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1.
Arq. bras. cardiol ; 118(1): 3-11, jan. 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1360121

ABSTRACT

Resumo Fundamento Problemas nutricionais são comuns em pacientes com insuficiência cardíaca (IC) e estão associados a um prognóstico ruim. É relevante mencionar que algumas populações de pacientes, como os com Doença de Chagas, são normalmente excluídas da maioria das análises. Objetivo Buscamos analisar a ocorrência de desnutrição e caquexia em pacientes com Doença de Chagas durante episódios de IC descompensada (ICD) em comparação a outras etiologias, e investigar a influência desses achados em desfechos hospitalares. Método Realizamos um estudo de série de casos consecutivos com pacientes hospitalizados com ICD. Os pacientes foram submetidos à Avaliação Nutricional Subjetiva Global (ASG), além de medidas antropométricas e laboratoriais, e foram avaliados para a ocorrência de caquexia, baixa massa muscular e força. Estudamos a ocorrência de morte e transplante cardíaco de urgência durante a internação. Resultados Ao todo, 131 pacientes foram analisados e 42 (32,1%) tinham Doença de Chagas. Pacientes com Doença de Chagas apresentavam índice de massa corporal (IMC) menor (22,4 kg/m2 [19,9-25,3] vs. 23,6 kg/m2 [20,8-27,3], p=0,03), maior frequência de desnutrição (76,2% vs 55,1%, p=0,015) e mais ocorrências de morte ou transplante (83,3% vs. 41,6%, p<0,001). Observamos que, dentre os pacientes com etiologia da Doença de Chagas, a ocorrência de morte ou transplante cardíaco esteve associada com desnutrição (3 [42,9%] pacientes com alta hospitalar vs. 29 [82,9%] pacientes que morreram ou receberam transplante cardíaco, P=0,043). Conclusões Ao todo, nossos resultados indicam que pacientes com Doença de Chagas internados com ICD costumam apresentar problemas nutricionais, principalmente desnutrição. É importante mencionar que este achado esteve associado à ocorrência de morte e transplante cardíaco durante a internação.


Abstract Background Nutritional disorders are common among patients with heart failure (HF) and associated with poor prognosis. Importantly, some populations of patients, like the ones with Chagas disease, are frequently excluded from most analyses. Objective We sought to study the occurrence of undernutrition and cachexia in patients with Chagas disease during episodes of decompensated HF (DHF) as compared to other etiologies, and to investigate the influence of these findings on hospital outcomes. Methods We performed a consecutive case series study with patients hospitalized with DHF. Patients underwent the Subjective Global Assessment of nutritional status (SGA), besides anthropometric and laboratorial measures, and were evaluated for the occurrence of cachexia, low muscle mass and strength. We studied the occurrence of death or urgent heart transplantation during hospitalization. Results Altogether, 131 patients were analyzed and 42 (32.1%) had Chagas disease. Patients with Chagas disease had lower Body Mass Index (BMI) (22.4 kg/m2[19.9-25.3] vs. 23.6 kg/m2 [20.8-27.3], p=0.03), higher frequency of undernutrition (76.2% vs 55.1%, p=0.015) and higher occurrence of death or transplant (83.3% vs. 41.6%, p<0.001). We found that, in patients with Chagas etiology, the occurrence of death or cardiac transplantation were associated with undernutrition (3 [42.9%] patients with hospital discharge vs 29 [82.9%] patients with death or heart transplant, p=0.043). Conclusions Taken together, our results indicate that patients with Chagas disease hospitalized with DHF often present with nutritional disorders, especially undernutrition; importantly, this finding was associated with the occurrence of death and heart transplant during hospitalization.


Subject(s)
Humans , Chagas Cardiomyopathy/complications , Malnutrition/complications , Heart Failure/etiology , Cachexia/etiology , Hospitals
2.
Arq. bras. cardiol ; 117(6): 1191-1201, dez. 2021. graf
Article in English, Portuguese | LILACS | ID: biblio-1350048

ABSTRACT

Resumo A prevalência de obesidade e insuficiência cardíaca com fração de ejeção preservada (ICFEP) aumenta significativamente em mulheres na pós-menopausa. Embora a obesidade seja um fator de risco para disfunção diastólica do ventrículo esquerdo (DDFVE), o mecanismo que liga a interrupção da produção de hormônios ovarianos, especialmente o estrogênio, ao desenvolvimento da obesidade, DDFVE, e ICFEP em mulheres em processo de envelhecimento não é claro. Estudos clínicos e epidemiológicos demonstram que mulheres na pós-menopausa com obesidade abdominal (definida pela circunferência de cintura) têm risco maior de desenvolver a ICFEP do que homens ou mulheres sem obesidade abdominal. Este estudo analisa dados clínicos que corroboram a existência de uma ligação de mecanismo entre a perda de estrogênio mais obesidade e o remodelamento ventricular esquerdo com ICFEP. Ele também discute os possíveis mecanismos celulares e moleculares para a proteção mediada por estrogênio contra tipos de células, depósitos de tecidos, função e metabolismo de adipócitos negativos que podem contribuir para a DDFVE e a ICFEP.


Abstract The prevalence of obesity and heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women. Although obesity is a risk factor for left ventricular diastolic dysfunction (LVDD), the mechanisms that link the cessation of ovarian hormone production, and particularly estrogens, to the development of obesity, LVDD, and HFpEF in aging females are unclear. Clinical, and epidemiologic studies show that postmenopausal women with abdominal obesity (defined by waist circumference) are at greater risk for developing HFpEF than men or women without abdominal obesity. The study presents a review of clinical data that support a mechanistic link between estrogen loss plus obesity and left ventricular remodeling with LVDD. It also seeks to discuss potential cell and molecular mechanisms for estrogen-mediated protection against adverse adipocyte cell types, tissue depots, function, and metabolism that may contribute to LVDD and HFpEF.


Subject(s)
Humans , Male , Female , Ventricular Dysfunction, Left/etiology , Heart Failure/etiology , Stroke Volume , Ventricular Function, Left , Estrogens , Obesity, Abdominal/complications
4.
Rev. cuba. med ; 60(2): e1609, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280347

ABSTRACT

Introducción: La hiponatremia es la alteración electrolítica más frecuente en el paciente geriátrico. Existen evidencias que la asocian a un peor pronóstico en pacientes con insuficiencia cardiaca. Objetivo: Caracterizar los pacientes geriátricos ingresados con hiponatremia al ingreso e insuficiencia cardíaca. Método: Se realizó un estudio descriptivo, longitudinal y prospectivo durante el año 2018 en el Hospital Universitario Clínico Quirúrgico Calixto García que incluyó 260 pacientes con insuficiencia cardíaca e hiponatremia al ingreso. Para el análisis estadístico de los datos reutilizaron la prueba de chi cuadrada y el análisis multivariado de ANOVA para la asociación entre variables. Resultados: La edad media fue 72,6 ± 8,2, predominaron las mujeres (55,0 por ciento). Prevaleció la puntuación de Charlson 3-4 (33,8 por ciento), la fracción de eyección conservada, 70,8 por ciento; clase funcional III, 33,8 por ciento; estadía menor a 6 días, 43,1 por ciento y fallecieron 51,9 por ciento de la muestra estudiada. Se asociaron significativamente con la mortalidad al egreso, el índice de comorbilidad y la clase funcional III-IV, p< 0,05. Conclusiones: Existe una elevada mortalidad en pacientes geriátricos hospitalizados por insuficiencia cardiaca e hiponatremia al ingreso asociada a la presencia de comorbilidad y a la clasificación de la insuficiencia cardiaca(AU)


Introduction: Hyponatremia is the most frequent electrolyte alteration in geriatric patients. There is evidence that associates it with a worse prognosis in patients with heart failure. Objective: To describe geriatric patients admitted with hyponatremia on admission and heart failure. Method: A descriptive, longitudinal and prospective study was carried out in 2018 at Calixto García Surgical Clinical University Hospital, including 260 patients with heart failure and hyponatremia on admission. For the statistical analysis of the data, they reused the chi-square test and the multivariate analysis of ANOVA for the association between variables. Results: The mean age was 72.6 ± 8.2, women predominated (55.0 percent). Prevalence was observed in the Charlson score 3-4 (33.8 percent), the ejection fraction preserved (70.8 percent); functional class III was 33.8 percent; 43.1 percent stayed less than 6 days and 51.9 percent of the sample studied died. They were significantly associated with mortality at discharge, the comorbidity index and functional class III-IV, p <0.05. Conclusions: There is a high mortality in geriatric patients hospitalized for heart failure and hyponatremia on admission associated with the presence of comorbidity and the classification of heart failure(AU)


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Aged , Health Services for the Aged , Heart Failure/etiology , Hyponatremia/diagnosis , Epidemiology, Descriptive , Prospective Studies , Longitudinal Studies
5.
Rev. inf. cient ; 100(3): e3327, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1289637

ABSTRACT

RESUMEN - Introducción: Se revelan controversias respecto a los mecanismos que determinan la vulnerabilidad de los pacientes con insuficiencia cardiaca a la infección por el virus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), que produce el síndrome respiratorio llamado Coronavirus Infectious Disease-19 (COVID-19). Objetivo: Recopilar información sobre la fisiopatología de la insuficiencia cardiaca aguda en el contexto de la COVID-19. Método: En el Policlínico Comunitario "Ramón López Peña" de Santiago de Cuba, entre septiembre y noviembre del 2020, se realizó una revisión narrativa sobre este tema. La búsqueda se efectuó consultando las bases de datos Pubmed, Infomed y SciELO, sin restricción de fecha, en los idiomas español e inglés. Desarrollo: Se manifiestan incertidumbre en los mecanismos implicados en la fisiopatología de la insuficiencia cardiaca de los pacientes con esta enfermedad infecciosa. El daño miocárdico se debe a los efectos directos de la infección viral sobre el miocito, que se expresa como una respuesta inflamatoria local y a la participación del corazón como órgano diana de respuesta inflamatoria sistémica e inapropiada generada por la marcada liberación de citocinas. Esta última, además, genera un daño endotelial que desencadena complicaciones tromboembólicas e isquémicas, disfunción sistodiastólica del corazón, y finalmente la falla multiorgánica. Consideraciones finales: A pesar de los avances en el conocimiento de la etiopatogenia de esta enfermedad, aún se requiere que se esclarezcan con precisión los mecanismos fisiopatológicos que determinan la presentación de la insuficiencia cardiaca, si bien se reconoce la influencia de la respuesta inflamatoria inapropiada, inducida por citoquinas, en la presentación del daño miocárdico.


ABSTRACT - Introduction: The mechanisms that are suggested as determinant in the vulnerability of patients with heart failure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and which cause the respiratory syndrome labeled COVID-19 (Coronavirus Infectious Disease-19), has revealed controversial. Objective: To gather information on the pathophysiological features of acute heart failure in the context of COVID-19. Method: Concerning this topic, from September to November 2020 at the Policlínico Comunitario "Ramón López Peña" in Santiago de Cuba, a narrative review was carried out. The search was conducted checking the databases Pubmed, Infomed and SciELO, without date restriction, and in Spanish and English language. Development: The mechanisms involved on the pathophysiological features of heart failure in patients with this infectious disease revealed uncertainty. Myocardial damage is achievement of two aspects, the direct effect of viral respiratory infection on the myocyte, which is expressed as a local inflammatory response, and the heart participation as a target organ to the systemic and inappropriate inflammatory response, generated by a marked cytokines release. Conclusions: Despite the advances in understanding the etiopathogenesis of this disease, the pathophysiological mechanisms that determine on the heart failure still require to be precisely clarified, although the influence of the inappropriate inflammatory response, induced by cytokines, it is recognized in the onset myocardial damage.


RESUMO - Introdução: Revelam-se controvérsias a respeito dos mecanismos que determinam a vulnerabilidade dos pacientes com insuficiência cardíaca à infecção pelo vírus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), gerador da síndrome respiratória denominada Coronavirus Infectious Disease-19 (COVID-19). Objetivo: Coletar informações sobre a fisiopatologia da insuficiência cardíaca aguda no contexto da COVID-19. Método: Na Policlínica Comunitária "Ramón López Peña" de Santiago de Cuba, entre setembro e novembro de 2020, foi realizada uma revisão narrativa sobre o tema. A busca foi realizada por meio de consulta às bases de dados Pubmed, Infomed e SciELO, sem restrição de datas, nos idiomas espanhol e inglês. Desenvolvimento: A incerteza se manifesta nos mecanismos envolvidos na fisiopatologia da insuficiência cardíaca em pacientes com essa doença infecciosa. O dano miocárdico se deve aos efeitos diretos da infecção viral no miócito, que se expressa como resposta inflamatória local, e ao envolvimento do coração como órgão alvo da resposta inflamatória sistêmica e inadequada gerada pela liberação acentuada de citocinas. Esta última também gera dano endotelial que desencadeia complicações tromboembólicas e isquêmicas, disfunção cardíaca sistodiastólica e, finalmente, falência de múltiplos órgãos. Conclusões: Apesar dos avanços no conhecimento da etiopatogenia desta doença, ainda é necessário esclarecer com precisão os mecanismos fisiopatológicos que determinam a apresentação da insuficiência cardíaca, embora se reconheça a influência da resposta inflamatória inadequada, induzida por citocinas, na apresentação de dano miocárdico.


Subject(s)
Humans , COVID-19/complications , Heart Failure/etiology , Heart Failure/physiopathology
6.
Arch. cardiol. Méx ; 91(2): 229-234, abr.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1248790

ABSTRACT

Resumen Hoy una de las principales causas de mortalidad es el cáncer. La supervivencia en pacientes con cáncer ha incrementado de 1970 (25%) a la actualidad (80%). A raíz de la introducción de las antraciclinas como tratamiento de cáncer desde 1960-1970, más del 60% de los pacientes son tratados con estos agentes; sin embargo, la exposición de quimioterápicos conlleva las enfermedades cardiovasculares como la principal causa de mortalidad en enfermos supervivientes de cáncer en el s. XXI. Hay múltiples factores que incrementan la sensibilidad de cardiotoxicidad inducida por antracíclicos. En 1970 el estándar de oro para la detección de disfunción ventricular era la biopsia endomiocárdica, en forma posterior la detección y manejo de la cardiotoxicidad fue guiada por los síntomas, en 1981 la detección de cardiotoxicidad fue reportada con la determinación de la fracción de expulsión del ventrículo izquierdo (FEVI) por ecocardiografía 2D. En la actualidad el ecocardiograma 3D para FEVI y volúmenes sistólico y diastólico han presentado una alta correlación de los valores obtenidos por resonancia magnética para la evaluación de la función cardiaca. Hoy en día la ecocardiografía strain, strain-rate y speckle tracking se utilizan para determinar la función miocárdica regional y global. Para una valoración integral estos resultados se pueden complementar con biomarcadores cardiacos (troponinas y propéptido natriurético tipo B) y cambios electrocardiográficos. De esta forma se puede detectar insuficiencia cardiaca subclínica y dar un tratamiento oportuno.


Abstract Today one of the main causes of mortality is cancer. Survival in cancer patients has increased from 1970 (25%) to the present (80%). Following the introduction of anthracyclines as a cancer treatment since 1960-70, more than 60% of patients are treated with these agents, although chemotherapeutic exposure leads to cardiovascular diseases as the main cause of mortality in surviving patients. of cancer in the 21st Century. There are multiple factors that increase the sensitivity of anthracyclic-induced cardiotoxicity. In 1970 the gold standard for the detection of ventricular dysfunction was endomyocardial biopsy, subsequently the detection and management of cardiotoxicity was guided by symptoms, in 1981 the detection of cardiotoxicity was reported with the determination of the ejection fraction of the left ventricle (LVEF), by 2D echocardiography. Currently, the 3D echocardiogram for LVEF and systolic and diastolic volumes have presented a high correlation of the values obtained by magnetic resonance imaging for the evaluation of cardiac function. Today strain, strain-rate and speckle tracking echocardiography are used to determine regional and global myocardial function. For a comprehensive assessment, these results can be complemented with cardiac biomarkers (troponins) and electrocardiographic changes. In this way, subclinical heart failure can be detected and timely treatment can be given.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Young Adult , Echocardiography/methods , Echocardiography, Three-Dimensional/methods , Cardiotoxicity/diagnostic imaging , Heart Failure/diagnosis , Neoplasms/drug therapy , Antineoplastic Agents/toxicity , Heart Failure/etiology , Antineoplastic Agents/therapeutic use
7.
Acta Paul. Enferm. (Online) ; 34: eAPE03193, 2021. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1278068

ABSTRACT

Resumo Objetivo: Identificar a prevalência da síndrome cardiorrenal (SCR) em pacientes com insuficiência cardíaca (IC) crônica descompensada e sua associação com os dados sociodemográficos, clínicos, achados admissionais, mortalidade e tempo de hospitalização. Método: Estudo transversal, com abordagem quantitativa. A amostra foi constituída por 379 prontuários de pacientes adultos com o diagnóstico médico de IC crônica descompensada, admitidos em hospital público no estado de São Paulo, ao longo de 2015. A coleta de dados ocorreu em 2016. A disfunção renal foi considerada em pacientes com diagnóstico prévio de doença renal crônica (DRC) pela taxa de filtração glomerular (TFG) < 89 mL/min/1.73 m2. Testes com valor de p menor ou igual a 0,05 foram estatisticamente significativos. Resultados: A prevalência da SCR foi de 54,1%, sendo 24,8% do tipo 1 e 29,3% do tipo 2. Os principais fatores associados à SCR foram: maior média de idade, mulheres, IC de etiologia isquêmica, menor fração de ejeção, portadores de diabetes mellitus, doença arterial coronariana, uso de estimuladores cardíacos artificiais, hipotireoidismo e doença de Chagas, bem como o perfil hemodinâmico de descompensação da IC nos tipos C e L. Destacam-se, ainda, inapetência, sonolência, estertores na ausculta respiratória, alteração na perfusão tissular, redução do débito urinário, com aumento dos níveis séricos de potássio, ureia e creatinina na avaliação clínica inicial. Os pacientes com disfunção renal apresentaram maior mortalidade, sem diferença significativa quanto ao tempo de hospitalização. Conclusão: Houve alta prevalência da SCR em pacientes com IC crônica descompensada, associada à maior mortalidade e diversos indicadores clínicos.


Resumen Objetivo: Identificar la prevalencia del síndrome cardiorrenal (SCR) en pacientes con insuficiencia cardíaca (IC) crónica descompensada y su relación con los datos sociodemográficos, clínicos y descubiertos en la admisión, la mortalidad y el tiempo de hospitalización. Métodos: Estudio transversal, con enfoque cuantitativo. La muestra estuvo compuesta por 379 historias clínicas de pacientes adultos con diagnóstico médico de IC crónica descompensada, ingresados en hospital público en el estado de São Paulo, durante 2015. La recolección de datos se realizó en 2016. La disfunción renal fue considerada en pacientes con diagnóstico previo de enfermedad renal crónica (ERC) por el índice de filtración glomerular (IFG) < 89 mL/min/1.73 m2. Pruebas con un valor de p menor o igual a 0,05 fueron estadísticamente significativos. Resultados: La prevalencia del SCR fue del 54,1 %, del cual el 24,8 % fue de tipo 1 y el 29,3 % de tipo 2. Los principales factores asociados al SCR fueron: mayor promedio de edad, mujeres, IC de etiología isquémica, menor fracción de eyección, portadores de diabetes mellitus, enfermedad arterial coronaria, uso de estimuladores cardíacos artificiales, hipotiroidismo y enfermedad de Chagas, así como también el perfil hemodinámico de descompensación de la IC en el tipo C y L. Además, se destacan la inapetencia, somnolencia, estertores en la auscultación pulmonar, alteración en la perfusión tisular, reducción del flujo urinario, con aumento del nivel en sangre de potasio, urea y creatinina en la evaluación clínica inicial. Los pacientes con disfunción renal presentaron mayor mortalidad, sin diferencia significativa con relación al tiempo de hospitalización. Conclusión: Se observó una alta prevalencia del SCR en pacientes con IC crónica descompensada, relacionada con una mayor mortalidad y diversos indicadores clínicos.


Abstract Objective: to identify cardiorenal syndrome (CRS) prevalence in patients with decompensated chronic heart failure (HF) and its association with sociodemographic and clinical data, admission findings, mortality and length of hospital stay. Methods: a cross-sectional study with a quantitative approach. The sample consisted of 379 medical records of adult patients with a medical diagnosis of decompensated chronic HF admitted to a public hospital in the state of São Paulo, throughout 2015. Data collection occurred in 2016. Kidney failure was considered in patients with a previous diagnosis of chronic kidney disease (CKD) by glomerular filtration rate (GFR) <89 mL/min/1.73 m2. Tests with a p value less than or equal to 0.05 were statistically significant. Results: CRS prevalence was 54.1%, with 24.8% being type 1 and 29.3% being type 2. The main factors associated with CRS were: higher mean age; women; HF of ischemic etiology; lower ejection fraction; people with diabetes mellitus; coronary artery disease; artificial cardiac stimulator use; hypothyroidism and Chagas disease; hemodynamic profile of HF decompensation in types C and L. Also noteworthy are inappetence, drowsiness, rales on respiratory auscultation, alteration in tissue perfusion, decreased urine output, with increased serum levels of potassium, urea and creatinine in the initial clinical assessment. Patients with kidney failure had higher mortality, with no significant difference in length of hospital stay. Conclusion: There was a high prevalence of CRS in patients with decompensated chronic HF, associated with higher mortality and several clinical indicators.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Medical Records , Renal Insufficiency, Chronic/complications , Acute Kidney Injury/complications , Cardio-Renal Syndrome , Heart Failure/etiology , Chronic Disease , Cross-Sectional Studies , Evaluation Studies as Topic , Nursing Care
8.
ABC., imagem cardiovasc ; 34(3)2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1291983

ABSTRACT

Introdução: A doença de Chagas é uma infecção causada pelo protozoário Trypanosoma cruzi. É considerada um importante problema de saúde do mundo, tendo como manifestações a dilatação cardíaca, arritmias e morte. A insuficiência cardíaca é uma síndrome complexa e de elevada morbimortalidade, que evolui com complicações semelhantes. Para categorizar a gravidade da insuficiência cardíaca, utilizamos a classificação funcional da New York Heart Association, para estratificar risco e terapias para cardiopatias. Além disso, a reduzida fração de ejeção do ventrículo esquerdo, medida pelo ecocardiograma, tem relação direta com mau prognóstico. Objetivo: Comparar a relação entre a classificação funcional pela New York Heart Association e a medida da fração de ejeção do ventrículo esquerdo em pacientes ambulatoriais chagásicos e não chagásicos. Metódos: Estudo de corte transversal na coorte, composto de pacientes acompanhados em ambulatório de insuficiência cardíaca. Foram realizadas avaliação de prontuários, entrevista clínica e verificação da classificação funcional e da fração de ejeção do ventrículo esquerdo pelo ecocardiograma. Os dados foram arquivados em banco de dados e analisados pelo Statistical Package for the Social Sciences. Resultados: No período de agosto de 2018 a julho de 2019, foram selecionados 127 indivíduos com insuficiência cardíaca. Destes, 34 (26,8%) eram portadores da doença de Chagas e 93 (73,3%) eram não Chagas. Observou-se predominância do sexo masculino (53,5%) e de idade >60 anos (61,4%). Houve predomínio da classe funcional II nos grupos. Em relação à fração de ejeção dos pacientes chagásicos e não chagas, observou-se que, respectivamente, 71% contra 93% dos pacientes tinham fração de ejeção reduzida, 21% versus 6% tinham fração de ejeção intermediária e 8% versus 1% fração de ejeção preservada. Conclusão: Houve associação entre classe funcional avançada e reduzida fração de ejeção do ventrículo esquerdo principalmente em chagásicos, podendo ser usada para acompanhamento evolutivo ambulatorial. (AU)


Introduction: Chagas disease, an infection caused by the protozoan Trypanosoma cruzi, is an important health problem worldwide that causes cardiac dilation, arrhythmias, and death. Heart failure is a complex syndrome with high morbidity and mortality rates that progresses with similar complications. The New York Heart Association functional classification is used to categorize heart failure severity and stratify heart disease risks and therapies. A reduced left ventricular ejection fraction measured by echocardiography is directly related to a poor prognosis. Objective: To compare the relationship between New York Heart Association functional classification and left ventricular ejection fraction in Chagas versus no Chagas disease outpatients. Methods: Cross-sectional study in a cohort of patients followed at a heart failure clinic. Medical records, clinical interviews, functional classification, and left ventricular ejection fraction by echocardiography were analyzed. The data were filed in a database and analyzed using SPSS software. Results: A total of 127 patients with heart failure were selected from August 2018 to July 2019. Of them, 34 (26.8%) had Chagas disease and 93 (73.3%) had no Chagas disease. There was a predominance of men (53.5%) and patients aged > 60 years (61.4%). There was also a predominance of functional class II. Of the Chagas and no Chagas disease patients, 71% versus 93% had a reduced ejection fraction, 21% versus 6% had a mid-range ejection fraction, and 8% versus 1% had a preserved ejection fraction, respectively. Conclusion: There was an association between advanced functional class and reduced left ventricular ejection fraction, especially in Chagas patients, information that can be used for outpatient follow-up. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Stroke Volume , Chagas Cardiomyopathy/physiopathology , Heart Failure/classification , Heart Failure/physiopathology , Cross-Sectional Studies , Heart Failure, Systolic/classification , Heart Failure, Systolic/etiology , Heart Failure, Systolic/physiopathology , Heart Failure/etiology
9.
Arq. bras. cardiol ; 115(5): 945-948, nov. 2020. tab, graf
Article in Portuguese | SES-SP, LILACS, SES-SP | ID: biblio-1142261

ABSTRACT

Resumo Evidências recentes sugerem que a amiloidose cardíaca é uma doença amplamente subdiagnosticada, particularmente na sua forma ligada à transtirretina, podendo ser uma causa comum de insuficiência cardíaca com fração de ejeção preservada (ICFEP) no idoso. Os novos paradigmas sobre a doença incluem o desenvolvimento de novas terapias específicas que modificam a história natural da doença. Este artigo traz uma síntese destes novos conceitos.


Abstract Recent evidence suggests cardiac amyloidosis (CA) is a mostly underdiagnosed condition, particularly in the transthyretin-mediated form, and is a frequent cause of heart failure with preserved ejection fraction (HFpEF) in the elderly. New paradigms about CA also involve the development of disease-modifying specific therapies. This article summarizes these new concepts.


Subject(s)
Humans , Aged , Heart Failure/etiology , Amyloidosis , Stroke Volume , Prealbumin
10.
Arch. cardiol. Méx ; 90(2): 173-176, Apr.-Jun. 2020. graf
Article in English | LILACS | ID: biblio-1131027

ABSTRACT

Abstract Relapsing polychondritis (RP) is an inflammatory disease that involves cartilaginous structures predominantly in the nose, ears, and respiratory tract. Cardiovascular involvement is not common. Despite this, they are the second cause of death in patients with RP. The structures usually affected by this disease are the heart valves, with regurgitation being the most common valvulopathy. We present the case of a patient without the previous diagnosis of RP who was referred to our institute with heart failure secondary to aortic regurgitation, initially attributed to endocarditis.


Resumen La policondritis recurrente (PR) es una enfermedad inflamatoria que afecta a estructuras cartilaginosas, predominantemente las que se encuentran en nariz, pabellones auriculares y vías respiratorias. Las manifestaciones cardiovasculares son poco comunes; sin embargo, son la segunda causa de mortalidad en pacientes con PR. Unas de las estructuras afectadas casi siempre en la PR son las estructuras valvulares y la valvulopatía más común es la insuficiencia aórtica (IA). A continuación se presenta el caso de una paciente sin diagnóstico previo de PR a quien se refirió a este instituto por insuficiencia cardíaca secundaria a IA, atribuida en un principio a endocarditis.


Subject(s)
Humans , Female , Adult , Aortic Valve Insufficiency/diagnosis , Polychondritis, Relapsing/complications , Heart Failure/diagnosis , Aortic Valve Insufficiency/etiology , Polychondritis, Relapsing/diagnosis , Endocarditis/diagnosis , Heart Failure/etiology
12.
Rev. chil. cardiol ; 39(1): 24-33, abr. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115446

ABSTRACT

INTRODUCCIÓN: Los ratones SR-B1 KO/ApoER6 1h/h que son alimentados con una dieta rica en grasas saturadas, desarrollan enfermedad coronaria aterosclerótica severa, complicaciones isquémicas e insuficiencia cardíaca, con alta mortalidad. Los estudios con este modelo se han enfocado fundamentalmente en la enfermedad coronaria y menos en el remodelado cardíaco. El OBJETIVO del trabajo ha sido caracterizar el remodelado miocárdico, evaluar la evolución temporal de la función ventricular izquierda y la sobrevida asociada a enfermedad cardíaca por ateromatosis. MÉTODO: Ratones homocigotos SR-B1 KO/ApoER6 1h/h fueron alimentados por 8 semanas con dieta aterogénica o dieta normal y se comparó la sobrevida en ambos grupos. A las 4 semanas se realizó un ecocardiograma bidimensional. En los ratones eutanasiados se evaluó en la pared cardíaca fibrosis miocárdica y tamaño de los cardiomiocitos por morfometría, apoptosis con técnica de TUNEL e infiltración por células inflamatorias mononucleares (ED1) por inmunohistoquímica. RESULTADOS: En el grupo que recibió dieta aterogénica la sobrevida se redujo en 46,7% (p < 0.001), debido a muerte súbita y a falla cardíaca progresiva. En este grupo, a las 4 semanas se observó dilatación de cavidades izquierdas y disminución de la fracción de eyección del ventrículo izquierdo en comparación con el grupo control (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01). También se observó aumento de la masa cardíaca relativa de 2.1 veces (p<0,001) y del peso pulmonar relativo en 80% (p<0,001), sin cambios en las dimensiones de los cardiomiocitos. En el miocardio de los ratones que recibieron dieta aterogénica hubo un aumento de la fibrosis cardíaca de 7.9 veces (p < 0.01) y del número de cardiomiocitos apoptóticos en 55.9 veces (p < 0.01), junto a un aumento del número de células inflamatorias mononucleares ED1. CONCLUSIONES: En el modelo de falla cardíaca severa de etiología isquémica con alta mortalidad en el ratón homocigoto SR-B1 KO/ApoER6 1h/h sometido a una dieta aterogénica, con falla cardíaca izquierda por disfunción sistólica, el remodelado patológico del miocardio está dado fundamentalmente por apoptosis y fibrosis. También se observa un aumento discreto de macrófagos en la pared cardíaca. Es posible que el edema parietal también pueda ser un mecanismo de remodelado relevante en este modelo.


Abstract: SR-B1 KO/ApoER6 1h/h mice fed a high saturated fat diet develop severe coronary atheromatosis, and cardiac failure with a high mortality rate. Cardiac remodeling under these conditions has not been well studied. AIM: To evaluate the time course of left ventricular function, cardiac remodeling and survival associated to the administration of an atherogenic diet. METHOD: Homozygote SR-B1 KO/ApoER6 1h/h mice received an atherogenic diet for 8 weeks. Mice receiving a normal diet served as controls. Survival rate, myocardial fibrosis, cardiomyocyte size, apoptosis and infiltration by inflammatory or mononuclear cells were compared between groups. A TUNEL technique was used to evaluate apoptosis. RESULTS: A 46.7% survival reduction compared to controls was observed in the experimental group (p<0.01), due to left ventricular and atrial dilatation associated to a decrease in ejection fraction (79,3 ± 1,3% vs 66 ± 3,7%, p<0,01, respectively). Also, an increased cardiac weight, 2.6 times greater was observed in the experimental group, compared to controls. Mice receiving the atherogenic diet showed an 80% increased lung weight. There was no evident change in cardiomyocytes, but there was more (7.9 times) cardiac fibrosis (p<0.01) and 55.9 times more apoptotic cells. (p<0.01), along with a greater number of inflammatory cells and ED1 mononuclear cells. CONCLUSION: Mice receiving an atherogenic diet develop heart failure and reduced survival rate. This is associated with cardiac remodeling with underlying apoptosis an ventricular wall fibrosis. It is posible that wall edema might contribute to the observed cardiac remodeling.


Subject(s)
Animals , Mice , Ventricular Remodeling , Diet, Atherogenic , Heart Failure/etiology , Hyperlipidemias/pathology , Ischemia/etiology , Fibrosis , Survival Analysis , Ventricular Function, Left , Apoptosis , Mice, Knockout , Ventricular Dysfunction , Disease Models, Animal , Heart Failure/physiopathology , Heart Failure/mortality , Heart Failure/pathology , Ischemia/physiopathology , Ischemia/mortality , Ischemia/pathology
13.
Medwave ; 20(7): e8008, 2020.
Article in English, Spanish | LILACS | ID: biblio-1122676

ABSTRACT

En diciembre de 2019 se reportó en Wuhan, China, la aparición de una nueva cepa de coronavirus SARS-CoV-2 que producía un compromiso pulmonar severo y progresaba a estrés respiratorio agudo. A la fecha, son más de diecisiete millones los casos confirmados y más de medio millón los fallecidos en todo el mundo a causa de COVID-19. Los estudios reportan que los pacientes con enfermedad cardiovascular son más susceptibles a contraer esta enfermedad y a presentar más complicaciones. El propósito de esta revisión es proporcionar información actualizada para los profesionales de la salud que atienden a pacientes con COVID-19 y que tienen además enfermedad cardiovascular y por ende un riesgo elevado de complicaciones y mortalidad. Realizamos una búsqueda de bibliografía científica acerca de la asociación de enfermedad cardiovascular y COVID-19 en diferentes bases de datos como Scopus, MEDLINE vía PubMed y Cochrane Library. El tratamiento con inhibidores de la enzima convertidora de angiotensina y bloqueadores del receptor de angiotensina ha sido motivo de discusión y no hay evidencia sólida para contraindicarlo en pacientes con COVID-19. Respecto al tratamiento con hidroxicloroquina asociado o no con azitromicina, hay evidencia que demuestra un mayor riesgo con su utilización, que beneficio clínico y/o disminución de mortalidad. En este contexto, los pacientes con insuficiencia cardíaca representan un grupo importante de riesgo por su condición per se y por el dilema diagnóstico generado al evaluar un paciente con COVID-19, en el que los signos de insuficiencia cardíaca aguda podrían enmascararse. Por otro lado, en los pacientes con síndrome coronario agudo, el enfoque terapéutico inicial podría cambiar en el contexto de la pandemia, aunque sólo sobre la base de opiniones de expertos. Quedan, sin embargo, muchos temas en controversia que serán motivo de investigaciones futuras.


In December 2019, a new strain of the SARS-CoV-2 coronavirus was reported in Wuhan, China, which produced severe lung involvement and progressed to respiratory distress. To date, more than seventeen million confirmed cases and more than half a million died worldwide from COVID-19. Patients with cardiovascular disease are more susceptible to contracting this disease and presenting more complications. We did a literature search on the association of cardiovascular disease and COVID-19 in databases such as Scopus, PubMed/MEDLINE, and the Cochrane Library. The purpose of this review is to provide updated information for health professionals who care for patients with COVID-19 and cardiovascular disease, given that they have a high risk of complications and mortality. Treatment with angiotensin-converting enzyme inhibitors and receptor blockers is controversial, and there is no evidence not to use these medications in patients with COVID-19. Regarding treatment with hydroxychloroquine associated or not with azithromycin, there is evidence of a higher risk with its use than clinical benefit and decreased mortality. Likewise, patients with heart failure are an important risk group due to their condition per se. Patients with heart failure and COVID-19 are a diagnostic dilemma because the signs of acute heart failure could be masked. On the other hand, in patients with acute coronary syndrome, the initial therapeutic approach could change in the context of the pandemic, although only based on expert opinions. Nonetheless, many controversial issues will be the subject of future research.


Subject(s)
Humans , Cardiovascular Diseases/complications , SARS-CoV-2 , COVID-19/complications , Antiviral Agents/adverse effects , Prognosis , Renin-Angiotensin System/physiology , Algorithms , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Azithromycin/adverse effects , Peptidyl-Dipeptidase A/metabolism , Drug Therapy, Combination , Electrocardiography/drug effects , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/therapy , Pandemics , COVID-19/drug therapy , Heart Failure/etiology , Heart Failure/therapy , Hydroxychloroquine/adverse effects , Hypertension/complications , Hypertension/drug therapy
14.
Autops. Case Rep ; 10(3): e2020204, 2020. graf
Article in English | LILACS | ID: biblio-1131831

ABSTRACT

We present the case of a female patient diagnosed in childhood with Friedreich Ataxia (FA). At the age of 6, she developed left congestive heart failure with cardiomyopathy, as evident on echocardiogram. Neurologic signs only appeared at age 7, including marked loss of muscle mass, gait instability, muscle clonus, and Babinski's signal. At age 27, she had a stroke and was hospitalized; a few days later, she had a cardiorespiratory arrest with asystole, leading to death. The autopsy disclosed severe cardiomyopathy and significant myocardial replacement with fibrosis; therefore, the cause of death was assumed to be heart failure. Compared to the literature, our case has some unique features, such as cardiac disease as the presenting manifestation instead of gait instability, which is the major initial sign in most FA cases. Since our patient was submitted to an autopsy, it was an opportunity to retrieve important data to confirm the diagnosis and to evaluate the pathophysiology of this entity, such as myocardium fibrosis and cerebellar degeneration. In summary, our case demonstrates that cardiac disease can be the first manifestation of FA, with eventual diagnostic and prognostic implications. In addition, the autopsy provided findings of severe cardiomyopathy associated with FA.


Subject(s)
Humans , Female , Adult , Friedreich Ataxia/complications , Heart Diseases , Autopsy , Cerebellar Ataxia , Fatal Outcome , Heart Failure/etiology
16.
Rev. medica electron ; 41(4): 862-878, jul.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1094094

ABSTRACT

RESUMEN Introducción: las enfermedades cardiovasculares constituyen la principal causa de muerte en la mayoría de los países. Se describen los factores de riesgo para enfermedad coronaria como no modificables: edad, sexo y antecedentes familiares; y modificables relacionados al estilo de vida: tabaquismo, dislipidemia, obesidad, sedentarismo, diabetes, uso abusivo de alcohol y la enfermedad hipertensiva. Objetivo: caracterizar los factores de riesgo asociados a la cardiopatía isquémica en Atención Secundaria de Salud. Materiales y métodos: estudio observacional, descriptivo transversal en pacientes ingresados en el Hospital "Mártires del 9 de Abril" de Sagua la Grande, en el periodo comprendido entre los años 2016 y 2017. Integraron la muestra 96 pacientes que ingresaron con diagnóstico de cardiopatía isquémica. Se describieron las características demográficas de los mismos; fueron identificados los factores de riesgo y se determinó la frecuencia de asociación de otras formas clínicas de ateromatosis. Resultados: los pacientes fueron mayores de 60 años de edad; la mayoría tenían color de la piel blanca; presentaban antecedentes patológicos familiares de cardiopatía isquémica; las principales formas de cardiopatía isquémica fueron: angina e insuficiencia cardiaca; todos los pacientes presentaron uno o más factores de riesgo cardiovascular, los más significativos fueron, hipertensión arterial, tabaquismo aumento de la circunferencia abdominal y personalidad tipo "A". Conclusiones: la mayoría de los pacientes exhibieron alteraciones en el electrocardiograma: descenso del segmento ST, bloqueo de rama izquierda del haz de His y fibrilación auricular; se observó hipertrigliceridemia y se apreció asociación entre enfermedad renal crónica y angina.


ABSTRACT Introduction: cardiovascular diseases are the main cause of death in most of the countries. The risk factors for coronary disease are described as unmodifiable: age, sex and family history; and modifiable related to lifestyle: smoking, dyslipidemia, obesity, sedentary lifestyle, diabetes, abusive use of alcohol and hypertensive disease. Objective: to characterize the risk factors associated to ischemic heart disease in secondary health care. Material and methods: observational, cross-sectional, descriptive study in patients admitted in "Mártires del 9 de Abril" Hospital, Sagua la Grande, between 2016 and 2017. The sample consisted of 96 patients admitted with a diagnosis of ischemic heart disease. Their demographic characteristics were described; the risk factors were identified and the frequency of association of other clinical forms of atheromatosis was determined. Results: the patients were aged more than 60 years; most of them were white people and had family pathological antecedents of ischemic heart disease; the main forms of ischemic heart disease were angina and heart failure; all patients showed one or more cardiovascular risk factors being arterial hypertension, smoking, increase of abdominal circumference and type A personality the most significant ones. Conclusions: the majority of patients showed alterations in the electrocardiogram: ST segment decrease, His bundle left branch blockage and atrial fibrillation; hypertriglyceridemia was observed and there was an association between chronic kidney disease and angina.


Subject(s)
Humans , Aged , Tobacco Use Disorder/etiology , Risk Factors , Myocardial Ischemia/diagnosis , Myocardial Ischemia/genetics , Myocardial Ischemia/epidemiology , Hypertension/etiology , Inpatients , Cardiovascular System/physiopathology , Epidemiology, Descriptive , Cross-Sectional Studies , Abdominal Circumference , Observational Study , Heart Failure/etiology , Angina Pectoris/etiology , Life Style
17.
Arq. bras. cardiol ; 113(2): 197-204, Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019399

ABSTRACT

Abstract Background: Elevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic vascular disease. However, there are limited data regarding association between Lp(a) and recurrent heart failure (HF) in patients with chronic HF caused by coronary heart disease (CHD). Objective: Elevated levels of Lp(a) might have a prognostic impact on recurrent HF in patients with chronic HF caused by CHD. Methods: A total of 309 patients with chronic HF caused by CHD were consecutively enrolled in this study. The patients were divided into 2 groups according to whether Lp(a) levels were above or below the median level for the entire cohort (20.6 mg/dL): the high Lp(a) group (n = 155) and the low Lp(a) group (n = 154). A 2-sided p < 0.05 was statistically considered significant. Results: During the median follow-up period of 186 days, 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. A Kaplan-Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of recurrent HF than those with lower Lp(a) levels (log-rank < 0.0001). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the incidence of recurrent HF after adjustment of potential confounders (hazard ratio: 2.720, 95 % confidence interval: 1.730-4.277, p < 0.0001). Conclusions: In Chinese patients with chronic HF caused by CHD, elevated levels of Lp(a) are independently associated with recurrent HF.


Resumo Fundamento: Níveis plasmáticos elevados de lipoproteína (a) [Lp(a)] são reconhecidos como um fator de risco significativo para doença vascular aterosclerótica. No entanto, existem dados limitados sobre a associação entre a Lp(a) e insuficiência cardíaca (IC) recorrente em pacientes com IC crônica causada por doença arterial coronariana (DAC). Objetivo: Níveis elevados de Lp(a) podem ter um impacto prognóstico na IC recorrente em pacientes com IC crônica por DAC. Métodos: Um total de 309 pacientes com IC crônica causada por DAC foram consecutivamente incluídos neste estudo. Os pacientes foram divididos em 2 grupos de acordo com os níveis de Lp(a), acima ou abaixo do nível mediano de toda a coorte (20,6 mg/dL): o grupo Lp(a) alto (n = 155) e o grupo Lp ( a) baixo (n = 154). Um p < 0,05 bicaudal foi considerado estatisticamente significativo. Resultados: Durante a mediana do período de seguimento de 186 dias, 31 casos de um total de 309 pacientes (10,03%) não puderam ser contatados durante o acompanhamento. A análise de Kaplan-Meier demonstrou que pacientes com níveis mais elevados de Lp(a) apresentavam maior incidência de IC recorrente do que aqueles com níveis mais baixos de Lp(a) (log-rank < 0,0001). Uma análise de regressão multivariada de Cox revelou que os níveis de Lp(a) foram independentemente correlacionados com a incidência de IC recorrente após ajuste de potenciais fatores de confusão (hazard ratio 2,720, intervalo de confiança de 95%: 1,730-4,277, p < 0,0001). Conclusões: Em pacientes chineses com IC crônica causada por DAC, níveis elevados de Lp(a) estão associados de forma independente à IC recorrente.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Coronary Artery Disease/blood , Heart Failure/blood , Lipoproteins/blood , Recurrence , Reference Values , Time Factors , Coronary Artery Disease/complications , Echocardiography , Chronic Disease , Regression Analysis , Retrospective Studies , Risk Factors , Statistics, Nonparametric , Risk Assessment/methods , Kaplan-Meier Estimate , Heart Failure/etiology
18.
Med. infant ; 26(2): 189-196, Junio 2019. Tab, ilus
Article in Spanish | LILACS | ID: biblio-1021542

ABSTRACT

La Insuficiencia Cardíaca (IC) es un síndrome clínico que epresenta una de las mayores causas de mobi-mortalidad en pacientes pediátricos. Refleja la incapacidad del corazón para satisfacer las necesidades metabólicas del organismo, incluido el crecimiento y el ejercicio. En el niño la causa más frecuente es la cardiopatía congénita. Otras causas las miocardiopatía, las miocarditis, las arritmias y las causas no cardíacas como: insuficiencia renal, hipertensión arterial, enfermedades pulmonares crónicas, anemia, sepsis, hiper e hipotiroidismo, cardiotoxicidad, etc. Clásicamente el tratamiento estaba dirigido a mejorar la contractilidad y evitar la retención hidrosalina con digital y diuréticos. En la actualidad, dado a la mejor comprensión del mecanismo fisiopatológico, en los últimos años, el tratamiento se centra en el control de los sistemas renina-angiotensina (SRAA) y nervioso simpático. En los casos de IC descompensada que presentan síndrome de bajo gasto cardíaco que no responde a la terapia médica, previo al trasplante cardíaco, está indicado el soporte mecánico (AU)


Heart failure (HF) reflects the inability of the heart to meet the metabolic needs of the body, including growth and exercise. In the child, the most common cause is congenital heart disease. Other causes are cardiomyopathy, myocarditis, arrhythmias, and non-cardiac causes, such as renal failure, high blood pressure, chronic pulmonary diseases, anemia, sepsis, hyper- and hypothyroidism, cardiotoxicity. Classically, the treatment aimed at improving contractility and avoiding salt and fluid retention using digitalis and diuretics. Given the current better understanding of the pathophysiological mechanism, over the past years treatment has focused on the control of renin-angiotensin (RAAS) and sympathetic nervous systems. In cases of decompensated HF with low cardiac output syndrome not responding to medical therapy, prior to cardiac transplantation mechanical support is indicated (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/drug therapy , Heart Failure/therapy , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cardiotonic Agents/therapeutic use , Heart-Assist Devices , Adrenergic beta-Agonists/therapeutic use , Diuretics/therapeutic use
19.
Arq. bras. cardiol ; 112(4): 410-421, Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1001291

ABSTRACT

Abstract Background: Considering the potential deleterious effects of right ventricular (RV) pacing, the hypothesis of this study is that isolated left ventricular (LV) pacing through the coronary sinus is safe and may provide better clinical and echocardiographic benefits to patients with bradyarrhythmias and normal ventricular function requiring heart rate correction alone. Objective: To assess the safety, efficacy, and effects of LV pacing using an active-fixation coronary sinus lead in comparison with RV pacing, in patients eligible for conventional pacemaker (PM) implantation. Methods: Randomized, controlled, and single-blinded clinical trial in adult patients submitted to PM implantation due to bradyarrhythmias and systolic ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred before PM implantation. The main results of the study were procedural success, safety, and efficacy. Secondary results were clinical and echocardiographic changes. Chi-squared test, Fisher's exact test and Student's t-test were used, considering a significance level of 5%. Results: From June 2012 to January 2014, 91 patients were included, 36 in the RV Group and 55 in the LV Group. Baseline characteristics of patients in both groups were similar. PM implantation was performed successfully and without any complications in all patients in the RV group. Of the 55 patients initially allocated into the LV group, active-fixation coronary sinus lead implantation was not possible in 20 (36.4%) patients. The most frequent complication was phrenic nerve stimulation, detected in 9 (25.7%) patients in the LV group. During the follow-up period, there were no hospitalizations due to heart failure. Reductions of more than 10% in left ventricular ejection fraction were observed in 23.5% of patients in the RV group and 20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed that 91.2% of subjects in the RV group and 68.8% of those in the LV group had interventricular dyssynchrony (p = 0.022). Conclusion: The procedural success rate of LV implant was low, and the safety of the procedure was influenced mainly by the high rate of phrenic nerve stimulation in the postoperative period.


Resumo Fundamento: Considerando-se os potenciais efeitos deletérios da estimulação do ventrículo direito (VD), a hipótese desse estudo é que a estimulação unifocal ventricular esquerda pelo seio coronário é segura e pode proporcionar melhores benefícios clínicos e ecocardiográficos aos pacientes com bradiarritmias que apresentam função ventricular normal, necessitando apenas da correção da frequência cardíaca. Objetivos: Avaliar a segurança, a eficácia e os efeitos da estimulação do ventrículo esquerdo (VE), utilizando um cabo-eletrodo com fixação ativa, em comparação à estimulação do VD. Métodos: Estudo clínico, randomizado, simples-cego em pacientes adultos com indicação de marca-passo (MP) devido a bradiarritmias e função ventricular sistólica ≥ 0,40. A randomização aleatória (VD vs VE) ocorreu antes do procedimento. Os desfechos primários do estudo foram: o sucesso, a segurança e a eficácia do procedimento proposto. Os desfechos secundários foram: a evolução clínica e alterações ecocardiográficas. Empregou-se os testes Qui-quadrado, Exato de Fisher e t de Student, com nível de significância de 5%. Resultados: De junho de 2012 a janeiro de 2014 foram incluídos 91 pacientes, sendo 36 no grupo VD e 55 no grupo VE. As características basais dos pacientes dos dois grupos foram similares. O implante de MP foi realizado com sucesso e sem nenhuma intercorrência em todos os pacientes do grupo VD. Dos 55 pacientes inicialmente alocados para o grupo VE, o implante do cabo-eletrodo em veias coronárias não foi possível em 20 (36,4%) pacientes. Dentre os 35 pacientes que permaneceram com o cabo-eletrodo no VE, a estimulação frênica foi a complicação mais frequente e foi detectada em 9 (25,7%) pacientes. Na fase de seguimento clínico, não houve hospitalizações por insuficiência cardíaca. Reduções superiores a 10% na fração de ejeção do VE foram observadas em 23,5% dos pacientes do grupo VD e em 20,6% dos pacientes do grupo VE (p = 0,767). A análise feita pelo Doppler tecidual mostrou que 91,2% dos indivíduos do grupo VD e 68,8% dos do grupo VE apresentaram dissincronia interventricular (p = 0,022). Conclusões: A taxa de sucesso do implante no VE foi baixa e a segurança do procedimento foi influenciada, principalmente, pela alta taxa de estimulação frênica no pós-operatório.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pacemaker, Artificial/adverse effects , Bradycardia/therapy , Cardiac Pacing, Artificial/methods , Heart Ventricles/physiopathology , Stroke Volume , Bradycardia/physiopathology , Cardiac Pacing, Artificial/adverse effects , Single-Blind Method , Reproducibility of Results , Treatment Outcome , Prosthesis Implantation/methods , Heart Failure/etiology , Heart Failure/physiopathology
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