RESUMO
BACKGROUND AND AIM OF THE STUDY: The appropriate management of patients with mitral regurgitation (MR) and left ventricular dysfunction (LVD) is controversial. The study aim was to determine whether the presence of contractile reserve (CR) assessed by dobutamine stress echocardiography (DSE) was associated with improved outcomes. METHODS: Death and heart transplantation were analyzed as the primary outcomes associated with the presence of CR. A total of 125 consecutive patients (96 males, 29 females; mean age 60 +/- 12 years) with left ventricular ejection fraction (LVEF) < or = 35% and hemodynamically significant MR underwent DSE between 1999 and 2005. CR was defined as an increase in LVEF of > or = 10% during dobutamine infusion. RESULTS: Among 125 patients, 55 (43.0%) showed evidence of CR. Within five years after DSE, 24 patients (34.3%) in the CR- group and seven (12.7%) in the CR+ group had died or required heart transplantation (p < 0.01, log rank). After adjusting for age, baseline LVEF, NYHA class and moderate/severe tricuspid regurgitation (TR), CR remained an independent predictor of time to death or heart transplantation (HR 0.34; 95% CI: 0.15-0.76, p < 0.01). Improvement in the degree of MR was present at one year in 85.0% of CR+ patients, and in 62.5% of CR- patients (p = 0.03). An improvement of 5% in LVEF was noted in the CR+ group, compared to 0% in the CR- group (p = 0.04). CONCLUSION: In patients with advanced LVD and severe MR, CR detected by DSE was associated with significant reductions in the risk of death and heart transplantation.
Assuntos
Ecocardiografia sob Estresse , Insuficiência da Valva Mitral/diagnóstico por imagem , Contração Miocárdica , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Intervalo Livre de Doença , Feminino , Transplante de Coração , Hemodinâmica , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Insuficiência da Valva Mitral/cirurgia , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgiaRESUMO
Increased levels of N-terminal pro-brain natriuretic peptide (NT pro- BNP) in infectious settings may not reflect myocardial depression. In addition to NT pro-BNP measurement, clinical assessment remains a valuable tool for diagnosis and prognosis of heart failure. A case of excessively increased NT pro-BNP level associated with Mycobacterium tuberculosis infection that was not indicative of myocardial dysfunction is described.
Assuntos
Insuficiência Cardíaca/diagnóstico , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Tuberculose Pulmonar/sangue , Tuberculose Pulmonar/diagnóstico , Biomarcadores/sangue , Eletrocardiografia , Insuficiência Cardíaca/sangue , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Fluorbenzenos/efeitos adversos , Hiperlipidemias/tratamento farmacológico , Hipotireoidismo/diagnóstico , Doenças Musculares/induzido quimicamente , Pirimidinas/efeitos adversos , Sulfonamidas/efeitos adversos , Relação Dose-Resposta a Droga , Esquema de Medicação , Fluorbenzenos/uso terapêutico , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/diagnóstico , Hipotireoidismo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Doenças Musculares/fisiopatologia , Pirimidinas/uso terapêutico , Medição de Risco , Rosuvastatina Cálcica , Índice de Gravidade de Doença , Sulfonamidas/uso terapêutico , Testes de Função Tireóidea , Tireotropina/uso terapêuticoRESUMO
In addition to its importance in clinical assessment, N-terminal pro-brain natriuretic peptide (NT pro-BNP) is a valuable marker for evaluation of treatment and prognosis of heart failure. However, there are situations where NT pro-BNP is not related to myocardial dysfunction. Two cases of sepsis with markedly elevated NT pro-BNP levels that are not indicative of depressed myocardial function are described.