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1.
Clinics (Sao Paulo) ; 76: e1991, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33503176

RESUMO

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33438847

RESUMO

INTRODUCTION: In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. METHODS: Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. RESULTS: Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. CONCLUSION: An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.

3.
Clinics ; 76: e1991, 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1153946

RESUMO

OBJECTIVES: This observational, cross-sectional study based aimed to test whether heart failure (HF)-disease management program (DMP) components are influencing care and clinical decision-making in Brazil. METHODS: The survey respondents were cardiologists recommended by experts in the field and invited to participate in the survey via printed form or email. The survey consisted of 29 questions addressing site demographics, public versus private infrastructure, HF baseline data of patients, clinical management of HF, performance indicators, and perceptions about HF treatment. RESULTS: Data were obtained from 98 centers (58% public and 42% private practice) distributed across Brazil. Public HF-DMPs compared to private HF-DMP were associated with a higher percentage of HF-DMP-dedicated services (79% vs 24%; OR: 12, 95% CI: 94-34), multidisciplinary HF (MHF)-DMP [84% vs 65%; OR: 3; 95% CI: 1-8), HF educational programs (49% vs 18%; OR: 4; 95% CI: 1-2), written instructions before hospital discharge (83% vs 76%; OR: 1; 95% CI: 0-5), rehabilitation (69% vs 39%; OR: 3; 95% CI: 1-9), monitoring (44% vs 29%; OR: 2; 95% CI: 1-5), guideline-directed medical therapy-HF use (94% vs 85%; OR: 3; 95% CI: 0-15), and less B-type natriuretic peptide (BNP) dosage (73% vs 88%; OR: 3; 95% CI: 1-9), and key performance indicators (37% vs 60%; OR: 3; 95% CI: 1-7). In comparison to non- MHF-DMP, MHF-DMP was associated with more educational initiatives (42% vs 6%; OR: 12; 95% CI: 1-97), written instructions (83% vs 68%; OR: 2: 95% CI: 1-7), rehabilitation (69% vs 17%; OR: 11; 95% CI: 3-44), monitoring (47% vs 6%; OR: 14; 95% CI: 2-115), GDMT-HF (92% vs 83%; OR: 3; 95% CI: 0-15). In addition, there were less use of BNP as a biomarker (70% vs 84%; OR: 2; 95% CI: 1-8) and key performance indicators (35% vs 51%; OR: 2; 95% CI: 91,6) in the non-MHF group. Physicians considered changing or introducing new medications mostly when patients were hospitalized or when observing worsening disease and/or symptoms. Adherence to drug treatment and non-drug treatment factors were the greatest medical problems associated with HF treatment. CONCLUSION: HF-DMPs are highly heterogeneous. New strategies for HF care should consider the present study highlights and clinical decision-making processes to improve HF patient care.

5.
Arq Bras Cardiol ; 115(5): 1006-1043, 2020 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33295473
6.
Hajjar, Ludhmila Abrahão; Costa, Isabela Bispo Santos da Silva da; Lopes, Marcelo Antônio Cartaxo Queiroga; Hoff, Paulo Marcelo Gehm; Diz, Maria Del Pilar Estevez; Fonseca, Silvia Moulin Ribeiro; Bittar, Cristina Salvadori; Rehder, Marília Harumi Higuchi dos Santos; Rizk, Stephanie Itala; Almeida, Dirceu Rodrigues; Fernandes, Gustavo dos Santos; Beck-da-Silva, Luís; Campos, Carlos Augusto Homem de Magalhães; Montera, Marcelo Westerlund; Alves, Sílvia Marinho Martins; Fukushima, Júlia Tizue; Santos, Maria Verônica Câmara dos; Negrão, Carlos Eduardo; Silva, Thiago Liguori Feliciano da; Ferreira, Silvia Moreira Ayub; Malachias, Marcus Vinicius Bolivar; Moreira, Maria da Consolação Vieira; Valente Neto, Manuel Maria Ramos; Fonseca, Veronica Cristina Quiroga; Soeiro, Maria Carolina Feres de Almeida; Alves, Juliana Barbosa Sobral; Silva, Carolina Maria Pinto Domingues Carvalho; Sbano, João; Pavanello, Ricardo; Pinto, Ibraim Masciarelli F; Simão, Antônio Felipe; Dracoulakis, Marianna Deway Andrade; Hoff, Ana Oliveira; Assunção, Bruna Morhy Borges Leal; Novis, Yana; Testa, Laura; Alencar Filho, Aristóteles Comte de; Cruz, Cecília Beatriz Bittencourt Viana; Pereira, Juliana; Garcia, Diego Ribeiro; Nomura, Cesar Higa; Rochitte, Carlos Eduardo; Macedo, Ariane Vieira Scarlatelli; Marcatti, Patricia Tavares Felipe; Mathias Junior, Wilson; Wiermann, Evanius Garcia; Val, Renata do; Freitas, Helano; Coutinho, Anelisa; Mathias, Clarissa Maria de Cerqueira; Vieira, Fernando Meton de Alencar Camara; Sasse, André Deeke; Rocha, Vanderson; Ramires, José Antônio Franchini; Kalil Filho, Roberto.
Arq. bras. cardiol ; 115(5): 1006-1043, nov. 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, CONASS, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1142267
10.
Arq Bras Cardiol ; 111(3): 436-539, 2018 09.
Artigo em Português | MEDLINE | ID: mdl-30379264
12.
Chest ; 154(4): 808-817, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30213463

RESUMO

BACKGROUND: Exercise and CPAP improve OSA. This study examined the effects of exercise in patients with heart failure (HF) and OSA. METHODS: Patients with HF and OSA were randomized to the following study groups: control, exercise, CPAP, and exercise + CPAP. RESULTS: Sixty-five participants completed the protocol. Comparing baseline vs 3 months, the mean apnea-hypopnea index (AHI) did not change significantly (in events per hour) in the control group, decreased moderately in the exercise group (28 ± 17 to 18 ± 12; P < .03), and decreased significantly more in the CPAP group (32 ± 25 to 8 ± 11; P < .007) and in the exercise + CPAP group (25 ± 15 to 10 ± 16; P < .007). Peak oxygen consumption, muscle strength, and endurance improved only with exercise. Both exercise and CPAP improved subjective excessive daytime sleepiness, quality of life, and the New York Heart Association functional class. However, compared with the control group, changes in scores on the 36-item Medical Outcomes Study Short Form Survey and Minnesota Living with Heart Failure Questionnaire were only significant in the exercise groups. CONCLUSIONS: In patients with HF and OSA, our preliminary results showed that exercise alone attenuated OSA and improved quality of life more than CPAP. In the landscape treatment of OSA in patients with HF, this analysis is the only randomized trial showing any treatment (in this case, exercise) that improved all the studied parameters. The results highlight the important therapeutic benefits of exercise, particularly because adherence to CPAP is low.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Terapia por Exercício/métodos , Insuficiência Cardíaca/terapia , Apneia Obstrutiva do Sono/terapia , Adulto , Idoso , Exercício Físico/fisiologia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Consumo de Oxigênio/fisiologia , Polissonografia , Qualidade de Vida , Comportamento Sexual/fisiologia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/fisiopatologia , Volume Sistólico , Inquéritos e Questionários , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/terapia
13.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 28(4): 434-439, out.-dez. 2018. ilus, graf
Artigo em Português | LILACS | ID: biblio-970628

RESUMO

A insuficiência cardíaca aguda é a principal causa de hospitalização em pacientes acima de 65 anos, além de possuir altos índices de mortalidade hospitalar. Na sua abordagem terapêutica é mandatório um diagnóstico rápido e pronta caracterização do perfil hemodinâmico, baseando-se nos sinais clínicos de congestão e baixo débito cardíaco, para que possamos instituir a terapêutica com drogas endovenosas para alívio rápido dos sintomas, restabelecer a perfusão adequada dos órgãos e reduzir o risco de morte. As drogas a serem administradas de forma isolada ou em combinação são representadas pela furosemida endovenosa em infusão intermitente e contínua, dependendo do grau de congestão pulmonar e/ou sistêmica, as drogas vasodilatadoras e os agentes inotrópicos. As drogas vasodilatadoras, como o nitroprussiato de sódio e a nitroglicerina via endovenosa são, frequentemente, adicionadas aos diuréticos para o tratamento da insuficiência cardíaca aguda com perfil hemodinâmico B, promovendo estabilidade hemodinâmica mais rápida e pronto alívio da dispneia. O nitroprussiato de sódio é preferível nos pacientes com IC perfil B com níveis elevados de resistência vascular periférica e grave congestão pulmonar. Já a nitroglicerina é preferível nos pacientes com cardiopatia isquêmica ou com insuficiência coronariana aguda associada à insuficiência cardíaca. Os agentes inotrópicos positivos estão indicados nos pacientes com IC aguda e evidências de baixo débito cardíaco (perfil hemodinâmico C), a fim de garantir a melhora da perfusão tissular mediante aumento do débito cardíaco, principalmente, nos pacientes hipotensos e com piora da função renal. A associação de inotrópicos com vasodilatadores deve ser considerada quando existe a combinação de baixo débito cardíaco e aumento significativo de resistência vascular pulmonar e ou sistêmica


Acute heart failure is the leading cause of hospitalization in patients over 65 years of age and is accompanied by high hospital mortality rates. In its therapeutic approach, rapid diagnosis and prompt characterization of the hemodynamic profile based on clinical signs of congestion and low cardiac output are mandatory so that we can provide intravenous drug therapy for rapid symptom relief to restore adequate organ perfusion and reduce the risk of death. Drugs to be used alone or in combination are represented by intravenous furosemide in intermittent infusion and continue to depend on the degree of pulmonary and/or systemic congestion, vasodilator drugs, and inotropic agents. Vasodilator drugs, such as sodium nitroprusside and intravenous nitroglycerin, are often added to diuretics for the treatment of acute cardiac insufficiency with hemodynamic profile B, promoting faster hemodynamic stability and prompt relief of dyspnea. Sodium nitroprusside is preferable in patients with hemodynamic profile B with high peripheral vascular resistance and severe pulmonary congestion. Nitroglycerin is preferable in patients with ischemic heart disease or acute coronary insufficiency associated with heart failure (HF). Positive inotropic agents are indicated in patients with acute HF and evidence of low cardiac output (hemodynamic profile C) to ensure improvement in tissue perfusion by increasing cardiac output, especially in patients with hypotension and worsening renal function. The association of inotropes and vasodilators should be considered when there is a combination of low cardiac output and significant increase in pulmonary and/or systemic vascular resistance


Assuntos
Humanos , Masculino , Feminino , Vasodilatadores/uso terapêutico , Doença Aguda , Insuficiência Cardíaca/terapia , Terapêutica , Cardiotônicos , Doenças Cardiovasculares , Diuréticos/uso terapêutico , Dobutamina/uso terapêutico , Hemodinâmica
14.
Clin Rehabil ; 32(1): 66-74, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28633534

RESUMO

OBJECTIVE: To evaluate the impact of a short-term neuromuscular electrical stimulation program on exercise tolerance in hospitalized patients with advanced heart failure who have suffered an acute decompensation and are under continuous intravenous inotropic support. DESIGN: A randomized controlled study. SUBJECTS: Initially, 195 patients hospitalized for decompensated heart failure were recruited, but 70 were randomized. INTERVENTION: Patients were randomized into two groups: control group subject to the usual care ( n = 35); neuromuscular electrical stimulation group ( n = 35) received daily training sessions to both lower extremities for around two weeks. MAIN MEASURES: The baseline 6-minute walk test to determine functional capacity was performed 24 hours after hospital admission, and intravenous inotropic support dose was daily checked in all patients. The outcomes were measured in two weeks or at the discharge if the patients were sent back home earlier than two weeks. RESULTS: After losses of follow-up, a total of 49 patients were included and considered for final analysis (control group, n = 25 and neuromuscular electrical stimulation group, n = 24). The neuromuscular electrical stimulation group presented with a higher 6-minute walk test distance compared to the control group after the study protocol (293 ± 34.78 m vs. 265.8 ± 48.53 m, P < 0.001, respectively). Neuromuscular electrical stimulation group also demonstrated a significantly higher dose reduction of dobutamine compared to control group after the study protocol (2.72 ± 1.72 µg/kg/min vs. 3.86 ± 1.61 µg/kg/min, P = 0.001, respectively). CONCLUSION: A short-term inpatient neuromuscular electrical stimulation rehabilitation protocol improved exercise tolerance and reduced intravenous inotropic support necessity in patients with advanced heart failure suffering a decompensation episode.


Assuntos
Cardiotônicos/administração & dosagem , Terapia por Estimulação Elétrica , Tolerância ao Exercício/fisiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Adulto , Idoso , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Teste de Caminhada
15.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 26(4): 266-71, out.-dez.2016.
Artigo em Português | LILACS | ID: biblio-831953

RESUMO

A doença de Chagas afeta 16 a 18 milhões de pessoas na América Latina. No Brasil, estima-se a existência de 5 a 7 milhões de chagásicos, encontrados em quase todos os estados brasileiros. Aproximadamente 30% dos infectados desenvolvem a forma crônica da doença, com elevadas taxas de morbidade e mortalidade pelo envolvimento cardíaco, e a miocardiopatia chagásica apresenta pior prognóstico quando comparada a outras etiologias da insuficiência cardíaca. Em nosso meio, aproximadamente 30% dos pacientes com insuficiência cardíaca crônica refratária ao tratamento clínico, encaminhados para transplante cardíaco têm como etiologia a doença de Chagas. A experiência acumulada no Brasil demonstra que, a despeito de elevadas taxas da reativação da infecção pelo T. cruzi em decorrência da imunossupressão, os resultados do transplante cardíaco na doença de Chagas são altamente satisfatórios e com evolução pós-transplante a médio e longo prazo semelhante aos resultados do transplante cardíaco em pacientes não chagásicos. Esses resultados colocam o transplante cardíaco como uma excelente opção terapêutica nos casos de pacientes chagásicos com grave comprometimento funcional ou com arritmias malignas.


Chagas disease affects 16 to 18 million people in Latin America. In Brazil, the estimate is that there are 5-7 million people infected, located in almost all Brazilian states. Approximately 30% of those infected develop the chronic form of the disease, with high morbidity and mortality rates due to cardiac involvement, and Chagas cardiomyopathy has worse prognosis when compared to other causes of heart failure. In Brazil, approximately 30% of patients with chronic heart failure refractory to medical treatment, referred for heart transplantation have Chagas disease as etiology. The cumulative experience in Brazil shows that despite high rates of reactivation of infection with T. cruzi due to immunosuppression, the results of heart transplantation in Chagas disease are highly satisfactory and the results post-transplant in medium and long-term are similar to those of heart transplantation in patients without Chagas disease. These results make heart transplantation an excellent therapeutic option in cases of patients with Chagas disease with severe functional impairment or malignant arrhythmias.


Assuntos
Humanos , Doença de Chagas/etiologia , Insuficiência Cardíaca/terapia , Transplante de Coração/história , Doenças Transmissíveis/sangue , Infecções/patologia , Trypanosoma cruzi/parasitologia
16.
Arq Bras Cardiol ; 104(6): 433-42, 2015 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26131698

RESUMO

BACKGROUND: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. OBJECTIVE: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. METHODS: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. RESULTS: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. CONCLUSION: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.


Assuntos
Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização , Registros Médicos , Qualidade da Assistência à Saúde , Sistema de Registros/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Comorbidade , Métodos Epidemiológicos , Feminino , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Resultado do Tratamento
17.
Arq. bras. cardiol ; 105(1): 65-70, July 2015. tab, ilus
Artigo em Inglês | LILACS | ID: lil-754999

RESUMO

Background:

Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure.

Objective:

We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM).

Methods:

Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e´ wave, E/e´ ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson´s coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables.

Results:

Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e´ ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e´ ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase.

Conclusion:

The LAV is independently determined by LV filling pressures (E/e´ ratio) and mitral regurgitation in DCM.

.

Fundamento:

O Volume do Átrio Esquerdo (VAE) é preditor prognóstico em pacientes com insuficiência cardíaca.

Objetivo:

O objetivo do estudo foi avaliar os determinantes do VAE em pacientes com Cardiomiopatia Dilatada (CMD).

Métodos:

Incluídos 90 pacientes com CMD e fração de ejeção do Ventrículo Esquerdo (VE) ≤ 0,50. O VAE foi medido pela ecocardiografia tridimensional (eco3D). Foram avaliados frequência cardíaca, pressão arterial sistólica, volume diastólico e sistólico final do VE, fração de ejeção do VE, onda E mitral, onda e´ do anel mitral (Doppler tecidual), relação E/e´, dissincronia intraventricular, índice de dissincronia tridimensional e insuficiência mitral. O coeficiente de correlação de Pearson analisou a correlação do VAE com as variáveis avaliadas e a regressão linear múltipla as variáveis independentes associadas ao VAE.

Resultados:

A idade média foi 53 ± 11 anos, fração de ejeção do VE: 31,5 ± 8,0% e VAE: 39,2 ± 15,7 ml/m2. As variáveis que se correlacionaram com o VAE foram: volume diastólico final do VE (r = 0,38; p < 0,01), volume sistólico final do VE (r = 0,43; p < 0,001), fração de ejeção do VE (r = -0,36; p v 0,01), onda E (r = 0,50; p < 0,01), relação E/e´ (r = 0,51; p < 0,01) e insuficiência mitral (r = 0,53; p < 0,01). A análise multivariada identificou relação E/e´ (p = 0,02) e insuficiência mitral (p = 0,02) como os únicos preditores independentes do aumento do VAE.

Conclusão:

O VAE na CMD é determinado independentemente pelas pressões de enchimento do VE (relação E/e´) e insuficiência mitral.

.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Função do Átrio Esquerdo/fisiologia , Volume Cardíaco/fisiologia , Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada , Pressão Sanguínea/fisiologia , Ecocardiografia Doppler , Ecocardiografia Tridimensional , Átrios do Coração/fisiopatologia , Átrios do Coração , Valor Preditivo dos Testes , Prognóstico , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda
18.
Arq. bras. cardiol ; 104(6): 433-442, 06/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-750702

RESUMO

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .


Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .


Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antipsicóticos/uso terapêutico , Transtornos de Ansiedade/tratamento farmacológico , Transtorno Bipolar , Esquizofrenia , Antipsicóticos/economia , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/economia , Transtorno Bipolar/epidemiologia , Análise Custo-Benefício , Prescrições de Medicamentos/estatística & dados numéricos , Custos de Cuidados de Saúde , Seguro Saúde/economia , Medicaid/economia , Prevalência , Esquizofrenia/tratamento farmacológico , Esquizofrenia/economia , Esquizofrenia/epidemiologia , Estados Unidos/epidemiologia
19.
Arq Bras Cardiol ; 105(1): 65-70, 2015 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25993483

RESUMO

BACKGROUND: Left atrial volume (LAV) is a predictor of prognosis in patients with heart failure. OBJECTIVE: We aimed to evaluate the determinants of LAV in patients with dilated cardiomyopathy (DCM). METHODS: Ninety patients with DCM and left ventricular (LV) ejection fraction ≤ 0.50 were included. LAV was measured with real-time three-dimensional echocardiography (eco3D). The variables evaluated were heart rate, systolic blood pressure, LV end-diastolic volume and end-systolic volume and ejection fraction (eco3D), mitral inflow E wave, tissue Doppler e' wave, E/e' ratio, intraventricular dyssynchrony, 3D dyssynchrony index and mitral regurgitation vena contracta. Pearson's coefficient was used to identify the correlation of the LAV with the assessed variables. A multiple linear regression model was developed that included LAV as the dependent variable and the variables correlated with it as the predictive variables. RESULTS: Mean age was 52 ± 11 years-old, LV ejection fraction: 31.5 ± 8.0% (16-50%) and LAV: 39.2±15.7 ml/m2. The variables that correlated with the LAV were LV end-diastolic volume (r = 0.38; p < 0.01), LV end-systolic volume (r = 0.43; p < 0.001), LV ejection fraction (r = -0.36; p < 0.01), E wave (r = 0.50; p < 0.01), E/e' ratio (r = 0.51; p < 0.01) and mitral regurgitation (r = 0.53; p < 0.01). A multivariate analysis identified the E/e' ratio (p = 0.02) and mitral regurgitation (p = 0.02) as the only independent variables associated with LAV increase. CONCLUSION: The LAV is independently determined by LV filling pressures (E/e' ratio) and mitral regurgitation in DCM.


Assuntos
Função do Átrio Esquerdo/fisiologia , Volume Cardíaco/fisiologia , Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Ecocardiografia Doppler , Ecocardiografia Tridimensional , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estatísticas não Paramétricas , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
20.
Rev. bras. hipertens ; 21(4): 189-193, out.-dez.2014.
Artigo em Português | LILACS | ID: biblio-881318

RESUMO

A dissecção aórtica é a mais letal das emergências cardiovasculares e, portanto, requer diagnóstico preciso imediato e intervenções terapêuticas clínica e intervencionista em regimes de urgência. Os métodos de imagens, como a ecocardiografia e a angiotomografia, são os métodos diagnósticos de escolha e devem ser considerados na suspeita clínica de dissecção aórtica. A hipertensão é o principal fator de risco para a dissecção e, com frequência, o paciente com dissecção aórtica se apresenta com um quadro de emergência hipertensiva que requer terapêutica rigorosa e imediata. O objetivo da terapêutica é o imediato controle da pressão arterial com nitroprussiato de sódio e a redução da frequência cardíaca com betabloqueador endovenoso, reduzindo a pressão de pulso e o stress parietal na aorta e reduzindo o risco de rotura da aorta ou propagação anterógrada ou retrógada da dissecção. Feito o diagnóstico, a dissecção que envolve a aorta ascendente (Tipo A) deve ser tratada cirurgicamente em regime de emergência. Adissecção restrita à aorta descendente (Tipo B) recebe abordagem clínica inicial e, na vigência de complicações como expansão da falsa luz, hemotórax, dor persistente ou isquemia visceral, deve ser tratada invasivamente com o implante endovascular de stents


Aortic dissection is the most lethal cardiovascular emergencies and, therefore, it requires prompt and accurate diagnosis as well as interventional and clinical therapeutic interventions in emergency regimes. Theimaging methods, such as echocardiography and angiotomography, are the diagnostic methods of choice and should be considered in clinical suspicion of aortic dissection. Hypertension is the leading risk factor for dissection and often the patient with aortic dissection presents with a case of hypertensive emergency that requires accurate and immediate therapy. The goal of therapy is the immediate control of blood pressure withsodium nitroprusside and the heart rate reductionwith intravenous beta-blocker, reducing pulse pressure and the parietal stress in the aorta and the risk of aortic rupture or anterograde or retrograde propagation of dissection. Diagnosed dissection involving the ascending aorta (Type A) should be surgically treated in emergency. The dissection restricted to the descending aorta (Type B) receives initial clinical approach and, in the presence of complications such as expansion of the false lumen, hemothorax, persistent pain or visceral ischemia, it should be treated invasively with endovascular stenting.


Assuntos
Assistência Ambulatorial , Dissecação , Hipertensão/terapia
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