RESUMO
Left ventricular dysfunction due to adverse remodeling constitutes the underlying structural anatomical condition of heart failure and is the main and most severe sequela of long-term coronary artery disease, and it is the only pathology that can benefit from surgical myocardial revascularization. For its control, there are current medical treatment guidelines supported by the favorable results of contemporary clinical trials. However, in recent studies, there was no benefit of surgical revascularization in addition to optimal medical therapy when compared to optimal medical therapy alone. The identification of myocardial viability to guide revascularization was also not favorable. The results of the extension of these trials showed benefit of revascularization treatment, but the detection of viability remained unfavorable. Increased left ventricular ejection fraction, as a marker of benefit from revascularization, was not associated with lower mortality. There are many reasons why the known advantages of revascularization were not identified. Despite this discrepancies, myocardial revascularization and the identification of viability in these patients are supported and are usually indications for routine treatment.
Assuntos
Anti-Hipertensivos , Hipertensão , Canadá , Educação em Saúde , Humanos , Guias de Prática Clínica como AssuntoRESUMO
The aim of this study is the methodological evaluation of Clinical Practice Guidelines (CPG) in atrial fibrillation. This is the second in a series of articles of review, analysis, assessment in methodology and content of clinical practice guidelines in Cardiology. Among all clinical practice guidelines, we selected the American, Canadian and NICE (National Institute for Health and Care Excellence) guidelines. We used the AGREE (Appraisal of Guidelines for Research and Evaluation) II instrument for the assessment. In general, the guidelines obtained the lowest score in the applicability domain (mean 36.1%); while the highest score was for clarity of presentation (mean 93.5%). The lowest percentage was found in the editorial independence domain (Canadian guideline) and the highest of all scores in the applicability domain (NICE guideline). Regarding global quality, the NICE guideline obtained the AGREE II instrument best scores, followed by the American guideline, both recommended for use without modifications.
El objetivo del presente estudio es la evaluación metodológica de las guías de práctica clínica en fibrilación auricular. Este es el segundo de una serie de artículos de revisión, análisis, valoración metodológica y contenido de las guías de práctica clínica en cardiología. De todas las guías de práctica clínica se seleccionaron la Guía Americana, Canadiense y la del National Institute for Health and Care Excellence, (NICE, por su sigla en inglés), y se utilizó el instrumento Appraisal of Guidelines for Research and Evaluation (AGREE II) para evaluar cada una de ellas En general, las guías obtuvieron el menor puntaje en el dominio de aplicabilidad (media 36,1%); mientras que el mayor puntaje fue para el dominio de claridad en la presentación (media 93,5%). El menor puntaje hallado fue en el dominio de independencia editorial (Guía Canadiense) y el mayor de todos los puntajes fue en el dominio Claridad de la presentación (guía The National Institute for Health and Care Excellence, NICE). Al evaluar la calidad global de las guías de práctica clínica analizadas, NICE es la que mejor puntuaciones obtiene al aplicar el instrumento Appraisal of Guidelines for Research and Evaluation II (AGREE), seguido de la americana, siendo ambas recomendadas sin modificaciones.
Assuntos
Fibrilação Atrial/terapia , Guias de Prática Clínica como Assunto , Fibrilação Atrial/diagnóstico , Canadá , Humanos , Reino Unido , Estados UnidosRESUMO
Se evaluó la prevalencia de disincronía ventricular en pacientes con cardiomiopatía dilatada en programade rehabilitación cardiaca. METODOS: Estudio observacional, descriptivo, transversal y prospectivo donde se realizó mediciones ecocardiogrßficas yelectrocardiogrßficas en busca de disincronia intra y/o interventricular a los pacientes con cardiomiopatía dilatada, se realizó test ergométricos para relacionar la disincronía con la clase funcional. RESULTADOS: Se incluyeron 43 pacientes. En su mayoría varones (93 por ciento) con etiología isquémica. Se encontró disincronía intraventricular en 29 pacientes (67.4 por ciento) e interventricular en 14 (32.5 por ciento). El 58 por ciento de pacientes con QRS angosto y el 91 por ciento con QRS ancho tenían disincronía intraventricular. No se encontró relación entre la duración del QRS y la disincronía intraventricular. El QRS predijo disincronía con una sensibilidad del 37 por ciento y especificidad del 92 por ciento. La clase funcional empeoró con la presencia de disincronía. CONCLUSIONES: La duración normal del complejo QRS no es un parßmetro adecuado para descartar disincronía intraventricular. La presencia de un ventrículo disincrónico empeora la capacidad funcional del paciente con cardiomiopatía dilatada.
We evaluated the prevalence of ventricular dissynchrony in patients with dilated cardiomyopathy included in a cardiac rehabilitation program. METHODS: Was a descriptive, observational, transversal and prospective trial, we made ecocardiographycs and electrocardiographycs measures searching for intraventricular or interventricular dissynchrony inthose patients, there were also made ergometrics tests to correlate the dissynchrony with the functional class.RESULTS: A total of 43 patients were included, mostly men (93 per cent), with ischemic aetiology. Intraventriculardissynchrony was present in 29 patients (67.4 per cent) and interventricular dissynchrony in 14 (32.5 per cent). A 58 per cent of patients with narrow QRS complex and a 91 per cent with a wide one, had intraventricular dissynchrony. There was no relationship between the QRS complex duration and the presence of intraventricular dissynchrony. Thesensibility and specifity of QRS complex duration to predict dissynchrony was 37 per cent and 92 per cent respectively.The functional class worsened in patients with dissynchrony. CONCLUSION: The normal durationof the QRS complex is not a good parameter to rule out the presence of intraventricular dissynchrony. Adissynchronous ventricle worsens the functional class of the patient with dilated cardiomyopathy.
