RESUMO
BACKGROUND: Changes in extracellular matrix are recognized as a contributing factor in the cardiac remodeling process. Several studies have addressed the value of turnover markers of collagen as predictors of death or new heart failure episodes. The aim of the present study was to evaluate the relationship between peripheral serum concentration of propeptide of procollagen type I (PIP) and outcomes in patients with decompensated heart failure. METHODS: A total of 111 patients admitted to our Unit between September 2000 and May 2003 for decompensated heart failure were analyzed. Death from any cause or due to heart failure and readmission were considered primary endpoints. RESULTS: The mean PIP concentration was 80.84+/-36.40 ng/mL. The PIP serum level was significantly higher among those patients who suffered some endpoint during follow-up (88.12+/-37.31 ng/mL vs 73.13+/-34.06 ng/mL; p=0.029). Twenty-five (22.52%) of the 111 patients died during the 21 months of follow-up, and 54 (48.6%) were readmitted with new bouts of heart failure. Using Cox proportional hazards regression analyses, serum PIP levels, systolic dysfunction, and diabetes mellitus were identified as independent predictors of death. Serum PIP levels, age, and sex were independent predictors of new heart failure episodes and readmission. CONCLUSION: A single serum measurement of PIP seems to have prognostic value in patients with decompensated heart failure. Accordingly, patients with higher values of PIP at decompensation are at a higher risk of death or readmission during follow-up.
RESUMO
Introducción y objetivos: La insuficiencia cardíaca (IC) es un motivo frecuente de ingreso en los Servicios de Medicina Interna. En este estudio analizamod las características epidemiológicas, métodos diagnósticos y tratamiento de los pacientes con IC ingresados en un Servicio de Medicina Interna. Métodos. Se revisaron las historias clínicas de los pacientes ingresados en una Unidad de Medicina Interna a lo largo de un año y se seleccionaron aquellos pacientes con diagnóstico de IC. Resultados. Las características epidemiológicas de este grupo fueron similares a las de otros pacientes ingresados en otros servicios de Medicina Interna de nuestro entorno, destacando la elevada edad, el predominio del sexo femenino y una importante comorbilidad asociada. Se realizó ecocardiograma en el 41,8% de los pacientes sin diagnóstico previo de IC. Aplicando técnicas de análisis multivariante no se identificaron variables que condicionarasn una menor aplicación de la ecocardiografía. La no determinación de la fracción de eyección se relacionó con una menor prescripción de inhibidores del enzima conversor de la angiotensina (IECA) (OR: 9.409, p<0,01). No se encontraron diferencias en el tratamiento con IECA y beta bloqueantes en función de la edad, sexo o etiología de la IC. La edad se asoció con una menor prescripción de tratamiento anticoagulante en pacientes con fibrilación auricular (OR 1.27; p<0,01). Los pacientes de edad elevada permanecieron menos días ingresados que aquellos más jóvenes (p<0,05). Conclusión. Se objetivo una infrautilización de la ecocardiografía así como una baja prescripción de IECA. Lo diferente de las características de estos pacientes con respecto a los que participan en los ensayos clínicos hacen que las conclusiones de estos sean difíciles de llevar a la práctica diaria
Background and objetives. Heart failure (HF) is an important cause of admission at Internat Medicine Units. In this survey we asses the epidemiological features and management of patients with heart failure in an Internal Medicine Unit. Methods. We reviewed medical records of patients admitted at Internal Medicine Unit for a year and we selected patients with diagnosis of HF. Results. Epidemiological features in this group were similar to patients admitted in others Internal Medicine Units in our country. High age, sex female predominance and Associated diseases were more noteworthy features. Echocardiogram was performed in 41.8% of patients without previous diagnosis of heart failure. Multivariate analysis did not found features that to explain a less application of echocardiography. In patients without echocardiography, angiotensin converting enzyme (ACE) inhibitors prescription was less than patients in who echocardiography was performed (OR: 9.409, p<0,01). Age, sex or etiology of HF were not associated with a significantly different prescription of ACE inhibitors and beta blockers. Age was associated with no anticoagulant prescription in patients with atrial fibrillation (OR 1.27; p<0,01). Elderly patients were discharged earlier than young patients (p<0.05). Conclusion. Under utilization of echocardiography and poor prescription of ACE inhibitors were verified. This fact result in a Epidemiological features of these patients are different than ones in patients included in clinical trials. Thus, their conclusions are difficult to apply in diary clinical practice
