ABSTRACT
FUNDAMENTO: Estudos prévios avaliaram o papel do polimorfismo genético da enzima óxido nítrico-sintetase endotelial sobre o prognóstico na insuficiência cardíaca. Entretanto, faltam estudos relacionando o G894T e a insuficiência cardíaca na população brasileira. OBJETIVO: Avaliar a associação do G894T com o prognóstico de amostra de pacientes brasileiros com insuficiência cardíaca. MÉTODOS: Coorte com 145 pacientes com insuficiência cardíaca sistólica, num segmento de 40 meses (média = 22 meses), em dois hospitais universitários do Estado do Rio de Janeiro. Foi avaliada a relação do G894T com os desfechos: remodelamento reverso; melhora da classe funcional (NYHA); taxas de mortalidade e hospitalização. Os diâmetros do átrio e ventrículo esquerdos e a fração de ejeção do ventrículo esquerdo foram medidos na admissão e após 6 meses, para avaliação do remodelamento reverso. A melhora na classe funcional foi avaliada após 6 meses e as taxas de mortalidade e de hospitalização durante todo o seguimento. A raça foi autodeclarada. O polimorfismo G894T foi analisado por reação em cadeia de polimerase e por análise do polimorfismo dos fragmentos de restrição. RESULTADOS: A frequência genotípica foi GG (40%), GT (48,3%) e TT (11,7%), e a frequência alélica foi guanina (64,1%) e tiamina (35,8%). Não houve diferença entre as frequências genotípica ou alélica conforme a raça autodeclarada, tampouco conforme as características basais. Não houve relação entre o genótipo ou a frequência alélica e os desfechos analisados. CONCLUSÃO: Não se observou associação do polimorfismo G894T (Glu298Asp) com o prognóstico de amostra de pacientes ambulatoriais brasileiros com insuficiência cardíaca sistólica.
BACKGROUND: Previous studies have analyzed the role of the genetic polymorphism of endothelial nitric oxide synthase on heart failure prognosis. However, there are no studies relating the G894T and heart failure in Brazil. OBJECTIVE: To evaluate the association between G894T GP and the prognosis of a sample of Brazilian outpatients with heart failure. METHODS: Cohort study included 145 patients with systolic heart failure, followed for up to 40 months (mean = 22), at two university hospitals, in the State of Rio de Janeiro. We evaluated the relationship between G894T and the following outcomes: reverse remodeling, improvement in functional class (NYHA), and mortality and hospitalization rates. The diameters of the left atrium and ventricle, as well as the ejection fraction of the left ventricle, were evaluated at baseline and at 6 months to assess reverse remodeling. The improvement in functional class was evaluated after 6 months, and mortality rate and hospitalization were evaluated during follow-up. Race was self-declared. G894T polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. RESULTS: The genotypic frequencies were GG (40%), GT (48.3%) and TT (11.7%). The allele frequency was guanine (64.1%) and thiamine (35.8%). There were no differences between the genotype or allelic frequencies according to self-declared race, either as baseline characteristics. There was no relationship between genotype or allele frequency and the outcome measures. CONCLUSION: No association was observed between the G894T polymorphism (Glu298Asp) and prognosis in this sample of Brazilian outpatients with systolic heart failure.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Heart Failure/genetics , Nitric Oxide Synthase Type III/genetics , Nitric Oxide/genetics , Polymorphism, Genetic/genetics , Brazil , Epidemiologic Methods , Gene Frequency , Hospitalization , Heart Failure/mortality , Outpatients , Polymerase Chain Reaction , Prognosis , Prospective Studies , Time FactorsABSTRACT
BACKGROUND: Previous studies have analyzed the role of the genetic polymorphism of endothelial nitric oxide synthase on heart failure prognosis. However, there are no studies relating the G894T and heart failure in Brazil. OBJECTIVE: To evaluate the association between G894T GP and the prognosis of a sample of Brazilian outpatients with heart failure. METHODS: Cohort study included 145 patients with systolic heart failure, followed for up to 40 months (mean = 22), at two university hospitals, in the State of Rio de Janeiro. We evaluated the relationship between G894T and the following outcomes: reverse remodeling, improvement in functional class (NYHA), and mortality and hospitalization rates. The diameters of the left atrium and ventricle, as well as the ejection fraction of the left ventricle, were evaluated at baseline and at 6 months to assess reverse remodeling. The improvement in functional class was evaluated after 6 months, and mortality rate and hospitalization were evaluated during follow-up. Race was self-declared. G894T polymorphism was analyzed by polymerase chain reaction and restriction fragment length polymorphism. RESULTS: The genotypic frequencies were GG (40%), GT (48.3%) and TT (11.7%). The allele frequency was guanine (64.1%) and thiamine (35.8%). There were no differences between the genotype or allelic frequencies according to self-declared race, either as baseline characteristics. There was no relationship between genotype or allele frequency and the outcome measures. CONCLUSION: No association was observed between the G894T polymorphism (Glu298Asp) and prognosis in this sample of Brazilian outpatients with systolic heart failure.
Subject(s)
Heart Failure/genetics , Nitric Oxide Synthase Type III/genetics , Nitric Oxide/genetics , Polymorphism, Genetic/genetics , Aged , Brazil , Epidemiologic Methods , Female , Gene Frequency , Heart Failure/mortality , Hospitalization , Humans , Male , Middle Aged , Outpatients , Polymerase Chain Reaction , Prognosis , Prospective Studies , Time FactorsABSTRACT
Brazilian population has a multi-ethnical profile and the prevalence of endothelial nitric oxide synthase enzyme (eNOS) polymorphism in heart failure (HF) has not been previously studied. Therefore the present study assessed the association of eNOS Glu298Asp polymorphism in patients with HF and controls. In a crossover study, was analysed the distribution of the Glu298Asp in 100 outpatients with HF, and 103 healthy controls. Self-reported race were analyzed. Left atria and left ventricle diameters and ejection fraction were evaluated in patients group. Glu298Asp was analysed by polymerase chain reaction and restriction fragment length polymorphism. The patient's average age was 59 years, 66% males, 49% Afro-descendants. The allelic frequency in patient group was Glu298=72%/Asp298=28% and the genotype frequency (GF) was Glu298Glu:49%; Glu298Asp:47%; Asp298Asp:4%. In control group, 60% Glu298 and 40% Asp298; 35% Glu298Glu, 49.5% Glu298Asp and 15.5% Asp298Asp. The prevalence of allele Glu298 was significantly higher in patients (p=0.009) as genotype Glu298Glu (p=0.03). The Glu298 in Afro-Brazilians (79%) and white patients (67%) were similar, although there was significant difference (p=0.03) in GF Glu298Glu between Afro-Brazilians and whites. There was an increased prevalence of hypertension and increased atria in Glu298Glu patients comparing with combined genotype Glu298Asp and Asp298Asp. This study suggests a regional variation in the distribution of Glu298Asp. The comparison of this distribution in African-Brazilian suggests a synergistic effect of African-descendent, Glu298Glu genotype and HF. Also demonstrated an increased frequency of Glu298 and Glu298Glu, suggesting interaction of them with HF. In HF patients, the clinical, echocardiograph and genotype analysis suggests an association of Glu298 allele and hypertension.
