Prognosis of Heart Failure with Preserved Ejection Fraction in Primary Care by the H2FPEF Score

Abstract Background: Primary care physicians have difficulty dealing with patients who have HF with preserved LVEF(HFpEF). The prognosis of HFpEF is poor, and difficult to predict on primary care. Objective: The aim of the study is to apply the H2FPEF score to primary care patients and verify its power to assess the risk of death or hospitalization due to cardiovascular disease. Methods: This longitudinal study included 402 individuals, with signs or symptoms of HF, aged≥45 years and, underwent an evaluation which included clinical examination, BNP and echocardiogram. The diagnosis of HFpEF was confirmed by the criteria of the European Society of Cardiology. After five years, the patients were reassessed as to the occurrence of the composite outcome, death from any cause or hospitalization for cardiovascular disease. H2FPEF used six variables: body mass index, medications for hypertension, age, pulmonary artery systolic pressure, atrial fibrillation and E/e' ratio ranged from 0 to 9 points. The level of statistical significance was p<0.05. Results: HFpEF was diagnosed in 58(14.4%). Among patients with H2FPEF≥4, 30% had HFpEF and in those with a score≤4, HFpEF was present in 12%. Patients with HFpEF and H2FPEF≥4 had 53% of outcomes, whereas patients with HFpEF and a score ≤4 had a 21% of outcomes. BNP values were higher in patients with HFpEF compared to those without HFpEF(p<0.0001). Conclusion: H2FPEF≥4 indicated a worse prognosis in patients with HFpEF assisted in primary care. H2FPEF may be a simple and useful tool for risk stratification in patients with HFpEF at the primary care.

Disfunción cardiaca en la cirrosis hepática / Cardiac dysfunction in liver cirrhosis

Objetivo: determinar las alteraciones de la función cardiaca en las personas que padecen cirrosis hepática. Métodos: se desarrolló un estudio descriptivo transversal en el Instituto de Gastroenterología durante el período 2011-2012, en 33 cirróticos de causa viral y alcohólica, 57,6 por ciento del sexo masculino, con una edad promedio de 50 años, la mayoría (84,8 por ciento) tenía la enfermedad compensada. Resultados: la disfunción diastólica fue la alteración cardiaca más frecuente (39,3 por ciento) seguida de la prolongación del intervalo QT (12,1 por ciento), disfunción sistólica (6,1 por ciento) y miocardiopatía cirrótica (3 por ciento). No se identificaron rasgos distintivos epidemiológicos y/o clínicos que caracterizara a estos pacientes. La circulación hiperdinámica fue más evidente en los que presentaron disfunción diastólica y en la cirrosis de origen alcohólico; las dimensiones cardiacas fueron normales en todos los casos. Conclusiones: las personas que padecen cirrosis son susceptibles de presentar alteraciones de la función cardiaca, incluso, desde la etapa compensada de la enfermedad, lo que debe considerarse por las implicaciones terapéuticas que demanda este tipo de paciente...

Objective: to determine abnormalities of cardiac function in subjects with liver cirrhosis. Methods: a descriptive cross-sectional study was conducted at the Institute of Gastroenterology from 2011 to 2012, in 33 cirrhotic patients due to alcoholic and viral causes, 57.6 percent male, with an average age of 50 years, most (84,8 percent) had compensated disease. Results: diastolic dysfunction was the most common cardiac disorders (39.3 percent) followed by QT prolongation (12.1 percent), systolic dysfunction (6.1 percent) and cirrhotic (3 percent) cardiomyopathy interval. No distinctive epidemiological and/or clinical studies were identified to characterize these patients. The hyperdynamic circulation was more evident in those presenting diastolic dysfunction and alcohol-related cirrhosis. Cardiac dimensions were normal in all cases. Conclusions: people with cirrhosis are susceptible to alterations in cardiac function, even from the compensated stage of the disease, which should be considered by the therapeutic implications of this type of patient demand...

Exercício na insuficiência cardíaca de fração de ejeção normal / Exercise in heart failure with normal ejection fraction

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Suplementação de vitamina D na insuficiência cardíaca com fração de ejeção normal: impacto na qualidade de vida: estudo FITNESS / Vitamin D supplementation in normal ejection fraction heart: impact on quality of life: FITNESS study

Fundamentos: Estudos demonstram a importante prevalência do déficit de vitamina D (vit. D) em pacientes com insuficiência cardíaca com fração deejeção reduzida (ICFER). O déficit de vit. D se relaciona com a piora na qualidade de vida e redução do desempenho funcional. Com o envelhecimento, a insuficiência cardíaca com fração de ejeção normal (ICFEN) tornar-se-á o tipo de insuficiência cardíaca mais comum, com resultados referentes ao prognóstico semelhantes aos da ICFER. Apesar das evidências daação benéfica da vit. D no sistema cardiovascular em pacientes com ICFER, não há estudos clínicos que demonstrem a melhora morfofuncional cardiovascularcom a suplementação de vit.D em pacientes com ICFEN. Objetivo: Demonstrar a melhora da qualidade de vida e função diastólica em pacientes com ICFEN, após suplementação de vit. D. Métodos: E s t u d o p ro s p e c t i v o , d u p l o-c e g o randomizado, placebo controlado, envolvendo 40 pacientes com ICFEN e deficiência de vit. D (25OHD<30ng/mL), por 20 semanas de tratamento. Os pacientes receberão suplementação de 100.000UI decolecalciferol ou placebo no início do estudo e na 10ª semana, sob supervisão médica. Os pacientes serão avaliados por: testes funcionais (timed up and go test e 6 minute walk test), exames laboratoriais, questionário Minnesota Living with Heart Failure, eletrocardiograma e ecoDopplercardiograma, avaliando a função sistólica, a diastólica e o remodelamento ventricular no início doestudo, em 10 semanas e em 20 semanas. Conclusão: O estudo FITNESS avaliará o impacto morfofuncional cardiovascular e na qualidade de vida em 20 semanas na suplementação de colecalciferol em pacientes com ICFEN e déficit de vit. D.

Background: Studies have shown a significant prevalence of vitamin D (Vit. D) deficits in heart failure patients with reduced ejection fraction(HFREF), related to poorer quality of life andreductions in functional performance. With anaging population, heart failure with preserved ejection fraction (HFPEF) will become the most common type of heart failure (HF), with similar results for HFREF predictions. Despite evidence of the beneficial action of vit. D on the cardiovascular system in HFREF patients, there are no clinical s t u d i e s demo n s t r a t i n g c a rd i o v a s c u l a r morphofunctional improvement through vit.D supplementation in HFPEF patients. Objective: To demonstrate improvements in the quality of life and diastolic function for FPEF patients taking vit. D supplements. Methods: Prospective, double-blind, randomized, placebo-controlled study, with 40 patients with HFNEF and vit. D deficiency (25OHD <30ng/mL)for 20 weeks of treatment. Patients will receive supplements of 100,000IU of cholecalciferol (Vit. D3)or placebo at baseline and at 10 weeks under medical supervision. They will be assessed by: functional tests (timed up-and-go test and 6-minute walk test),laboratory examinations, the Minnesota Living with Heart Failure Questionnaire, electrocardiogram, evaluating systolic and diastolic functions and ventricular remodeling at baseline, and at 10 and 20weeks.Conclusion: The FITNESS study will evaluate cardiovascular morphofunctional impacts and effects on the quality of life during 20 weeks of cholecalciferol supplementation in HFPEF patients with vit. D deficits.