RESUMO
The insertion-deletion (ID) polymorphism of the angiotensin-converting enzyme (ACE) gene is a marker linked to differences in plasma and cardiac ACE activity as well as to an increased mortality in patients with idiopathic heart failure. We examined the possibility that ACE gene ID variants are associated with differences in left ventricular (LV) systolic performance or internal LV dimensions in a high-risk cohort of patients with idiopathic dilated cardiomyopathy (IDC). The ACE genotype was determined in 171 patients selected with IDC in New York Heart Association functional class II to III heart failure and with a LV ejection fraction of < or = 40%. Left ventricular performance and dimensions were assessed using echocardiography (n = 161) and radionuclide ventriculography (n = 169). The frequency of ACE gene ID alleles was not different in the study versus non-age-matched (n = 171; odds ratio 0.94) and age-matched (n = 106, odds ratio 0.88) control groups. Ejection fraction was found to be worse in patients with the DD genotype (echocardiography, DD = 23.5 +/- 0.70, ID + II = 26.8 +/- 0.8, p = 0.009; ventriculography, DD = 21.7 +/- 0.9, ID + II = 25.3 +/- 0.8, p = 0.003). LV end-systolic and end-diastolic diameters were increased in patients with the DD genotype. Multifactor regression analysis showed the ACE genotype to be an independent predictor of both ejection fraction (echocardiography, p <0.02; ventriculography, p <0.03) and end-diastolic diameter (p <0.02). In conclusion, the results of this study indicate that the DD genotype of the ACE gene is independently associated with both a reduced LV systolic performance and an increased LV cavity size in patients with IDC.
Assuntos
Cardiomiopatia Dilatada/enzimologia , Ventrículos do Coração/patologia , Peptidil Dipeptidase A/genética , Sístole/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Alelos , Baixo Débito Cardíaco/enzimologia , Baixo Débito Cardíaco/genética , Baixo Débito Cardíaco/fisiopatologia , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/fisiopatologia , Estudos de Casos e Controles , Estudos de Coortes , Diástole , Ecocardiografia , Feminino , Previsões , Imagem do Acúmulo Cardíaco de Comporta , Deleção de Genes , Marcadores Genéticos , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Mutagênese Insercional/genética , Miocárdio/enzimologia , Razão de Chances , Peptidil Dipeptidase A/sangue , Peptidil Dipeptidase A/metabolismo , Polimorfismo Genético/genética , Análise de Regressão , Fatores de Risco , Volume Sistólico/fisiologia , Taxa de SobrevidaRESUMO
Echocardiographic quantification of the severity of anterior mitral leaflet retraction aids prediction of severe mitral regurgitation after balloon valvuloplasty.
