power was the variable associated with death in both groups and should be more widely used as an indicatorof prognosis in heart failure.
Subject(s)
Humans , Male , Young Adult , Middle Aged , Chagas Cardiomyopathy/prevention & control , Exercise Test , Heart Failure/etiology , Echocardiography , Follow-Up Studies , Retrospective Studies , Clinical Decision-Making/methodsABSTRACT
BACKGROUND: Behavioral and psychological symptoms in dementia (BPSD) contribute to caregiver burden and institutionalization of elderly. Neuroleptics are prescribed to control agitation. Side effects of typical neuroleptics are harmful, making atypical neuroleptics an indication. OBJECTIVES: To evaluate efficacy and tolerability of risperidone oral solution (ROS) given once daily to demented elderly outpatients with BPSD (agitation). METHOD: Patients (n=26), 76.35 + or 8.63 years, Diagnostic and Statistical Manual of Mental Disorders 4th ed. (DSM-IV) criteria for dementia. RSO was given, starting dose of 0.25 mg and increments of 0.25 mg every week. Mini-Mental State Examination (MMSE) assessed cognitive status, Behavioral and Emotional Activities Manifested in Dementia (BEAM-D) and Clinical Global Impression (CGI) measured BPSD, Extrapiramidal Symptom Rating Scale (ESRS) evaluated extrapyramidal symptoms. Cardiovascular side effects were evaluated clinically. RESULTS: There was a 26 percent reduction in agitation and no cardiovascular side effects in the range from 1.0 to 1.25 mg. Side effects were more prevalent above 2.5 mg. CONCLUSION: Risperidone oral solution improved agitation with good tolerability from 0.5 to 1.25 mg. A single dose with increments of 0.25 mg may be more acceptable to patients and caregivers