Intragraft vasculitis and gene expression analysis: Association with acute rejection and prediction of mortality in long-term heart transplantation.

INTRODUCTION: Vasculitis entails heterogeneous origins; it starts with an inflammatory process that leads to small vessels' necrosis, hemorrhage, and ischemic lesion, and may further result in occlusion of the vascular lumen. Vasculitis' contribution to allograft rejection is still unclear. This study aims to investigate the incidence of vasculitis in the early stages of heart transplantation as well as to assess the intragraft genes' expression associated with vascular function and subsequently to verify the way in which it affects the outcome of the allograft. METHODS: In this retrospective study, 300 archive paraffin-embedded endomyocardial biopsies from 63 heart allograft recipients were assessed. Cellular rejection and vasculitis were diagnosed through histological analysis, and antibody-mediated rejection was performed with immunohistochemical C4d staining. The transcripts of ICAM, VCAM, VEGF, CCL2, IFNG, TGFB, TNF, ADIPOR1, and ADIPOR2 genes were examined through quantitative polymerase chain reaction using B2M for normalization. RESULTS: We observed a higher prevalence of severe vasculitis in the early period of post-transplant, and recovery was observed to take place around 1 year post-transplant. Additionally, vasculitis was found to be directly associated with acute cellular rejection and antibody-mediated rejection. The intense C4d capillary positivity predicts higher long-term cardiovascular disease mortality. In comparison with the vasculitis-free group, the group with severe vasculitis displayed reduced left ventricular ejection fraction and an upregulation of VCAM and IFNG associated with the downregulation of VEGF, ADIPOR1, and ADIPOR2. CONCLUSION: The vasculitis associated with the presence of C4d and the change in intragraft gene expression profile may contribute to poor allograft outcomes.

Echocardiographic assessment of atrial function in patients with hypertrophic cardiomyopathy with and without paroxysmal atrial fibrillation.

INTRODUCTION AND OBJECTIVES: Hypertrophic cardiomyopathy (HCM) is accompanied by pathophysiological changes that predispose to the development of atrial fibrillation (AF). This arrhythmia impacts negatively on the morbidity, mortality and quality of life of these patients. Our objective was to evaluate the behavior of left atrial function, by means of atrial strain (derived from speckle tracking) and volumetric analysis by three-dimensional echocardiography, in patients with HCM with paroxysmal AF. METHOD: We analysed left atrial function in 53 patients with HCM, 25 of whom were paroxysmal AF carriers (mean age 61.7±9.9 years; 56% female) compared with 28 members of the control group (mean age 60.5±10 years; 53.6% female) who were matched especially for sex, age and other demographic data. RESULTS: It was observed that patients with HCM and a history of paroxysmal AF had lower left atrial emptying fractions than individuals in the control group; and the active atrial emptying fraction was a factor independently associated with the presence of this arrhythmia (p=0.018; odds ratio=0.93). Moreover, we found a significant reduction of the left atrial strain in all its components in the total sample of patients, with no difference between the groups. CONCLUSIONS: Measurements of atrial emptying fractions by three-dimensional echocardiography allowed differentiating patients with HCM with and without paroxysmal AF.

Association of variants in MYH7, MYBPC3 and TNNT2 with sudden cardiac death-related risk factors in Brazilian patients with hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is characterized by unexplained left ventricular hypertrophy (LVH) and is one of the major causes of sudden cardiac death (SCD). An exon-targeted gene sequencing strategy was used to investigate the association of functional variants in sarcomeric genes (MYBPC3, MYH7 and TNNT2) with severe LVH and other SCD-related risk factors in Brazilian HCM patients. Clinical data of 55 HCM patients attending a Cardiology Hospital (Sao Paulo city, Brazil) were recorded. Severe LVH, aborted SCD, family history of SCD, syncope, non-sustained ventricular tachycardia and abnormal blood pressure in response to exercise were evaluated as SCD risk factors. Blood samples were obtained for genomic DNA extraction and the exons and untranslated regions of the MYH7, MYBPC3 and TNNT2 were sequenced using Nextera® and MiSEq® reagents. Variants were identified and annotated using in silico tools, and further classified as pathogenic or benign according to the American College of Medical Genetics and Genomics guidelines. Variants with functional effects were identified in MYBPC3 (n = 9), MYH7 (n = 6) and TNNT2 (n = 4). The benign variants MYBPC3 p.Val158Met and TNNT2 p.Lys263Arg were associated with severe LVH (p < 0.05), and the MYH7 p.Val320Met (pathogenic) was associated with family history of SCD (p = 0.037). Increased risk for severe LVH was found in carriers of MYBPC3 Met158 (c.472 A allele, OR = 13.5, 95% CI = 1.80-101.12, p = 0.011) or combined variants (MYBPC3, MYH7 and TNNT2: OR = 12.39, 95% CI = 2.14-60.39, p = 0.004). Carriers of TNNT2 p.Lys263Arg and combined variants had higher values of septum thickness than non-carriers (p < 0.05). Molecular modeling analysis showed that MYBPC3 158Met reduces the interaction of cardiac myosin-binding protein C (cMyBP-C) RASK domain (amino acids Arg215-Ala216-Ser217-Lys218) with tropomyosin. In conclusion, the variants MYBPC3 p.Val158Met, TNNT2 p.Lys263Arg and MYH7 p.Val320Met individually or combined contribute to the risk of sudden cardiac death and other outcomes of hypertrophic cardiomyopathy.

[Sequence of unusual Chagas infection transmissions in the same family: mother by blood transfusion and child congenitally, with a treatment-resistant strain of Trypanosoma cruzi]. / Seqüência de transmissões não habituais da infecção chagásica em uma mesma família: transfusional para a mãe e congênita para o filho, de cepa de Trypanosoma cruzi resistente ao tratamento.

The authors present two cases of unusual transmission of Chagas infection in the same family: the mother by blood transfusion and her second child across the placenta. The child was diagnosed by chance and etiological treatment for both the mother and the child was ineffective in eradicating the parasitemia. At present, they continue to present the indeterminate form of the disease.

Correlation of Electrocardiographic Changes with Cardiac Magnetic Resonance Findings in Patients with Hypertrophic Cardiomyopathy.

BACKGROUND: Electrocardiogram is the initial test in the investigation of heart disease. Electrocardiographic changes in hypertrophic cardiomyopathy have no set pattern, and correlates poorly with echocardiographic findings. Cardiac magnetic resonance imaging has been gaining momentum for better assessment of hypertrophy, as well as the detection of myocardial fibrosis. OBJECTIVES: To correlate the electrocardiographic changes with the location of hypertrophy in hypertrophic cardiomyopathy by cardiac magnetic resonance. METHODS: This descriptive cross-sectional study evaluated 68 patients with confirmed diagnosis of hypertrophic cardiomyopathy by cardiac magnetic resonance. The patients' electrocardiogram was compared with the location of the greatest myocardial hypertrophy by cardiac magnetic resonance. Statistical significance level of 5% and 95% confidence interval were adopted. RESULTS: Of 68 patients, 69% had septal hypertrophy, 21% concentric and 10% apical hypertrophies. Concentric hypertrophy showed the greatest myocardial fibrosis mass (p < 0.001) and the greatest R wave size in D1 (p = 0.0280). The amplitudes of R waves in V5 and V6 (p = 0.0391, p = 0.0148) were higher in apical hypertrophy, with statistical significance. Apical hypertrophy was also associated with higher T wave negativity in D1, V5 and V6 (p < 0.001). Strain pattern was found in 100% of the patients with apical hypertrophy (p < 0.001). CONCLUSION: The location of myocardial hypertrophy by cardiac magnetic resonance can be correlated with electrocardiographic changes, especially for apical hypertrophy.

Resource utilization and costs related to the management of obstructive hypertrophic cardiomyopathy under the Brazilian supplementary healthcare system´s perspective: results from a modified Delphi panel / Utilização de recursos e custos relacionados ao manejo da cardiomiopatia hipertrófica obstrutiva sob a perspectiva do sistema de saúde suplementar brasileiro: resultados de um painel Delphi modificado

Objective: To generate data on the costs associated with the diagnosis and treatment of obstructive ypertrophic cardiomyopathy (HCM) from the perspective of the private health system in Brazil. Methods: A modified Delphi panel including seven different specialists (three clinical cardiologists with experience in obstructive HCM, two hemodynamicists with experience in septal ablation and two cardiac surgeons with expertise in myectomy), from two Brazilian states (São Paulo and Pernambuco), was conducted between August and November 2022. Two rounds of questions about the use of healthcare resources according to the functional class (NYHA I-IV) and a panel in a virtual platform were conducted to obtain the final consensus. Micro-costing defined costs and unit values were determined based on official price lists. Results: The total diagnosis cost per patient was estimated at BRL 11,486.81. The obstructive HCM management costs analysis showed average annual costs per patient of BRL 17,026.74, BRL 19,401.46, BRL 73,310.07, and BRL 94,885.75 for the functional classes NYHA I, NYHA II, NYHA III, and NYHA IV, respectively. The average costs per patient related to procedures in a year were BRL 12,698.53, BRL 13,462.30, BRL 58,841.67, and BRL 75,595.90 for the functional classes NYHA I, II, III, and IV, respectively. Conclusions: The annual costs of HCM management increased according to the functional class, highlighting the need for safe and effective strategies to improve patient's NYHA functional class while promoting a decrease in the need for invasive therapies.

Objetivo: Gerar dados acerca dos custos associados ao diagnóstico e tratamento da cardiomiopatia hipertrófica (CMH) obstrutiva, sob a perspectiva do sistema de saúde privado no Brasil. Métodos: Um painel Delphi modificado incluindo sete especialistas (três cardiologistas clínicos com experiência em CMH obstrutiva, dois hemodinamicistas com experiência em ablação de septo e dois cirurgiões cardíacos com experiência em miectomia) de dois estados brasileiros (São Paulo e Pernambuco) foi conduzido entre agosto e novembro de 2022. Foram realizadas duas rodadas de perguntas acerca da utilização de recursos de acordo com a classe funcional (NYHA I-IV) e uma reunião virtual para obtenção do consenso final. Os custos foram definidos por meio de microcusteio, e os valores unitários foram definidos com base em listas de preço oficiais. Resultados: O custo total do diagnóstico por paciente foi estimado em R$ 11.486,81. A análise de custos de manejo da CMH obstrutiva mostrou custos médios anuais por paciente de R$ 17.026,74, R$ 19.401,46, R$ 73.310,07 e R$ 94.885,75 para as classes funcionais NYHA I, NYHA II, NYHA III e NYHA IV, respectivamente. Os custos médios por paciente relacionados a procedimentos em um ano foram de R$ 12.698,53, R$ 13.462,30, R$ 58.841,67 e R$ 75.595,90 para as classes NYHA I, II, III e IV, respectivamente. Conclusões: Os custos anuais com o manejo da CMH aumentam de acordo com a classe funcional, destacando a necessidade de estratégias seguras e eficazes capazes de melhorar a classe funcional NYHA do paciente, ao mesmo tempo que promove diminuição da necessidade de terapias invasivas.

Correlation of Electrocardiographic Changes with Cardiac Magnetic Resonance Findings in Patients with Hypertrophic Cardiomyopathy / Correlação das Alterações Eletrocardiográficas com a Ressonância Magnética Cardíaca em Pacientes com Cardiomiopatia Hipertrófica

Abstract Background: Electrocardiogram is the initial test in the investigation of heart disease. Electrocardiographic changes in hypertrophic cardiomyopathy have no set pattern, and correlates poorly with echocardiographic findings. Cardiac magnetic resonance imaging has been gaining momentum for better assessment of hypertrophy, as well as the detection of myocardial fibrosis. Objectives: To correlate the electrocardiographic changes with the location of hypertrophy in hypertrophic cardiomyopathy by cardiac magnetic resonance. Methods: This descriptive cross-sectional study evaluated 68 patients with confirmed diagnosis of hypertrophic cardiomyopathy by cardiac magnetic resonance. The patients' electrocardiogram was compared with the location of the greatest myocardial hypertrophy by cardiac magnetic resonance. Statistical significance level of 5% and 95% confidence interval were adopted. Results: Of 68 patients, 69% had septal hypertrophy, 21% concentric and 10% apical hypertrophies. Concentric hypertrophy showed the greatest myocardial fibrosis mass (p < 0.001) and the greatest R wave size in D1 (p = 0.0280). The amplitudes of R waves in V5 and V6 (p = 0.0391, p = 0.0148) were higher in apical hypertrophy, with statistical significance. Apical hypertrophy was also associated with higher T wave negativity in D1, V5 and V6 (p < 0.001). Strain pattern was found in 100% of the patients with apical hypertrophy (p < 0.001). Conclusion: The location of myocardial hypertrophy by cardiac magnetic resonance can be correlated with electrocardiographic changes, especially for apical hypertrophy.

Resumo Fundamentos: O eletrocardiograma é o exame inicial na investigação das cardiopatias. As alterações eletrocardiográficas na cardiomiopatia hipertrófica não possuem padrão definido, tendo baixa correlação com o ecocardiograma. A ressonância magnética cardíaca vem ganhando destaque pela melhor avaliação da hipertrofia, bem como pela detecção de fibrose miocárdica. Objetivos: Correlacionar as alterações eletrocardiográficas com a localização da hipertrofia na cardiomiopatia hipertrófica pela ressonância magnética cardíaca. Métodos: Trata-se de estudo descritivo com delineamento transversal que avaliou 68 pacientes com diagnóstico confirmado de cardiomiopatia hipertrófica pela ressonância magnética cardíaca. Comparou-se o eletrocardiograma dos pacientes com a localização de maior hipertrofia miocárdica pela ressonância magnética. Admitiram-se um nível de significância estatística de 5% e intervalo de confiança de 95%. Resultados: Dos 68 pacientes, 69% possuíam hipertrofia septal, 21% concêntrica e 10% apical. A massa de fibrose miocárdica foi maior na hipertrofia concêntrica (p < 0,001), assim como o tamanho da onda R em D1 (p = 0,0280). A amplitude das ondas R em V5 e V6 (p = 0,0391, p = 0,0148) foi maior na hipertrofia apical, com significância estatística. A hipertrofia apical também se relacionou com maior negatividade da onda T em D1, V5 e V6 (p < 0,001). O padrão strain foi encontrado em 100% dos pacientes com hipertrofia apical (p < 0,001). Conclusão: A localização da hipertrofia miocárdica pela ressonância magnética pode ser correlacionada com alterações eletrocardiográficas, principalmente para hipertrofia apical.

Papillary fibroelastoma: report of seven cases.

The papillary fibroelastoma (PFE) is a benign heart tumor, mainly found in the valves. Most tumors are asymptomatic, but when present, they are nonspecific or related to embolic phenomena. They are usually diagnosed at routine imaging studies or valve surgery and autopsies. Its treatment is controversial, due to its rarity. We describe seven PFE cases diagnosed and treated at our institution between 1989 and 2010, which constitutes the largest national case series study of this pathology to date.

Fibroelastoma papilífero: relato de sete casos / Papillary fibroelastoma: report of seven cases / Fibroelastoma papilífero: relato de siete casos

O Fibroelastoma Papilífero é um tumor cardíaco benigno, encontrado principalmente nas válvulas. A maioria é assintomática, mas, quando presentes, são inespecíficos ou relacionados a fenômenos embólicos. Em geral, são diagnosticados em exames de imagem de rotina ou em cirurgias valvares e autópsias. Por sua raridade, há controvérsia sobre sua terapêutica. Descrevemos sete casos diagnosticados e tratados em nossa instituição entre 1989 a 2010, o que constitui a maior casuística nacional dessa patologia até o momento.

The papillary fibroelastoma (PFE) is a benign heart tumor, mainly found in the valves. Most tumors are asymptomatic, but when present, they are nonspecific or related to embolic phenomena. They are usually diagnosed at routine imaging studies or valve surgery and autopsies. Its treatment is controversial, due to its rarity. We describe seven PFE cases diagnosed and treated at our institution between 1989 and 2010, which constitutes the largest national case series study of this pathology to date.

El Fibroelastoma Papilífero es un tumor cardíaco benigno, encontrado principalmente en las válvulas. La mayoría es asintomático, pero, cuando están presentes, son inespecíficos o relacionados a fenómenos embólicos. En general, son diagnosticados en exámenes de imagen de rutina o en cirugías valvulares y autopsias. Por su raridad, hay controversia sobre su terapéutica. Describimos siete casos diagnosticados y tratados en nuestra institución entre 1989 y 2010, lo que constituye la mayor casuística nacional de esa patología hasta el momento.

Seqüência de transmissões não habituais da infecção chagásica em uma mesma família: transfusional para a mãe e congênita para o filho, de cepa de Trypanosoma cruzi resistente ao tratamento / Sequence of unusual Chagas infection transmissions in the same family: mother by blood transfusion and child congenitally, with a treatment-resistant strain of Trypanosoma cruzi

Os autores apresentam dois casos de transmissão não habitual da infecção chagásica em uma mesma família: a mãe, por transfusão sangüínea e seu segundo filho, via transplacentária. O diagnóstico da criança foi acidental e a resposta ao tratamento etiológico, em ambos, foi ineficaz em erradicar a parasitemia. Atualmente, mãe e filho permanecem em forma indeterminada da doença.

The authors present two cases of unusual transmission of Chagas infection in the same family: the mother by blood transfusion and her second child across the placenta. The child was diagnosed by chance and etiological treatment for both the mother and the child was ineffective in eradicating the parasitemia. At present, they continue to present the indeterminate form of the disease.

Cardiomiopatia hipertrófica / Hypertrophic cardiomyopathy

A cardiomiopatia hipertrófica caracteriza-se por hipertrofia ventricular esquerda, na ausência de condições que a justifiquem, desarranjo miofibrilar e fibrose progressiva determinada geneticamente por mutação em gene que codifica proteína do sarcômero. Sua expressão fenotípica é extremamente variada, com diferentes graus e localização de hipertrofia, sendo as formas septal assimétrica e não obstrutiva (a qual não se detecta gradiente intraventricular apesar do uso de manobras provocativas) as mais prevalentes. O tratamento visa principalmente o alívio dos sintomas e a prevenção de morte súbita com implante de cardiodesfibriladores em pacientes considerados de alto risco. Estudos recentes têm demonstrado que o uso de bloqueadores dos receptores de angiotensina II nas formas não obstrutivas da doença está associado à regressão da hipertrofia e fibrose, além da melhora da função diastólica, iniciando-se uma era de uma nova meta terapêutica, a de prevenção da progressão da doença. O tratamento farmacológico inclui os betabloqueadores, considerados medicamentos de primeira escolha, antagonistas de cálcio, disopiramida e amiodarona, a última indicada principalmente para tratamento de arritmias complexas e prevenção de recidiva da fibrilação atrial. O tratamento invasivo está indicado para os pacientes que persistem sintomáticos apesar do tratamento farmacológico otimizado e com gradientes intraventriculares de repouso ou provocados superiores a 50mmHg. Entre as modalidades de tratamento invasivo, a miectomia septal persiste como primeira escolha, seguida da alcoolização septal.

The Hypertrophic Cardiomyopathy is characterized by left ventricular hypertrophy in the absence of conditions that justify it, myofibril disarray and fibrosis, progressive, genetically determined by mutations in the gene encoding protein of the sarcomere. Its expression is extremely varied, with different degrees of hypertrophy and location, being that the septal form is asymmetric and not obstrusive (which is not detected intraventricular gradients despite the use of provocative maneuvers), the most prevalent. Treatment is intended primarily to relieve symptoms and the prevention of sudden death with implantation of cardiac defibrillators in patients considered of high risk. Recent studies have shown that the use of receptor blockers angiotensin II in non obstructive disease is associated with regression of hypertrophy and fibrosis, besides improvement in diastolic function, initiating an era of a new therapeutic goal, the prevention of disease progression. Pharmacological treatment includes beta-blockers which are considered firstchoice drugs, calcium antagonists, disopyramide and amiodarone, the latter mainly indicated for treatment of complex arrhythmias and prevention of recurrence of atrial fibrillation. The invasive treatment is indicated for patients who remain symptomatic despite optimal pharmacological treatment and with resting or provocable intraventricular gradients exceeding 50 mmHg. Among the methods of invasive treatment, septal myectomy remains the first choice, followed by percutaneous alcohol septal ablation.

Prevalência de insuficiência cardíaca congestiva após ventriculomiectomia em portadores da cardiomiopatia hipertrófica obstrutiva / Prevalence of congestive heart failure after ventriculomiectomy in patients with obstructive hypertrophyc cardiomyopathy

Objetivo - Avaliar a prevalência de insuficiência cardíaca congestiva (ICC) no pós-operatório tardio em portadores de cardiomipatia hipertrófica obstrutiva (CMHO) submetidos à ventriculomiectomia. Métodos - Trinta e seis pacientes portadores de CMHO, todos com gradiente sistólico basal intraventricular (GSBIV) * 50 mmHg foram estudados. Dezesseis deles (grupo I) foram submetidos a VM e 20 (grupo II) foram seguidos sob tratamento clínico. No grupo I, a idade variou de 2 meses a 61 anos (28,25 ñ 15,39), 10 masculino; o GSBIV variou de 50 a 192 mmHg (98,09 ñ 42,76) com um tempo médio de seguimento de 13,06 ñ 7,19 anos. No grupo II a idade variou de 2 meses a 58 anos (31,01) ñ 18,61), 12 masculinos (60%); o GSBIV variou de 52 a 185 mmHg (83,47 ñ 3508) com tempo médio de seguimento de 9,6 ñ 4,93 anos. Resultados - No grupo I, a evoluçäo foi boa em 4 pacientes (25%), estável em 2 (12,5%) e má em 3 (18%). Sete pacientes (43,75%) desenvolveram ICC em um tempo médio de 7,53 ñ 8,44 anos. Houve um óbito operatório e perdeu-se o seguimento em sete pacientes. No grupo II, a evoluçäo foi boa em 3 pacientes (15%), estável em 6(30%) e má em 9(45%). Näo registraram-se óbitos. Dois pacientes desenvolveram ICC em prazo médio de 3 anos após o aparecimento da doença e em 8 pacientes (40%) perdeu-se o controle evolutivo. Conclusäo - 1) A ICC foi mais freqüente em pacientes submetidos a VM que naqueles näo operados (p 0,05); 2) a evoluçäo a curto prazo foi melhor nos operados dos que nos näo operados

Purpose - To assess the prevalence of congestive heart failure in the late post-operative follow-up in patients with hypertrophic obstructive cardiomyophaty (HOCM) submitted to ventriculomectomy (VM). Methods - Thirty six patients with HOCM, all of them with basal intraventricular sistolic pressure gradient (BPG)³50 mmHg, were studied. Sixteen (group I) were submitted to VM and 20 (group II) remained under clinical treatment. At group I the ages were 1 month to 61 years (28.25±15.39), 10 mule (62.5%); BPG rangedirom 50 to 192 mmHg (98.09±42.76) with mean follow-up of 13.06±7.19 years. At group II the age rangedirom 2 months to 58 years (31.01±18.61); 12 male (60%); BPG rangedirom 52 to 185 mmHg (83.47±35.08) with mean follow-up of 9.6±4.93 years. Results - At group I the follow-up was good in 4 patients (25%), stable in 2 (12.5%) and poor in 3 (18%). Seven patients (43.75%) developed congestive heart failare at mean time of 7.53±8.44 years; there was one operative death and the follow-up control was lost in 7 patients. In group II, the follow-up was good in 3 patients (15%), stable in a 6 (30%) and poor in a 9 (45%); no deaths occurred. Two patients had hear failure within 3 years after the onset of the disease. The follow-up control was lost in 8 patients (40%). Conclusion - 1) congestive heart failure was more frequent in patients submitted to VM rather than the nonoperated ones (p < 0.05); 2) the short-term followup was better in operated patients rather than in nonoperated ones

Aspectos clínicos e evolutivos da miocardiopatia dilatada nos lactentes e na infância / Clinical and evolutive aspects of dilated cardiomyopathy in infants and in childhood

Avaliar os aspectos clínicos, evolutivos e de prognóstico, em lactentes e crianças com miocardiopatia dilatada (MCPD). Trinta e oito pacientes divididos em grupos: A) lactentes até 23 (11,60 ñ 6,50) meses, 15 femininos, e B) 15 crianças de 2 a 12 (5,23 ñ 3,12) anos, a maioria (10) masculinos. O estudo foi retrospectivo, através de avaliaçäo clínica, eletrocardiográfica, radiológica e ecocardiográfica. A dispnéia aos esforços (inclusive às mamadas) foi sintoma predominante, observada em 15 (65,22%) pacientes do grupo A e 10 (66,6%) do B, seguida da cianose perilabial, em 7 (30,43%) e 6 (40%) pacientes respectivamente. No grupo A, a hipótese clínica foi de miocardite inespecífica (MI) em 8 (34,79%), e de MCPD "idiopática" em 3 (13,04%). No grupo B diagnosticou-se miocardite em 10 (66,67%) - sendo 5 inespecíficos - FEM em 3 (20%) e MCPD "idiopática" em 2 (13,33%). O tempo médio de evoluçäo foi de 5,48 meses no grupo A e 18,56 no B. No grupo A a evloluçäo foi ótima em 3 (13,04%), boa em 10 (43,46%), estável em 2 (8,70%) e má em 1 (4,35%), e no B: ótima em 8 (53,33%), boa em 3 (20%) e estável em 1 (6,67%), em nenhum má evoluçäo. Houve um óbito do grupo A (4,34%) e 6 pacientes deste grupo (26,09%) e 3 (20%) do B interromperam o controle evolutivo. 1) o prognóstico dos lactentes com MCPD, inclusive com hipótese diagnóstica de FEM parece ser menos sombrio do que habitualmente se supöe; 2) o prognóstico de crianças nas quais a MCPD é diagnosticada acima de 2 anos parece ser boa; ...

Marcadores de prognósticos da insuficiência cardíaca / Prognostics makers of heart failure

A insuficiência cardíaca é uma síndrome complexa, caracterizada por disfunção ventricular, baixa tolerância ao esforço e reduzida expectativa de vida. O aumento da longevidade da população e e a progressiva redução da mortalidade das doenças coronarianas têm influenciado diretamente a sua maior prevalência.Apesar dos importantes avanços terapêuticos nos últimos anos, o transplante cardíaco permanece como a melhor alternativa para os casos refratários. Desta forma, a seleção ideal destes pacientes torna-se fundamental ante o número reduzido de doadores de órgãos...