RESUMO
We assessed prognostic value of clinical-laboratory and instrumental parameters in 100 patients with acute decompensation of chronic heart failure (CHF) in relation to hospital mortality. Independent predictors of lethal outcome in patients with acute decompensation of CHF were low systolic arterial pressure at admission (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01 to 1.05 per each 1 mm Hg of blood pressure lowering), elevation of urea content (OR 1.29, 95%CI 1.11 to 1.47 per each 1 mmol/L of elevation), potassium (OR 2.09, 95%CI 1.08 to 4.38 per 1 mmol/L of elevation) and creatinine (OR 1.01, 95%CI 1.01 to 1.03 per 1 mmol/L of elevation), lowering of glomerular filtration rate (OR 1.29, 95%CI 1.18 to 1.41 per 1 ml/min/1,73 m2 of lowering), left ventricular dilatation (OR 9.53, 95%CI 1.44 to 38.17; =0.043), pulmonary hypertension according to echocardiography data (=0.007), scarry changes according to electrocardiography data (OR 3.00, 95%CI 1.00 to 10.58; p=0.05), lack of therapy with acetylsalicylic acid (OR 6.21, 95%CI 1.62 to 22.73; =0.009) and -adrenoblockers (OR 6.99, 95%CI 1.39 to 14.49; =0,005) at ambulatory stage.
Assuntos
Pressão Sanguínea , Fármacos Cardiovasculares/uso terapêutico , Eletrocardiografia/métodos , Insuficiência Cardíaca , Mortalidade Hospitalar , Testes de Função Renal/métodos , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Progressão da Doença , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/tratamento farmacológico , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Prognóstico , Modelos de Riscos ProporcionaisRESUMO
AIM: To estimate the contribution of immuno-inflammatory changes to the formation of clinical and hemodynamic features in alcoholic patients with chronic heart failure (CHF). SUBJECTS AND METHODS: Forty-five males with CHF in the presence of alcohol-induced heart damage (AIHD) who had been admitted to therapeutic units for decompensated heart failure were examined. A control group consisted of 20 men with the CHF severity comparable with the NYHA classification in the presence of prior myocardial infarction. All the patients underwent examination of the immune-inflammatory status--the cytokines: interleukin (IL) 6, IL-8, IL-12, tumor necrosis factor-alpha (TNF-alpha), transforming growth factor-beta1, endotoxin, cellular immune parameters, and cardiac structure and function by echocardiography. RESULTS: The patients with CHF in the presence of AIHD, as compared to those with ischemic cardiomyopathy, showed the higher levels of inflammatory cytokines (IL-6, TNF-alpha, IL-12, and endotoxin) and cell-mediated immunity changes (the smaller count of suppressor T cells, natural killer cells, and a shift of the T-helper/T-suppressor ratio towards the T-helper population). The magnitude of these changes correlated with the severity of CHF and cardiac morphofunctional changes. CONCLUSION: The relationship of immuno-inflammatory changes to the severity of CHF and the morphofunctional state of the heart irrespective of the etiology of heart failure demonstrated the role of immune inflammation in its pathogenesis particularly in alcoholic patients who were found to have more marked immuno-inflammatory changes than in those with ischemic cardiomyopathy.
Assuntos
Alcoolismo/imunologia , Citocinas/biossíntese , Citocinas/sangue , Insuficiência Cardíaca/imunologia , Coração/fisiopatologia , Miocardite/imunologia , Adulto , Alcoolismo/complicações , Alcoolismo/patologia , Doença Crônica , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miocardite/etiologia , Miocardite/patologia , Índice de Gravidade de DoençaAssuntos
Infarto do Miocárdio/tratamento farmacológico , Trimetazidina/uso terapêutico , Vasodilatadores/uso terapêutico , Antagonistas Adrenérgicos beta/administração & dosagem , Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Diuréticos/administração & dosagem , Diuréticos/uso terapêutico , Quimioterapia Combinada , Ecocardiografia , Ecocardiografia Doppler , Feminino , Fibrinolíticos/administração & dosagem , Fibrinolíticos/uso terapêutico , Seguimentos , Hemodinâmica , Heparina/administração & dosagem , Heparina/uso terapêutico , Humanos , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/fisiopatologia , Nitroglicerina/administração & dosagem , Nitroglicerina/uso terapêutico , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/uso terapêutico , Terapia Trombolítica , Fatores de Tempo , Trimetazidina/administração & dosagem , Vasodilatadores/administração & dosagem , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação VentricularRESUMO
AIM: To study the hypotensive effect of the first dose in administration of perindopril and enalapril in patients with chronic cardiac failure (CCF). MATERIAL AND METHODS: The trial enrolled 213 patients with CCF of functional class II-III (mean age 57 +/- 1.4 years, 155 males and 58 females). The patients were randomized into 2 groups. Group 1 received perindopril in a dose 2 mg, group 2 received enalapril. Arterial pressure was measured for 10 hours with a 30-min interval, in the last 3 hours--once an hour. First dose hypotension was stated if systolic pressure was < 90 mmHg, diastolic under 60 mmHg, mean pressure < 75 mmHg after the first intake of the drug. RESULTS: Significant differences in the baseline pressure between the groups were absent. None of the patients demanded therapy of arterial hypotension. Side effects of hypotension were absent. In group 1 systolic pressure fell under 90 mmHg in 8(7.7%) patients, in group 2--in 24(22.0%) patients (p = 0.004), diastolic pressure fell under 60 mmHg in 47(45.2%) and 60(55.1%) patients, respectively (p = 0.151). Mean arterial pressure was < 75 mmHg in 42(40.4%) and 62(56.9%) patients, respectively, (p = 0.016). Multivariate correlation analysis has revealed a direct correlation between the first dose hypotension and age (r = 0.159, p < 0.01) and age > 70 years (r = 0.258, p < 0.01), acute myocardial infarction (r = 0.244, p < 0.01) and inverse correlation with the initial arterial pressure (r = -0.208, p < 0.01).