Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara.

BACKGROUND: Weight changes frequently occur after cardiac transplantation (CT) and increase the risk of secondary diseases. OBJECTIVE: To determine the impact of weight variation on serum levels of glucose, triglyceride, total cholesterol, LDL, HDL and triglycerides of cardiac transplant patients. METHODS: Retrospective documentary study conducted with 82 adult patients undergoing CT between October 1997 and December 2005 in the State of Ceara, Brazil. A total of 83% of the patients were male and the mean age was 45.06+/-12.04 years. The variables studied were biopathological profile, weight, and body mass index (BMI) in relation to biochemical and metabolic changes. Data were described using frequencies, measures of central tendency, Student's t test and Pearson's correlation coefficient. RESULTS: The mean overall BMI increased from 23.77+/-3.68 kg/m2 prior to CT, to 25.48+/-3.92 kg/m2 in the first year and to 28.38+/-4.97 kg/m2 in the fifth. Overweight/obese patients (BMI > or = 25 kg/m2) showed mean values of glucose, total cholesterol, low-density lipoprotein (LDL) and triglycerides higher than those of normal-weight/underweight patients (BMI < 25 kg/m2). CONCLUSION: There was a significant direct relation between nutritional state and weight variability on the metabolic profile of cardiac transplant patients.

Impacto da variabilidade de peso na estabilidade metabólica dos pacientes transplantados cardíacos no Ceará / Impact of weight variation on the metabolic stability of cardiac transplant patients in the state of Ceara

FUNDAMENTO: As alterações de peso após o transplante cardíaco (TC) freqüentemente ocorrem e aumentam os riscos de doenças secundárias. OBJETIVO: Determinar o impacto da variabilidade do peso nos níveis séricos de glicose, triglicérides, colesterol total e frações dos pacientes transplantados cardíacos. MÉTODOS: Estudo retrospectivo documental realizado com 82 pacientes adultos submetidos a TC entre outubro de 1997 e dezembro de 2005 no Ceará, sendo 83 por cento do sexo masculino e a idade média de 45,06±12,04 anos. As variáveis estudadas foram o perfil biopatológico, o peso e o índice de massa corporal (IMC) relacionadas às alterações bioquímico-metabólicas. Os dados foram descritos usando freqüências, medidas de tendência central, teste t de Student e coeficiente de correlação de Pearson. RESULTADOS: A média global do IMC aumentou de 23,77±3,68kg/m² antes do TC, para 25,48±3,92kg/m² no primeiro ano e para 28,38±4,97kg/m² no quinto. Os pacientes com sobrepeso/obesidade (IMC > 25 kg/m²) apresentaram valores médios de glicose, colesterol total, lipoproteína de baixa densidade (LDL) e triglicérides maiores que os pacientes com eutrofia/desnutrição (IMC < 25 kg/m²). CONCLUSÃO: Houve uma relação direta e significativa entre o estado nutricional e a variabilidade de peso no perfil metabólico de pacientes transplantados cardíacos.

BACKGROUND: Weight alterations post cardiac transplant (CT) frequently occur and increase the risks of secondary diseases. OBJECTIVE: This study aimed at determining the impact of weight variability on serum levels of glucose, triglycerides, total cholesterol and its fractions of cardiac transplant patients. METHODS: This was a retrospective documental study held with 82 patients submitted to CT between October, 1997 and December, 2005 in Ceará, Brazil. 83 percent were male and the average age was 45.06±12.04 years. The studied variables were: biopathology profile, the weight and the body mass index (BMI) related to the biochemical-metabolic alterations and to the survival. Data were described using frequencies, measures of central tendency, t-Student test and Pearson correlation coefficient. RESULTS: The average global BMI increased from 23.77±3.68kg/m² before CT to 25.48±3.92kg/m² on the first year and to 28.38±4.97kg/m² on the fifth year. The patients with overweight/ obesity (IMC > 25 kg/m²) presented average glucose mean levels, total cholesterol, low-density lipoprotein (LDL) and triglycerides higher than the patients with eutrophy/ malnutrition (IMC < 25 kg/m²). CONCLUSION: There was a significant direct relation between nutritional state and weight variability on the metabolic profile of cardiac transplant patients.

Prevalance of anemia and its association with cardio-renal syndrome.

BACKGROUND: Anemia is common in cardio-renal syndrome and may contribute to increase mortality. OBJECTIVE: To examine the prevalence of anemia and its relationship with cardio-renal syndrome, and to evaluate the risk factors for death. METHODS: Retrospective study with all patients admitted with congestive heart failure (CHF). The parameters as age, gender, hemoglobin (Hb), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA) functional class, ejection fraction (EF%), hospital stay, hypertension, diabetes, smoking and CHF etiology were analyzed. Anemia was defined as Hb<12 g/dL, systolic dysfunction EF<55% and renal failure was stratified according to K-DOQI classification. Statistical analysis was done by the programs EpiInfo and SPSS for windows. RESULTS: A total of 174 patients were studied. The average age was 63+/-16 years, 65.5% were males, and 18 of them (11%) were non-survivors. Anemia was observed in 45% of patients, and 82% presented some degree of renal failure. The majority of patients (87%) were classified as NYHA functional class III or IV. The average ejection fraction was 43.9+/-16.6%, and there was no difference between survivors and non-survivors (p>0.05). Mortality was not significantly higher among patients with anemia (12.4%) when comparing to those without anemia (8.3%, p=0.31). There was a progressive decrease in the level of hemoglobin as renal function decreased (p<0.05). Increased serum creatinine was a significant risk factor for death (OR=1.59, 95% CI=1.074-2.363, p=0.021), and increased EF% was a protection factor against development of death (OR=0.904, 95% CI=0.845-0.973, p=0.007). CONCLUSIONS: The prevalence of anemia is high among patients with cardio-renal syndrome but was not associated with increased mortality. Increased serum creatinine and low EF% were variables associated with death.

Baixas doses de óxido nítrico na seleçäo dos pacientes candidatos a transplante cardíaco com hipertensäo pulmonar / Low doses of nitric oxide in the selection of candidates to heart transplantation with pulmonary hypertension

A disfunçäo do ventrículo direito no pós-operatório do transplante cardíaco é uma complicaçäo freqüente com morbimortalidade elevada. A avaliaçäo hemodinâmica pulmonar dos candidatos precisa, às vezes, do emprego de prova farmacológica com o uso de drogas endovenosas vasodilatadoras tipo nitroprussiato de sódio (NTPNa), visando reduzir os níveis de pressäo e resistência vascular pulmonar (RVP) elevados a níveis compatíveis com os protocolos de inclusäo dos Programas de Transplante Cardíaco. Valores de RVP acima de 6 unidades Wood sem droga vasodilatadora, ou acima de 2,5 com a utilizaçäo destas, excluem os pacientes do Programa. Entre janeiro de 1997 e janeiro de 2000 foram submetidos a cateterismo direito, 40 pacientes candidatos a transplante. A maioria homens, com idade média (+ or - 12 anos). As etiologias mais encontradas foram miocardiopatia dilatada idiopática (59 por cento) e miocardiopatia isquêmica (25 por cento). Todos em CF IV da NYHA, com fraçäo de ejeçäo média do ventrículo esquerdo de 0,21 (+ ou - 0,03). A monitorizaçäo do débito cardíaco (DC), pressäo da artéria pulmonar (PAP) e RVP foi feita pelo método contínuo, utilizando para isto cateter de artéria pulmonar especial. Em 5 pacientes a prova farmacológica foi interrompida devido aos efeitos sistêmicos do NTPNa com queda da PAM, RVP e DC. Todos foram submetidos a inalaçäo de óxido nítrico (NO) por máscara, a uma dose de 20 ppm durante 10 minutos. Em 3, a RVP reduziu de 7,8 (+ ou - 0,88) para 2,4 (+ ou -0,36) unidades Wood, e eles foram incluídos no Programa de Transplante. Nos outros 2, apesar de doses de NO de 20,30 e 40 ppm, a reduçäo foi de 8,4 ( + ou - 2,12) para 4,9 (+ ou - 0,42) unidades Wood, ou seja, insuficiente para serem incluídos nos Programas de Transplante. Näo tivemos óbitos, nem complicaçöes durante os procedimentos. O NO inalatório na avaliaçäo hemodinâmica dos candidatos a TC -- pelo seu efeito vasodilatador seletivo -- permite identificar aqueles com hiper-resistência vascular pulmonar, que näo respondem ao uso de drogas vasodilatadoras endovenosas convencionais, evitando que sejam excluídos dos benefícios do procedimento do TC