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2.
Arq Bras Cardiol ; 115(5): 1006-1043, 2020 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33295473
3.
Heart ; 2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361353

RESUMO

OBJECTIVE: New York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial. METHODS: The ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient's self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0-100). RESULTS: Of 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4-30) for class I vs 27.5 (11-49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248-1333) vs 778 (421-1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330-466) vs 351 m (286-408), p=0.028; overlap=64%). Among NYHA class I patients, 19%-34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%-10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14). CONCLUSIONS: Most patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.

4.
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
6.
Acta Cardiol ; 75(6): 514-519, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31169075

RESUMO

Background: The prognostic value of cardiopulmonary exercise testing (CPET) variables for major cardiovascular events in patients with heart failure (HF) is widely established. However, the prognostic value of these variables as predictors of appropriate implantable cardioverter-defibrillator (ICD) therapies has not been sufficiently well addressed. This study aimed to evaluate CPET variables such as peak oxygen uptake (VO2 peak), relationship between change in minute ventilation (VE) and carbon dioxide output (VCO2) during incremental exercise (VE/VCO2 slope) and exercise-related periodic breathing (EPB) as appropriate ICD therapy predictors in HF patients.Methods: We retrospectively assessed 61 HF patients who underwent CPET and had ICD implanted for primary prevention. Patients were followed for 767 ± 601 days. Primary outcome was appropriate ICD-delivered therapy, either anti-tachycardia pacing (ATP) or shock.Results: The sample consisted mostly of male patients (65.6%), with severe ventricular dysfunction (mean left ventricular ejection fraction (LVEF) 27 ± 6%). The primary outcome occurred in 20 patients (32%). There were no significant differences in VO2 peak (17.7 ± 4.1 and 16.9 ± 4.5 mL/kg/min), VE/VCO2 slope (39.7 ± 8.4 and 39.6 ± 10.2) or EPB prevalence (20% and 19.5%) in patients with or without appropriate ICD therapy. According to Cox regression analysis, none of the CPET variables were significant predictors of appropriate ICD therapy.Conclusions: In this cohort study of HF patients, CPET variables did not predict appropriate ICD therapies. Further studies with large number of patients are warranted to address this issue.

7.
Eur Heart J ; 40(44): 3605-3612, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31424503

RESUMO

AIMS: Although loop diuretics are widely used to treat heart failure (HF), there is scarce contemporary data to guide diuretic adjustments in the outpatient setting. METHODS AND RESULTS: In a prospective, randomized and double-blind protocol, we tested the safety and tolerability of withdrawing low-dose furosemide in stable HF outpatients at 11 HF clinics in Brazil. The trial had two blindly adjudicated co-primary outcomes: (i) symptoms assessment quantified as the area under the curve (AUC) of a dyspnoea score on a visual-analogue scale evaluated at 4 time-points (baseline, Day 15, Day 45, and Day 90) and (ii) the proportion of patients maintained without diuretic reuse during follow-up. We enrolled 188 patients (25% females; 59 ± 13 years old; left ventricular ejection fraction = 32 ± 8%) that were randomized to furosemide withdrawal (n = 95) or maintenance (n = 93). For the first co-primary endpoint, no significant difference in patients' assessment of dyspnoea was observed in the comparison of furosemide withdrawal with continuous administration [median AUC 1875 (interquartile range, IQR 383-3360) and 1541 (IQR 474-3124), respectively; P = 0.94]. For the second co-primary endpoint, 70 patients (75.3%) in the withdrawal group and 77 patients (83.7%) in the maintenance group were free of furosemide reuse during follow-up (odds ratio for additional furosemide use with withdrawal 1.69, 95% confidence interval 0.82-3.49; P = 0.16). Heart failure-related events (hospitalizations, emergency room visits, and deaths) were infrequent and similar between groups (P = 1.0). CONCLUSIONS: Diuretic withdrawal did not result in neither increased self-perception of dyspnoea nor increased need of furosemide reuse. Diuretic discontinuation may deserve consideration in stable outpatients with no signs of fluid retention receiving optimal medical therapy. CLINICALTRIALS.GOV IDENTIFIER: NCT02689180.


Assuntos
Furosemida/uso terapêutico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/uso terapêutico , Suspensão de Tratamento/estatística & dados numéricos , Idoso , Líquidos Corporais/fisiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Método Duplo-Cego , Dispneia/diagnóstico , Dispneia/psicologia , Feminino , Seguimentos , Furosemida/administração & dosagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Segurança , Autoimagem , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda/efeitos dos fármacos , Escala Visual Analógica
10.
Arq Bras Cardiol ; 111(3): 436-539, 2018 09.
Artigo em Português | MEDLINE | ID: mdl-30379264
12.
Nutrition ; 54: 111-117, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29793053

RESUMO

OBJECTIVES: Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF. METHODS: Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d. RESULTS: Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% ± 8% for IG and 60% ± 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 ± 2.2 kg in the IG and 1.8 ± 2.1 kg in CG (P = 0.49) as well as the reduction in the congestion score (IG = 3.4 ± 3.5; CG = 3.8 ± 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P <0.001). No significant between-group differences at 30 d were found. CONCLUSIONS: Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF.


Assuntos
Dieta Hipossódica/métodos , Insuficiência Cardíaca/dietoterapia , Volume Sistólico , Privação de Água , Idoso , Idoso de 80 Anos ou mais , Ingestão de Energia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sede , Resultado do Tratamento , Perda de Peso
14.
Arq Bras Cardiol ; 110(3): 270-277, 2018 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29694552

RESUMO

BACKGROUND: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial. OBJECTIVE: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram. METHODS: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%. RESULTS: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66). CONCLUSION: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.


Assuntos
Pressão Atrial/fisiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia Doppler de Pulso/métodos , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Veias Jugulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Exame Físico , Estudos Prospectivos , Radiografia Torácica/métodos , Valores de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/sangue
15.
Arq. bras. cardiol ; 110(3): 270-277, Mar. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-888035

RESUMO

Abstract Background: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial. Objective: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram. Methods: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%. Results: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66). Conclusion: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.


Resumo Fundamento: Exame físico e peptídeo natriurético do tipo B (BNP) foram usados para estimar a hemodinâmica e adequar a terapia de pacientes com insuficiência cardíaca aguda descompensada (ICAD). Entretanto, correlação entre esses parâmetros e a pressão de enchimento do ventrículo esquerdo é controversa. Objetivo: Avaliar a acurácia diagnóstica do exame físico, da radiografia de tórax (RT) e do BNP para estimar a pressão atrial esquerda (PAE) avaliada pelo ecodopplercardiograma tecidual. Métodos: Pacientes admitidos com ICAD foram avaliados prospectivamente. As características diagnósticas dos sinais físicos de insuficiência cardíaca, RT e BNP para predizer elevação da PAE (> 15 mmHg), isolados ou combinados, foram calculadas. Teste de Spearman foi usado para analisar a correlação entre variáveis de distribuição não normal. O nível de significância foi 5%. Resultados: Este estudo incluiu 43 pacientes com idade média de 69,9 ± 11,1 anos, fração de ejeção ventricular esquerda de 25 ± 8.0%, e BNP de 1057 ± 1024,21 pg/mL. Individualmente, todos os parâmetros clínicos, RT e BNP apresentaram fraco desempenho para predizer PAE ≥ 15 mmHg. O escore clínico de congestão teve o pior desempenho [área sob a curva receiver operating characteristic (AUC) 0,53], seguindo-se escore clínico + RT (AUC 0,60), escore clínico + RT + BNP > 400 pg/mL (AUC 0,62) e escore clínico + RT + BNP > 1000 pg/mL (AUC 0,66). Conclusão: Exame físico, RT e BNP tiveram desempenho fraco para predizer PAE ≥15 mmHg. O uso desses parâmetros isoladamente ou em combinação pode levar a estimativa imprecisa do perfil hemodinâmico. (Arq Bras Cardiol. 2018; 110(3):270-277)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/fisiopatologia , Peptídeo Natriurético Encefálico/sangue , Pressão Atrial/fisiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Exame Físico , Valores de Referência , Volume Sistólico/fisiologia , Radiografia Torácica/métodos , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/sangue , Ecocardiografia Doppler de Pulso/métodos , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico por imagem , Veias Jugulares/fisiopatologia
16.
Am Heart J ; 194: 125-131, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29223430

RESUMO

AIMS: Furosemide is commonly prescribed for symptom relief in heart failure (HF) patients. Although few data support the continuous use of loop diuretics in apparently euvolemic HF patients with mild symptoms, there is concern about safety of diuretic withdrawal in these patients. The ReBIC-1 trial was designed to evaluate the safety and tolerability of withdrawing furosemide in stable, euvolemic, chronic HF outpatients. This multicenter initiative is part of the Brazilian Research Network in Heart Failure (ReBIC) created to develop clinical studies in HF and composed predominantly by university tertiary care hospitals. METHODS: The ReBIC-1 trial is currently enrolling HF patients in NYHA functional class I-II, left ventricular ejection fraction ≤45%, without a HF-related hospital admission within the last 6 months, receiving a stable dose of furosemide (40 or 80 mg per day) for at least 6 months. Eligible patients will be randomized to maintain or withdraw furosemide in a double-blinded protocol. The trial has two co-primary outcomes: (1) dyspnea assessment using a visual-analogue scale evaluated at 4 time points and (2) the proportion of patients maintained without diuretics during the follow-up period. Total sample size was calculated to be 220 patients. Enrolled patients will be followed up to 90 days after randomization, and diuretic will be restarted if clinical deterioration or signs of congestion are detected. Pre-defined sub-group analysis based on NT-proBNP levels at baseline is planned. PERSPECTIVE: Evidence-based strategies aiming to simplify HF pharmacotherapy are needed in clinical practice. The ReBIC-1 trial will determine the safety of withdrawing furosemide in stable chronic HF patients.


Assuntos
Tolerância a Medicamentos , Furosemida/administração & dosagem , Insuficiência Cardíaca/tratamento farmacológico , Pacientes Ambulatoriais , Idoso , Biomarcadores/sangue , Deterioração Clínica , Diuréticos/administração & dosagem , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Resultado do Tratamento
17.
Trials ; 15: 347, 2014 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-25187436

RESUMO

BACKGROUND: Although half of all patients with heart failure (HF) have a normal or near-normal ejection fraction and their prognosis differs little from that of patients with a reduced ejection fraction, the pathophysiology of HF with preserved ejection fraction (HF-PEF) is still poorly understood, and its management poorly supported by clinical trials. Sodium and fluid restriction is the most common self-care measure prescribed to HF patients for management of congestive episodes. However, its role in the treatment of HF-PEF remains unclear. This trial seeks to compare the effects of a sodium- and fluid-restricted diet versus an unrestricted diet on weight loss, neurohormonal activation, and clinical stability in patients admitted for decompensated HF-PEF. METHODS/DESIGN: This is a randomized, parallel trial with blinded outcome assessment. The sample will include adult patients (aged ≥18 years) with a diagnosis of HF-PEF admitted for HF decompensation. The patients will be randomized to receive a diet with sodium and fluid intake restricted to 0.8 g/day and 800 mL/day respectively (intervention group) or an unrestricted diet, with 4 g/day sodium and unlimited fluid intake (control group), and followed for 7 days or until hospital discharge. The primary outcome shall consist of weight loss at 7 days or discharge. The secondary outcome includes assessment of clinical stability, neurohormonal activation, daily perception of thirst and readmission rate at 30 days. DISCUSSION: Assessment of the effects of sodium and fluid restriction on neurohormonal activation and clinical course of HF-PEF can promote a deeper understanding of the pathophysiology and progression of this complex syndrome. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT01896908 (date of registration: 8 August 2013).


Assuntos
Protocolos Clínicos , Insuficiência Cardíaca/terapia , Sódio na Dieta/administração & dosagem , Volume Sistólico , Adulto , Ingestão de Líquidos , Insuficiência Cardíaca/fisiopatologia , Humanos , Avaliação de Resultados em Cuidados de Saúde
18.
Eur J Heart Fail ; 16(9): 1002-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25044072

RESUMO

AIMS: Home-based interventions for heart failure (HF) patients might be particularly effective in middle-income countries, where social, cultural, and economic constraints limit the effectiveness of HF treatment outside the hospital environment. METHODS AND RESULTS: HELEN-II was a randomized clinical trial conducted in Brazil designed to evaluate the clinical efficacy of a nurse-based strategy, started after discharge following an acute decompensated HF (ADHF) admission. HELEN-II compares the efficacy of home visits and telephone reinforcement (n = 123) with that of the conventional strategy, which is based on medical follow-up (n = 129). The primary outcome was a composite endpoint of a first visit to the emergency department (≤ 24 h), a hospital readmission (> 24 h), or all-cause death, assessed during the first 6 months of follow-up. Most enrolled subjects were middle-aged (62 ± 13 years) males (63%) in NYHA functional class II-III (84%) with severe LV dysfunction (mean LVEF 29.6 ± 9%). The primary composite endpoint was decreased by 27% in the interventional group (relative risk 0.73; 95% confidence interval 0.54-0.99; P = 0.049). At the end of follow-up, the rate of use of the standard-of-care HF medications was similar in both groups, except for the higher use of furosemide in the interventional group. Also, HF knowledge and self-care were significantly increased in the interventional group. CONCLUSIONS: A post-discharge, nurse-led management strategy significantly decreases the morbidity of ADHF patients in the public health system of a developing middle-income country.


Assuntos
Insuficiência Cardíaca/enfermagem , Pacientes Internados , Padrões de Prática em Enfermagem , Autocuidado/normas , Volume Sistólico/fisiologia , Doença Aguda , Brasil/epidemiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Readmissão do Paciente/tendências
19.
Can J Cardiol ; 30(3): 345-51, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24484913

RESUMO

BACKGROUND: QRS duration is considered to be an indicator of adverse outcome in patients with heart failure (HF), and genetic polymorphisms may be involved in this conductivity impairment. We studied the prognostic impact of the QRS widening rate (QRS-WR) on patients with HF and the influence of the matrix metalloproteinases gene polymorphisms on the QRS-WR. METHODS: This prospective cohort study included 184 patients with left ventricular (LV) systolic dysfunction (LV ejection fraction [LVEF] < 45%). The QRS-WR was calculated as the difference between 2 electrocardiogram assessments (in ms) divided by the time elapsed between each evaluation (months). The MMP-1 -1607 1G/2G, MMP-2 -790G/T and -1575G/A, MMP-3 -1171 5A/6A, MMP-9 -1562 C/T and R279Q, and MMP-12 -82A/G polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism. RESULTS: Patients were predominantly white (68%) men (67%) in New York Heart Association functional classes I and II (77%). Patients with HF with a QRS-WR ≥ 0.5 ms/month had more HF-related deaths and more combined clinical events than those with a QRS-WR < 0.5 ms/month (P = 0.03 and P = 0.01, respectively). After adjusting for other covariates, the QRS-WR remained an independent predictor of combined clinical events (hazard ratio, 1.6; 95% confidence interval, 1.1-2.5; P = 0.02). The MMP-1 2G2G genotype was associated with nearly a 2-fold increase in QRS-WR (P = 0.03). Conversely, patients with the MMP-3 5A5A genotype and a nonischemic cause of HF were protected against QRS enlargement (P = 0.03). CONCLUSIONS: QRS-WR retains prognostic value in patients with chronic HF receiving guideline-based pharmacologic treatment. MMP gene polymorphisms can influence the rate of QRS enlargement over time.


Assuntos
DNA/genética , Eletrocardiografia , Predisposição Genética para Doença , Insuficiência Cardíaca/genética , Metaloproteinases da Matriz/genética , Polimorfismo Genético , Função Ventricular Esquerda/fisiologia , Brasil/epidemiologia , Feminino , Seguimentos , Genótipo , Insuficiência Cardíaca/enzimologia , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Metaloproteinases da Matriz/metabolismo , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida/tendências
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