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Fração de Ejeção do Ventrículo Esquerdo Aumentada, Diminuída ou Estável ao Longo do Tempo em uma Série de 626 Pacientes com Insuficiência Cardíaca que Receberam Tratamento Médico / Increased, Decreased, or Stable Left Ventricle Ejection Fraction over Time in a Series of 626 Heart Failure Patients Receiving Medical Treatment
Han, Meng-Meng; Zhao, Wen-Shu; Xu, Xiao-Rong; Wang, Xin; Li, Kui-Bao; Dang, Cai-Jing; Zhang, Juan; Liu, Jia-Mei; Chen, Mu-Lei; Yang, Xin-Chun; Xu, Lin; Wang, Hua.
  • Han, Meng-Meng; Beijing Longfu Hospital. Intensive Care Unit. Beijing. CN
  • Zhao, Wen-Shu; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Xu, Xiao-Rong; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Wang, Xin; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Li, Kui-Bao; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Dang, Cai-Jing; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Zhang, Juan; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Liu, Jia-Mei; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Chen, Mu-Lei; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Yang, Xin-Chun; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Xu, Lin; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
  • Wang, Hua; Capital Medical University. Beijing Chaoyang Hospital. Heart Center and Beijing Key Laboratory of Hypertension Research. Beijing. CN
Arq. bras. cardiol ; 117(4): 639-647, Oct. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1345247
RESUMO
Resumo Fundamento A fração de ejeção (FE) tem sido utilizada em análises fenotípicas e na tomada de decisões sobre o tratamento de insuficiência cardíaca (IC). Assim, a FE tornou-se parte fundamental da prática clínica diária.

Objetivo:

Este estudo tem como objetivo investigar características, preditores e desfechos associados a alterações da FE em pacientes com diferentes tipos de IC grave.

Métodos:

Foram incluídos neste estudo 626 pacientes com IC grave e classe III-IV da New York Heart Association (NYHA). Os pacientes foram classificados em três grupos de acordo com as alterações da FE, ou seja, FE aumentada (FE-A), definida como aumento da FE ≥10%, FE diminuída (FE-D), definida como diminuição da FE ≥10%, e FE estável (FE-E), definida como alteração da FE <10%. Valores p inferiores a 0,05 foram considerados significativos.

Resultados:

Dos 377 pacientes com IC grave, 23,3% apresentaram FE-A, 59,5% apresentaram FE-E e 17,2% apresentaram FE-D. Os resultados mostraram ainda 68,2% de insuficiência cardíaca com fração de ejeção reduzida (ICFEr) no grupo FE-A e 64,6% de insuficiência cardíaca com fração de ejeção preservada (ICFEp) no grupo FE-D. Os preditores de FE-A identificados foram faixa etária mais jovem, ausência de diabetes e fração de ejeção do ventrículo esquerdo (FEVE) menor. Já os preditores de FE-D encontrados foram ausência de fibrilação atrial, baixos níveis de ácido úrico e maior FEVE. Em um seguimento mediano de 40 meses, 44,8% dos pacientes foram vítimas de morte por todas as causas.

Conclusão:

Na IC grave, a ICFEr apresentou maior percentual no grupo FE-A e a ICFEp foi mais comum no grupo FE-D.
ABSTRACT
Abstract

Background:

Ejection fraction (EF) has been used in phenotype analyses and to make treatment decisions regarding heart failure (HF). Thus, EF has become a fundamental part of daily clinical practice.

Objective:

This study aims to investigate the characteristics, predictors, and outcomes associated with EF changes in patients with different types of severe HF.

Methods:

A total of 626 severe HF patients with New York Heart Association (NYHA) class III-IV were enrolled in this study. The patients were classified into three groups according to EF changes, namely, increased EF (EF-I), defined as an EF increase ≥10%, decreased EF (EF-D), defined as an EF decrease ≥10%, and stable EF (EF-S), defined as an EF change <10%. A p-value lower than 0.05 was considered significant.

Results:

Out of 377 severe HF patients, 23.3% presented EF-I, 59.5% presented EF-S, and 17.2% presented EF-D. The results further showed 68.2% of heart failure with reduced ejection fraction (HFrEF) in the EF-I group and 64.6% of heart failure with preserved ejection fraction (HFpEF) in the EF-D group. The predictors of EF-I included younger age, absence of diabetes, and lower left ventricular ejection fraction (LVEF). The predictors of EF-D were absence of atrial fibrillation, lower uric acid level, and higher LVEF. Within a median follow-up of 40 months, 44.8% of patients suffered from all-cause death.

Conclusion:

In severe HF, HFrEF presented the highest percentage in the EF-I group, and HFpEF was most common in the EF-D group.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Heart Failure Type of study: Prognostic study Limits: Humans Language: Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2021 Type: Article Affiliation country: China Institution/Affiliation country: Beijing Longfu Hospital/CN / Capital Medical University/CN

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Full text: Available Index: LILACS (Americas) Main subject: Heart Failure Type of study: Prognostic study Limits: Humans Language: Portuguese Journal: Arq. bras. cardiol Journal subject: Cardiology Year: 2021 Type: Article Affiliation country: China Institution/Affiliation country: Beijing Longfu Hospital/CN / Capital Medical University/CN