Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement.

Background: Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective: The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods: A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results: 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion: BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Antecedentes: El sobrepeso y la obesidad (O/O) generan lipotoxicidad de la fibra cardíaca y aumentan la incidencia y progresión de la estenosis de la válvula aórtica. El síndrome de bajo gasto cardíaco (SBGC) es una complicación postquirúrgica de la cirugía de reemplazo de válvula aórtica (RVA). Objetivo: Investigar si el índice de masa corporal kg/m2 (IMC) es un factor de riesgo asociado con SBGC y mortalidad en el postoperatorio de RVA. Métodos: Se diseñó un estudio de cohorte histórico, que incluyó pacientes con estenosis aórtica importante (EAI), que fueron sometidos a RVA. Resultados: Se incluyeron 152 pacientes, 45 (29.6%), con peso normal (N), 60 tenían sobrepeso (39.5%) y 47 obesos (30.9%). La prevalencia de hipertensión sistémica (HT) fue mayor en O/O (p < 0.0001). La incidencia de SBGC fue del 44.7%, siendo más frecuente en los grupos O/O en comparación con el grupo N, 43.3%, 68.1%, 22.2% respectivamente, (p < 0.05 en sobrepeso y p < 0.0001 en obesos). Al evaluar la presencia o ausencia de SBGC asociado con el IMC como una variable numérica, encontramos que las mujeres, HT, IMC, masa ventricular izquierda y tamaño de la válvula, se asociaron con SBGC (p < 0.02, p < 0.02, p < 0.001, p < 0.032, p < 0.045, respectivamente). La mortalidad fue mayor en pacientes con SBGC (p < 0.02). El modelo multivariado mostró que el IMC fue un factor de riesgo independiente asociado a SBGC [OR 1.21 (IC 95% 1.08-1.35), p < 0.001]. Conclusión: El IMC es un factor de riesgo asociado a SBGC en el postoperatorio de RVA en pacientes con EAI.

Body mass index is associated with low postoperative cardiac output in patients undergoing aortic valve replacement / El índice de masa corporal se asocia a bajo gasto cardiaco postoperatorio de pacientes sometidos a reemplazo valvular aórtico

Abstract Background: Overweight and obesity (O/O) generate lipotoxicity of the cardiac fiber and increase the incidence and progression of aortic valve stenosis. The low cardiac output syndrome (LCOS) is a timing complication after to aortic valve replacement (AVR) surgery. Objective: The objective of the study was to investigate if body mass index (BMI) kg/m2 is a risk factor associated with LCOS and mortality in the post-operative period of AVR. Methods: A historic cohort study was designed, including patients with severe aortic stenosis (SAS), who were subjected to AVR. Results: 152 patients were included, 45 (29.6%), with normal weight (NW), 60 were overweight (39.5%), and 47 obese (30.9%). The prevalence of systemic hypertension (HT) was higher in O/O (p < 0.0001). Incidence of LCOS was 44.7%, being more frequent in the O/O groups compared to the NW group, 43.3%, 68.1%, and 22.2%, respectively, (p < 0.05 in overweight and p < 0.0001 in the obese). Assessing the presence or absence of LCOS associated with BMI as a numerical variable, we found that women, HT, BMI, left ventricular mass, and valve size, were associated with LCOS (p < 0.02, p < 0.02, p < 0.001, p < 0.032, and p < 0.045, respectively). Mortality was higher in patients who had LCOS (p < 0.02). Multivariate model showed that BMI was an independent risk factor for LCOS (odds ratio [OR] 1.21 [95% CI 1.08-1.35], p < 0.001). Conclusion: BMI is a risk factor associated to LCOS in the post-operative period of AVR in patients with SAS.

Resumen Antecedentes: El sobrepeso y la obesidad (O/O) generan lipotoxicidad de la fibra cardíaca y aumentan la incidencia y progresión de la estenosis de la válvula aórtica. El síndrome de bajo gasto cardíaco (SBGC) es una complicación postquirúrgica de la cirugía de reemplazo de válvula aórtica (RVA). Objetivo: Investigar si el índice de masa corporal kg/m2 (IMC) es un factor de riesgo asociado con SBGC y mortalidad en el postoperatorio de RVA. Métodos: Se diseñó un estudio de cohorte histórico, que incluyó pacientes con estenosis aórtica importante (EAI), que fueron sometidos a RVA. Resultados: Se incluyeron 152 pacientes, 45 (29.6%), con peso normal (N), 60 tenían sobrepeso (39.5%) y 47 obesos (30.9%). La prevalencia de hipertensión sistémica (HT) fue mayor en O/O (p < 0.0001). La incidencia de SBGC fue del 44.7%, siendo más frecuente en los grupos O/O en comparación con el grupo N, 43.3%, 68.1%, 22.2% respectivamente, (p < 0.05 en sobrepeso y p < 0.0001 en obesos). Al evaluar la presencia o ausencia de SBGC asociado con el IMC como una variable numérica, encontramos que las mujeres, HT, IMC, masa ventricular izquierda y tamaño de la válvula, se asociaron con SBGC (p < 0.02, p < 0.02, p < 0.001, p < 0.032, p < 0.045, respectivamente). La mortalidad fue mayor en pacientes con SBGC (p < 0.02). El modelo multivariado mostró que el IMC fue un factor de riesgo independiente asociado a SBGC [OR 1.21 (IC 95% 1.08-1.35), p < 0.001]. Conclusión: El IMC es un factor de riesgo asociado a SBGC en el postoperatorio de RVA en pacientes con EAI.

Improving risk assessment for post-surgical low cardiac output syndrome in patients without severely reduced ejection fraction undergoing open aortic valve replacement. The role of global longitudinal strain and right ventricular free wall strain.

Low cardiac output syndrome (LCOS) after surgical aortic valve replacement (SAVR) is related to increased mortality and treatment related costs. We aimed to evaluate whether echocardiography-derived left ventricular global longitudinal strain (LV-GLS) relates to the occurrence of postoperative LCOS in patients undergoing SAVR. We prospectively enrolled 75 patients with symptomatic severe aortic stenosis, left ventricular ejection fraction (LVEF) >40%, NYHA Class

Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure.

BACKGROUND: Perioperative advances have led to significant improvements in outcomes after many complex neonatal open heart procedures. Whether similar improvements have been realized for the modified Blalock-Taussig shunt, the most common palliative neonatal closed-heart procedure, is not known. METHODS: Data were abstracted from The Society of Thoracic Surgeons Congenital Heart Surgery Database (2002 to 2009). Inclusion criteria were all neonates who received a modified Blalock-Taussig shunt with or without cardiopulmonary bypass, and with or without concomitant ligation of a patent ductus arteriosus. Discharge mortality was the primary end point. A composite morbidity end point one or more of the following: postoperative extracorporeal membrane oxygenation, low cardiac output, or unplanned reoperation. Associations with patient and procedural variables were assessed with univariable and multivariable analyses. RESULTS: The inclusion criteria were met by 1273 patients. The discharge mortality rate was 7.2%, and composite morbidity, as defined, was 13.1%. Primary diagnoses were classified as (1) those potentially amenable to biventricular repair (62%), (2) functionally univentricular hearts (22%), and (3) pulmonary atresia with intact ventricular septum (PA/IVS; 14%), and miscellaneous (2%). Discharge mortality stratified by primary diagnoses was PA/IVS (15.6%), functionally univentricular hearts (7.2%), and diagnoses potentially amenable to biventricular repair (5.1%). Need for preoperative ventilatory support, diagnosis of PA/IVS or functionally univentricular hearts, and any weight less than 3 kg, were risk factors for death. Preoperative acidosis or shock (resolved or persistent) and diagnosis of PA/IVS or functionally univentricular hearts were predictors of composite morbidity. Nearly 33% of the deaths occurred within 24 hours postoperatively, and 75% within the first 30 days. CONCLUSIONS: The mortality rate after the neonatal modified Blalock-Taussig shunt remains high, particularly for infants weighing less than 3 kg and those with the diagnosis of PA/IVS.

Severe heart failure at intensive therapy unit--is there an ideal prognostic index?

OBJECTIVE: To assess the applicability of three prognostic indexes--APACHE II, SAPS II and UNICAMP II--in a subgroup of critical heart failure (HF) patients. METHODS: Ninety patients were studied, being 12 females and 78 males. Mean age was 56 (18-83). Patients were ranked in functional class IV (NYHA) or cardiogenic shock secondary to cardiomyopathies: dilated (44%), chagasic (25.5%), ischemic (18%), hypertensive (1.1%), hypertrophic (1.1%), alcoholic (1.1%), and secondary to valvopathies after surgical correction (7.7%). Tables with frequency of categorical variables and descriptive statistics of continuous variables were created in order to describe sample profile for the different variables under study. In order to analyze the relationship between prognostic indexes levels and course towards death, an analysis of the ROC curve, as well as Hosmer and Lemeshow Test of Goodness of Fit calculated, and Standardized Mortality Ratio (SMR) were carried out. RESULTS: The statistical analysis showed low sensitivity, specificity, and accuracy of the three prognostic indexes for HF patients. Mortality was underestimated in this group. Pulmonary thromboembolism (PTE) was a major factor of mortality rate in severe HF. CONCLUSION: The three prognostic indexes under study did not prove to be appropriate for the assessment of cardiopathy patients at Intensive Care Unit (ICU). For HF patients, PTE played a major role in mortality of heart failure. Specific prognostic indexes for cardiopathy patients with severe HF should be proposed, and the discussion on anticoagulation on those patients should be expanded.

Insuficiência cardíaca grave em unidade de terapia intensiva: existe um índice prognóstico ideal? / Severe heart failure at intensive therapy unit: is there an ideal prognostic index? / Severe heart failure at intensive therapy unit: is there an ideal prognostic index?

OBJETIVO: Avaliar a aplicabilidade de três índices prognósticos - APACHE II, SAPS II e Unicamp II, em um subgrupo de pacientes críticos, portadores de insuficiência cardíaca (IC). MÉTODOS: Foram estudados 90 pacientes, sendo 12 do sexo feminino e 78, do sexo masculino, com idade média de 56 (18-83) anos. Os pacientes encontravam-se em classe funcional IV (NYHA) ou choque cardiogênico secundário às cardiomiopatias: dilatada (44 por cento), chagásica (25,5 por cento), isquêmica (18 por cento), hipertensiva (1,1 por cento), hipertrófica (1,1 por cento), alcoólica (1,1 por cento), e secundário às valvopatias já submetidas à correção cirúrgica (7,7 por cento). Para descrever o perfil da amostra, segundo as diversas variáveis em estudo, foram feitas tabelas de freqüência das variáveis categóricas e estatísticas descritivas das variáveis contínuas. Para analisar a relação entre os valores dos índices prognósticos e a evolução para o óbito, foi realizada a análise da curva ROC, calculadas as estatísticas de bondade do ajuste de Hosmer e Lemeshow, assim como a SMR (Standardized Mortality Ratio). RESULTADOS: A análise estatística mostrou baixa sensibilidade, especificidade e acurácia dos três índices prognósticos para os pacientes com IC, tendo sido subestimada a mortalidade nesse grupo. Na IC refratária, a ocorrência de tromboembolismo pulmonar (TEP) foi um fator importante em relação à mortalidade. CONCLUSÃO: Os três índices prognósticos estudados não foram adequados para avaliação dos cardiopatas internados na Unidades de Terapia Intensiva (UTI). Nos pacientes com IC, o fator TEP foi importante para a descompensação aguda da IC e para a alta mortalidade do grupo. índices prognósticos para cardiopatas com IC refratária deverão ser propostos, e a discussão sobre anticoagulação nestes pacientes deve ser ampliada.

OBJECTIVE: To assess the applicability of three prognostic indexes - APACHE II, SAPS II and UNICAMP II - in a subgroup of critical heart failure (HF) patients. METHODS: Ninety patients were studied, being 12 females and 78 males. Mean age was 56 (18-83). Patients were ranked in functional class IV (NYHA) or cardiogenic shock secondary to cardiomyopathies: dilated (44 percent), chagasic (25.5 percent), ischemic (18 percent), hypertensive (1.1 percent), hypertrophic (1.1 percent), alcoholic (1.1 percent), and secondary to valvopathies after surgical correction (7.7 percent). Tables with frequency of categorical variables and descriptive statistics of continuous variables were created in order to describe sample profile for the different variables under study. In order to analyze the relationship between prognostic indexes levels and course towards death, an analysis of the ROC curve, as well as Hosmer and Lemeshow Test of Goodness of Fit calculated, and Standardized Mortality Ratio (SMR) were carried out. RESULTS: The statistical analysis showed low sensitivity, specificity, and accuracy of the three prognostic indexes for HF patients. Mortality was underestimated in this group. Pulmonary thromboembolism (PTE) was a major factor of mortality rate in severe HF. CONCLUSION: The three prognostic indexes under study did not prove to be appropriate for the assessment of cardiopathy patients at Intensive Care Unit (ICU). For HF patients, PTE played a major role in mortality of heart failure. Specific prognostic indexes for cardiopathy patients with severe HF should be proposed, and the discussion on anticoagulation on those patients should be expanded.

[Predictive value of ventilatory and metabolic variables for risk of death in patients with cardiac failure]. / Valor preditivo de variáveis ventilatórias e metabólicas para óbito em pacientes com insuficiência cardíaca.

OBJECTIVE: To analyze the predictive value of respiratory, metabolic, and hemodynamic variables obtained during the cardiopulmonary stress test for the risk of death in patients with heart failure. METHODS: Eighty-seven NYHA Functional Class II and III patients were analyzed, ages 51 +/- 0.5 years, 26 of them with Chagas' disease, 30 with coronary ischemia, and 31 with idiopathic etiology. The cardiopulmonary stress test consisted of a ramp-protocol with 5 to 15 W/min workload increments performed on a bicycle-ergonometer until exhaustion. RESULTS: In this study, the multiple Cox regression analysis of age, height, weight, body surface, and gender showed that these parameters were not statistically significant control factors. Oxygen uptake, ventilatory equivalent of oxygen, ventilatory equivalent of carbon dioxide production, oxygen pulse, and end-tidal partial pressure of carbon dioxide at the anaerobic threshold, respiratory compensation point, and peak exercise proved to be important death predictors in heart failure patients. The relationship between the increase in carbon dioxide output as a function of the increase in minute ventilation, and the association between the oxygen uptake increase and the elevation of the workload from the beginning of exercise to the anaerobic threshold were statistically significant predictors of death in heart failure patients (p<0.05). CONCLUSION: The cardiopulmonary stress test makes it possible to evaluate ventilatory, metabolic, and hemodynamic variables that may be utilized as important markers of life prognosis in these patients.

Valor preditivo de variáveis ventilatórias e metabólicas para óbito em pacientes com insuficiência cardíaca / Predictive value of ventilatory and metabolic variables for risk of death in patients with cardiac failure

OBJETIVO: Avaliar o valor preditivo de variáveis respiratórias, metabólicas e hemodinâmicas, no teste de esforço cardiopulmonar, para óbito em pacientes com insuficiência cardíaca. MÉTODOS: Foram estudados 87 pacientes em classe funcional II e III da NYHA, faixa etária de 51±0,5 anos, dos quais 26 eram de etiologia chagásica, 30 isquêmica e 31 idiopática. O teste de esforço cardiopulmonar consistiu de protocolo em rampa com incremento de 5 a 15W/min, realizado em cicloergômetro, até a exaustão. RESULTADOS: A análise dos fatores de controle, realizada com regressão múltipla de Cox, mostrou que a idade, estatura, peso, superfície corporal e sexo não foram estatisticamente significativos. O consumo de oxigênio, o equivalente ventilatório de oxigênio, o equivalente ventilatório de dióxido de carbono, o pulso de oxigênio, a pressão parcial de dióxido de carbono ao final da expiração, no limiar anaeróbio, no ponto de compensação respiratória e no pico do exercício apresentaram-se como importantes preditores de óbito. A relação do aumento de dióxido de carbono como função da elevação da ventilação minuto e a relação do aumento do consumo de oxigênio e da elevação da carga de trabalho do início do exercício até o limiar anaeróbio apresentaram correlação estatisticamente significativa com óbito (p<0,05). CONCLUSÃO: O teste de esforço cardiopulmonar possibilita a avaliação de variáveis ventilatórias, metabólicas e hemodinâmicas, que podem ser utilizadas como marcadores importantes do prognóstico de vida, nesses pacientes.

Randomised trial of telephone intervention in chronic heart failure: DIAL trial.

OBJECTIVE: To determine whether a centralised telephone intervention reduces the incidence of death or admission for worsening heart failure in outpatients with chronic heart failure. DESIGN: Multicentre randomised controlled trial. SETTING: 51 centres in Argentina (public and private hospitals and ambulatory settings). PARTICIPANTS: 1518 outpatients with stable chronic heart failure and optimal drug treatment randomised, stratified by attending cardiologist, to telephone intervention or usual care. INTERVENTION: Education, counselling, and monitoring by nurses through frequent telephone follow-up in addition to usual care, delivered from a single centre. MAIN OUTCOME MEASURE: All cause mortality or admission to hospital for worsening heart failure. RESULTS: Complete follow-up was available in 99.5% of patients. The 758 patients in the usual care group were more likely to be admitted for worsening heart failure or to die (235 events, 31%) than the 760 patients who received the telephone intervention (200 events, 26.3%) (relative risk reduction = 20%, 95% confidence interval 3 to 34, P = 0.026). This benefit was mostly due to a significant reduction in admissions for heart failure (relative risk reduction = 29%, P = 0.005). Mortality was similar in both groups. At the end of the study the intervention group had a better quality of life than the usual care group (mean total score on Minnesota living with heart failure questionnaire 30.6 v 35, P = 0.001). CONCLUSIONS: This simple, centralised heart failure programme was effective in reducing the primary end point through a significant reduction in admissions to hospital for heart failure.

[Effects of the prolonged inhibition of the angiotensin-converting enzyme on the morphological and functional characteristics of left ventricular hypertrophy in rats with persistent pressure overload]. / Efeitos da inibição prolongada da enzima de conversão da angiotensina sobre as características morfológicas e funcionais da hipertrofia ventricular esquerda em ratos com sobrecarga pressórica persistente.

OBJECTIVE: To assess the effects of lisinopril (L) on mortality (M) rate and congestive heart failure (CHF), and the characteristics of geometrical myocardial remodeling and left ventricular function in rats with supravalvular aortic stenosis (SAS). METHODS: Some Wistar rats underwent SAS or the simulated surgery (CG, n=10). After 6 weeks, the animals were randomized to receive lisinopril (LG, n=30) or no treatment (SG, n=73) for 15 weeks. Cardiac remodeling was assessed in the sixth and 21st weeks after the surgical procedures through concomitant echocardiographic, hemodynamic, and morphological studies. RESULTS: The M were 53.9% and 16.7% in SG and LG, respectively; the incidence of CHF was 44.8% and 20%, in SG and LG, respectively, (P<0.05). At the end of the experiment, the values of LV systolic pressure in SG and LG were equivalent and significantly greater than those in CG; (P<0.05) and did not differ from those observed 6 weeks after the surgical procedures. The values of LV diastolic pressure in SG were greater than those in LG; (P<0.05), and both were greater than those in CG; (P<0.05). The same behavior was observed with the following variables: E/A ratio; mass index; sectional area of the myocytes; and LV hydroxyproline content. Left ventricular shortening percentage was similar in CG and LG; (P>0.05), and both were greater than those in SG; (P<0.05). Similar results were obtained with the values of the positive and negative first derivate of LV pressure. CONCLUSION: In rats with SAS, the treatment with L reduced M rate and ICC and had beneficial effects on geometrical myocardial remodeling and left ventricular function.

Efeitos da inibição prolongada da enzima de conversão da angiotensina sobre as características morfológicas e funcionais da hipertrofia ventricular esquerda em ratos com sobrecarga pressórica persistente / Effects of the prolonged inhibition of the angiotensin-converting enzyme on the morphological and functional characteristics of left ventricular hypertrophy in rats with persistent pressure overload

OBJETIVO: Avaliar os efeitos do lisinopril (L) sobre as taxas de mortes (M), insuficiência cardíaca (ICC), características da remodelação miocárdica, geométrica e funcional do ventrículo esquerdo (VE), em ratos com estenose aórtica supravalvar (EAS). MÉTODOS: Ratos foram submetidos a EAS ou cirurgia simulada (GC:n=10). Randomizados após 6 semanas para receber L (GL:n=30) ou nenhum tratamento (GE:n=73) sendo avaliados 6s e 21s por estudos ecocardiográfico, hemodinâmico e morfológico concomitantes. RESULTADOS: As taxas de M (GE: 53,9 por cento vs GL: 16,7 por cento e ICC GE: 44,8 por cento vs GL: 20 por cento p<0,05). No final do experimento, os valores da pressão sistólica do VE dos grupos GE e GL foram equivalentes e significantemente mais elevados do que no grupo GC; (p<0,05) não diferindo dos observados 6 semanas após os procedimentos cirúrgicos. Os valores da pressão diastólica do VE no grupo GE foram maiores do que os do grupo GL (p<0,05) sendo ambos maiores do que os do grupo GC (4 ± 2 mmHg, p<0,05). O mesmo comportamento foi observado com as variáveis: razão E/A; índice de massa, área seccional dos miócitos e conteúdo de hidroxiprolina do VE. A porcentagem de encurtamento do VE foi semelhante nos grupos GC e GL (p>0,05) sendo ambos maiores que os verificados no grupo GE. Comportamento semelhante foram obtidos com os valores da primeira derivada positiva e negativa da pressão do VE. CONCLUSAO: Em ratos com EAS o L reduziu as taxas de M e ICC e exerceu efeitos benéficos sobre a remodelação e a função do VE.

Long-term prognostic value of triiodothyronine concentration in elderly patients with heart failure.

In this study the authors sought to determine the prevalence and long-term prognostic value of low triiodothyronine levels in elderly patients with heart failure and no thyroid disease. Lower levels of triiodothyronine are more prevalent in patients with advanced heart failure without thyroid disease, and this may have prognostic implications. However, this hormonal milieu has not been investigated in elderly patients. The authors prospectively followed a consecutive sample of 69 elderly patients aged 76.5+/-5.9 years with heart failure and 44 age-matched controls without heart failure between March 1997 and September 2000 at the Geriatric Cardiology Outpatient Clinic of the Heart Institute of Sao Paulo, Brazil. Events analyzed included death, hospitalization, and the combined end point of death or hospitalization. The study revealed that levels of triiodothyronine were lower in heart failure patients than in controls (89+/-23 vs. 101+/-16 ng/dL, p=0.001). During the follow-up period of 14.3+/-8.1 months there were 19 deaths and 33 hospitalizations in the heart failure group. The combined end point of death or hospitalization occurred in 38 patients. Triiodothyronine levels were lower in heart failure patients who had a cardiovascular event than in event-free patients (82.7+/-24.8 vs. 96.7+/-19.2 ng/dL, p=0.012). The odds ratio for events was 9.8 (95% confidence interval, 2.2-43, p=0.004) for patients in the lowest tertile of triiodothyronine, that is, lower than 80 ng/dL, compared with patients with levels above 80 ng/dL. The authors conclude that among elderly patients with heart failure, lower triiodothyronine concentrations are more prevalent and are associated with a worse prognosis.

[Heart failure in Argentina]. / Perspectiva de la insuficiencia cardíaca en la Argentina.

Heart failure is a common and costly clinical entity that implies high morbidity and mortality. The aim of this study was to establish the impact of the heart failure syndrome in our country. We analyzed: 1) the data-base of vital statistics from the National Program of Health Statistics, Ministry of Health, between 1980 and 1997, 2) the registers from two national surveys on heart failure patients performed by the Argentine Society of Cardiology and the Argentine Council of Residents in Cardiology. Cardiovascular syndromes have constituted the first cause of death in our country for the last twenty years. Among these, heart failure represents the most frequent entity. From 1980 to 1997 a progressive reduction of 31% in the rate of cardiovascular mortality was observed. From 1990 to 1997, a decrease in the mortality rate due to heart failure of 22.4% was registered. Age and sex adjusted mortality from heart failure suffered a steady increase in older groups, specially above 65 years of age. Hospital discharge data showed that heart failure and cerebrovascular illness are the highest prevalent entities. National surveys on heart failure demonstrate a high prevalence of hypertension, as an associated risk factor, and non compliance with the medication and diet as causes of decompensation. A trend towards an increase in pharmacological prescriptions was also observed.

Perspectiva de la insuficiencia cardiaca en la Argentina / Heart failure in Argentina

La insuficiencia cardíaca es una entidad clínica con alta prevalencia e incidencia que conlleva una elevada morbi-mortalidad, generando costos elevados en los sistemas de salud. Con el objetivo de establecer la importancia del problema en nuestro país analizamos: 1) la base de datos del Programa Nacional de Estadísticas de Salud del Ministerio de Salud y Acción Social durante el período 1980-1997, y 2) los registros de dos encuestas nacionales sobre insuficiencia cardíaca hechas por la Sociedad Argentina de Cardiologia y el Consejo Argentino de Residentes de Cardiologia. Las enfermedades cardiovasculares constituyen la primera causa de muerte en nuestro país, siendo la insuficiencia cardíaca la primera entidad responsible, situación que se ha mantenido estable durante los últimos 20 años. Desde 1980 a 1997 se registró una progresiva reducción del 31 por ciento de la tasa de mortalidad por enfermedades cardiovasculares. Desde 1990 a 1997 la declinación de la mortalidad por insuficiencia cardíaca alcanzó el 22.4 por ciento. Corregida por edad y sexo observamos un incremento sostenido en la tasa de mortalidad en grupos de edad avanzada, más manifesto a partir de los 65 años. Registros de egresos hospitalarios demuestran que las entidades cardiovasculares más frecuentes fueron la insuficiencia cardíaca y la enfermedad cerebrovascular. De las encuestas nacionales sobre insuficiencia cardíaca surge una elevada prevalencia de hipertensión arterial como enfermedad asociada y el abandono de la medicación y transgresiones dietéticas como factores desencadenanates, así como una tendencia hacia mayor prescripción de fármacos.

Perspectiva de la insuficiencia cardiaca en la Argentina / Heart failure in Argentina

La insuficiencia cardíaca es una entidad clínica con alta prevalencia e incidencia que conlleva una elevada morbi-mortalidad, generando costos elevados en los sistemas de salud. Con el objetivo de establecer la importancia del problema en nuestro país analizamos: 1) la base de datos del Programa Nacional de Estadísticas de Salud del Ministerio de Salud y Acción Social durante el período 1980-1997, y 2) los registros de dos encuestas nacionales sobre insuficiencia cardíaca hechas por la Sociedad Argentina de Cardiologia y el Consejo Argentino de Residentes de Cardiologia. Las enfermedades cardiovasculares constituyen la primera causa de muerte en nuestro país, siendo la insuficiencia cardíaca la primera entidad responsible, situación que se ha mantenido estable durante los últimos 20 años. Desde 1980 a 1997 se registró una progresiva reducción del 31 por ciento de la tasa de mortalidad por enfermedades cardiovasculares. Desde 1990 a 1997 la declinación de la mortalidad por insuficiencia cardíaca alcanzó el 22.4 por ciento. Corregida por edad y sexo observamos un incremento sostenido en la tasa de mortalidad en grupos de edad avanzada, más manifesto a partir de los 65 años. Registros de egresos hospitalarios demuestran que las entidades cardiovasculares más frecuentes fueron la insuficiencia cardíaca y la enfermedad cerebrovascular. De las encuestas nacionales sobre insuficiencia cardíaca surge una elevada prevalencia de hipertensión arterial como enfermedad asociada y el abandono de la medicación y transgresiones dietéticas como factores desencadenanates, así como una tendencia hacia mayor prescripción de fármacos. (AU)

[Heart failure at a large tertiary hospital of São Paulo]. / Insuficiência cardíaca em grande hospital terciário de São Paulo.

PURPOSE: To study the incidence, main causes, aggravating factors and secondary diagnoses of heart failure (HF) during 1995 at the Instituto do Coração of São Paulo. METHODS: Data from hospitalized patients according to the PRODESP data base were analyzed. The following data were studied; age, sex, principal and secondary diagnoses, surgical procedures and mortality. To analyze the data, tables according to sex, age and main cause were built. Analysis of variance and t test were employed to verify differences between groups. RESULTS: In 1995, 903 out of 9620 patients were hospitalized due to HF. The majority were male (60.4%) and the patients' age was between two days and 98 years old (mean 52.6). Ischemic (32.6), dilated (25.8%) and valvar heart disease (22%) were the main causes of HF. 32.1% were submitted to correction of the HF main cause, specially those with valvar heart disease (62.3%). There was greater incidence of multiple diagnoses in aged patients. The mortality was greater in patients younger than 20 and in those older than 80 years old. CONCLUSION: The incidence of HF at INCOR during 1995 was 9.38%. Ischemic myocardiopathy was the most frequent HF cause. The mortality was greater among children, probably because of heart disease complexity and, in the above-80 group due to the greater comorbidity.