[Malnutrition in dilated cardiomyopathy. Correlation with echocardiographic indices of left ventricular function]. / Desnutrição na miocardiopatia dilatada. Correlação com índices ecocardiográficos da função ventricular esquerda.

PURPOSE: To evaluate the incidence of severe protein-calorie malnutrition in patients with dilated cardiomyopathy (DC), and its correlation with left ventricular contractility. METHODS: Group A--51 patients with DC in decompensated congestive heart failure class III or IV, 36 men, aged 51.9 +/- 15.6 years. Group B--25 patients admitted for elective myocardial revascularization with normal LV contractility, 20 men, aged 57.2 +/- 10.5 years. Tricipital skinfold thickness (TS) and mid-arm muscle circumference (MAMC) were obtained in all patients. Severe protein-calorie malnutrition was defined when both measurements were below the fifth populational percentile (Frisancho tables). In Group Am the echocardiographic left ventricular (LV) diastolic diameter (DD), ejection fraction (EF) and systolic volume (SV) were obtained. Those LV parameters were compared between DC patients with and without severe malnutrition. Correlation analysis were performed between TS, MAMC and LV DD, EF, and SV, in the patients of Group A. RESULTS: Severe malnutrition occurred in 7/51 (13.7%) of Group A, and none in Group B. TS values were of 8.90 +/- 4.47 cm in Gr. A and 23.48 +/- 8.52 in B (p < 0.001). MAMC measured 22.25 +/- 3.13 cm in Gr. A and 23.58 +/- 8.52 in B (p = 0.03), LVEF was of 36.29 +/- 9.43% in severe malnutrition patients and of 37.84 +/- 9.78 in the other patients of Group A (p = 0.70). Conversely, LVDD was of 70.90 +/- 11.3 mm vs. 70.75 +/- 8.54 mm (p = 0.98), and LVSV was of 113.0 +/- 52.7 ml vs. 137.6 +/- 56.8 (p = 0.45), when compared severe malnutrition with the rest of patients of Group A. No correlation was found between TS and MAMC and LV, EF, DD and SV in Group A. CONCLUSION: Severe malnutrition was frequent in patients with DC and heart failure. TS measurements, reflecting caloric reserves, were more affected. Echocardiographic parameters of LV function did not correlate with nutritional status.

[Diet with usual quantity of salt in hospital treatment of congestive heart insufficiency]. / Dieta com quantidades habituais de sal no tratamento hospitalar da insuficiência cardíaca congestiva.

PURPOSE: To study the consequences of a diet with usual salt quantity (non salt-restricted) on hospital treatment of congestive heart failure (CHF), in behalf of a better food intake. METHODS: Thirty-two patients admitted to compensation of class III or IV CHF, randomly allowed to group I (2 g salt per day diet) or II (10 g salt). Hypertensive, renal failure or restrictive syndrome cases were excluded. Oral medication and water intake were standardized; furosemide dosage was adjusted on a daly basis, allowing the study of this drug's requirements in each group. Compensation of CHF was defined as a return to classes I or II without edema. RESULTS: Group I included 14 and group II 18 patients. There was no significant difference between groups respective to the time needed for compensation of CHF (7.5 x 6.6 days, mean) percentual weight loss (12.2 x 10.0%), cumulative furosemide dosage (568 x 599 mg), mean daily furosemide dosage per kilogram of lean weight (1.43 x 1.58 mg/kg/day), and to 24-hour urinary excretion of sodium (241 x 254 mEq) and potassium (38.8 x 53.9 mEq). Small elevations of blood urea and potassium were an uniform trend. There was no significant alteration of plasmatic sodium. Food intake was adequate. There was one death for each group, from causes not directly related to CHF. CONCLUSION: Dietary salt intake did not adversely influence in-hospital compensation of severe CHF in studied group. In selected cases, adoption of a more liberal diet in this aspect may allow the patient a better ingestion of food.