The Prevalence of Stages of Heart Failure in Primary Care: A Population-Based Study.

BACKGROUND: Planning strategies to prevent heart failure (HF) in developing countries require epidemiologic data in primary care. The purpose of this study was to estimate the prevalence of HF stages and their phenotypes, HF with preserved ejection fraction (HFPEF), and HF with reduced EF (HFREF) and to determine B-type natriuretic peptide (BNP) levels to identify HF in the adult population. METHODS AND RESULTS: This is a cross-sectional study including 633 individuals, aged ≥45 years, who were randomly selected and registered in a primary care program of a medium-sized city in Brazil. All participants were underwent clinical evaluations, BNP measurements, electrocardiograms, and tissue Doppler echocardiography in a single day. The participants were classified as stage 0 (healthy, 11.7%), stage A (risk factors, 36.6%), stage B (structural abnormalities, 42.7%), or stage C (symptomatic HF, 9.3%). Among patients with HF, 59% presented with HFPEF and 41% presented with HFREF. The mean BNP levels were 20 pg/mL(-1) in stage 0, 20 pg/mL(-1) in stage A, 24 pg/mL(-1) in stage B, 93 pg/mL(-1) in HFPEF, and 266 pg/mL(-1) in HFREF. The cutoff BNP level with optimal sensitivity (92%) and specificity (91%) to identify HF was 42 pg/mL(-1). CONCLUSION: The present study demonstrated a high prevalence of individuals at risk for HF and the predominance of HFPEF in a primary care setting. The clinical examination, along with BNP and tissue Doppler echocardiography, may facilitate early detection of stages A and B HF and allow implementation of interventions aimed at preventing progression to symptomatic HF.

Miocardiopatia alcoólica: classificaçäo anatomofuncional pelo ecocardiograma / Alcoholic cardiomyopathy: anatomo-functional classification by echocardiograhy

Com o aumento do consumo de bebidas alcoólicas em todo o mundo, vem crescendo o número de pacientes portadores das mais variadas síndromes orgânicas causadas pelo etanol, entre elas, as cardiovasculares. Com o objetivo de diagnosticarmos o comprometimento miocárdico na fase provavelmente reversível, isto é, antes da fase dilatada congestiva, estudamos 57 alcoólatras internados, principalmente, nas enfermarias das disciplinas de gastroenterologia, de dermatologia e de neurologia do Hospital Universitário Antônio Pedro. Com o auxílio do ecocardiograma, classificamos o comprometimento do miocárdico pelo álcool, após afastarmos agentes etiológicos responsáveis por cardiopatias - hipertensäo arterial sistêmica, coraçäo pulmonar crônico, aterosclerose coronariana, cardiopatias congênitas, doença reumática, por miocardite, por outras miocardiopatias e por pericardiopatias. Baseados nos achados ecocardiográficos, é a seguinte a classificaçäo da miocardiopatia alcoólica que propomos: 1 - Hipertrofia de VE sem dilataçäo (15 casos), com dois subgrupos: IA - com funçäo de VE normal (quatro casos) e IB - com funçäo de VE deprimida (11 casos); II - hipertrofia de VE e dilataçäo de VE (15 casos) com dois subgrupos: IIA - com funçäo de VE normal (um caso) e IIB - com funçäo de VE deprimida (13 casos); III - sem hipertrofia de VE e com dilataçäo de VE (14 casos), com dois subgrupos: IIIA - com funçäo de VE normal (dois casos) e IIIB - com funçäo de VE deprimida (12 casos); IV - Sem dilataçäo e sem hipertrofia de VE, com funçäo de VE deprimida (nove casos). Neste grupo encontramos quatro com movimento paradoxal do septo intraventreicular. O ecocardiograma foi normal em apenas cinco casos