Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
Arq Bras Cardiol ; 2019 Sep 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31482988

RESUMO

BACKGROUND: Heart failure (HF) is a multifactorial syndrome with repercussions on quality of life (QoL). OBJECTIVES: To investigate the main interacting factors responsible to worsen quality of life of outpatients with HF. METHODS: Cross-sectional observational study with 99 patients of both genders, attending a HF outpatient clinic at a university hospital, all with a reduced ejection fraction (<40%) by echocardiography. They were evaluated using sociodemographic and clinical questionnaires, the Minnesota Living with Heart Failure (MLwHF), and the Hospital Anxiety and Depression scale (HADS). QoL was the outcome variable. Two multivariate models were used: the parametric beta regression analysis, and the non-parametric regression tree, considering p < 0.05 and 0.05 < p < 0.10 for statistical and clinical significance, respectively. RESULTS: Beta regression showed that depression and anxiety symptoms worsened the QoL of HF patients, as well as male sex, age younger than 60 years old, lower education level, lower monthly family income, recurrent hospitalizations and comorbidities such as ischemic heart diseases and arterial hypertension. The regression tree confirmed that NYHA functional class III and IV worsen all dimensions of MLwHF by interacting with anxiety symptoms, which influenced directly or indirectly the presence of poorer total score and emotional dimension of MLwHF. Previous hospitalization in the emotional dimension and age younger than 60 years in general dimension were associated with anxiety and NYHA functional class, also worsening the QoL of HF patients. CONCLUSION: HF with reduced ejection fraction was associated with poorer MLwHF. Anxiety symptoms, previous hospitalization and younger age were also associated with worsened MLwHF. Knowledge of these risk factors can therefore guide assessment and treatment of HF patients.

2.
Arq Bras Cardiol ; 111(3): 436-539, 2018 Sep.
Artigo em Português | MEDLINE | ID: mdl-30379264
3.
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
4.
Arq Bras Cardiol ; 110(2): 140-150, 2018 Feb.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29561992

RESUMO

BACKGROUND: The high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes. OBJECTIVES: To assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early. METHODS: Prospective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05. RESULTS: Of 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0). CONCLUSION: The 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.


Assuntos
Antraciclinas/efeitos adversos , Antineoplásicos/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cardiotoxicidade/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Trastuzumab/efeitos adversos , Adulto , Brasil/epidemiologia , Cardiotoxicidade/epidemiologia , Cardiotoxicidade/etiologia , Diagnóstico Precoce , Ecocardiografia Doppler , Feminino , Seguimentos , Cardiopatias/induzido quimicamente , Cardiopatias/diagnóstico por imagem , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Função Ventricular Esquerda/efeitos dos fármacos
5.
Arq. bras. cardiol ; 110(3): 270-277, Mar. 2018. tab, graf
Artigo em Inglês | LILACS-Express | 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)

6.
Arq. bras. cardiol ; 110(2): 140-150, Feb. 2018. tab, graf
Artigo em Inglês | LILACS-Express | ID: biblio-888016

RESUMO

Abstract Background: The high cardiotoxicity morbidity and mortality rates associated with the antineoplastic therapy for breast cancer could be reduced with the early use of cardioprotective drugs. However, the low sensitivity of left ventricular ejection fraction limits its use in that preventive strategy. New parameters, such as global longitudinal strain, are being used in the early detection of contractile function changes. Objectives: To assess the incidence of cardiotoxicity in patients treated for breast cancer, the independent factors associated with that event, and the ability of strain to identify it early. Methods: Prospective observational study of consecutive outpatients diagnosed with breast cancer, with no previous antineoplastic treatment and no ventricular dysfunction, who underwent anthracycline and/or trastuzumab therapy. The patients were quarterly evaluated on a 6- to 12-month follow-up by an observer blind to therapy. Cox regression was used to evaluate the association of cardiotoxicity with clinical, therapeutic and echocardiographic variables. A ROC curve was built to identify the strain cutoff point on the third month that could predict the ejection fraction reduction on the sixth month. For all tests, the statistical significance level adopted was p ≤ 0.05. Results: Of 49 women (mean age, 49.7 ± 12.2 years), cardiotoxicity was identified in 5 (10%) on the third (n = 2) and sixth (n = 3) months of follow-up. Strain was independently associated with the event (p = 0.004; HR = 2.77; 95%CI: 1.39-5.54), with a cutoff point for absolute value of -16.6 (AUC = 0.95; 95%CI: 0.87-1.0) or a cutoff point for percentage reduction of 14% (AUC = 0.97; 95%CI: 0.9-1.0). Conclusion: The 14% reduction in strain (absolute value of -16.6) allowed the early identification of patients who could develop anthracycline and/or trastuzumab-induced cardiotoxicity.


Resumo Fundamentos: A elevada morbimortalidade da cardiotoxicidade associada à terapia antineoplásica para o câncer de mama poderia ser reduzida com uso precoce de drogas cardioprotetoras. No entanto, a baixa sensibilidade da fração de ejeção limita sua utilização nessa estratégia preventiva. Novos parâmetros, como o strain longitudinal global, estão sendo utilizados na detecção precoce das alterações da função contrátil. Objetivos: Avaliar a incidência de cardiotoxicidade entre pacientes tratados para câncer de mama, os fatores independentes associados a esse evento e a capacidade do strain em identificá-la precocemente. Métodos: Estudo prospectivo observacional de pacientes ambulatoriais consecutivos com diagnóstico de câncer de mama, sem tratamento antineoplásico prévio, sem disfunção ventricular, submetidos ao uso de antracíclicos e/ou trastuzumab, avaliados trimestralmente de forma cega em relação à terapia, seguidos por 6 a 12 meses. Regressão de Cox foi utilizada para avaliar a associação de variáveis clínicas, terapêuticas e ecocardiográficas com cardiotoxicidade. Curva ROC foi construída para identificar o ponto de corte do strain capaz de prever redução da fração de ejeção. Para todos os testes, o nível de significância estatística foi definido com p ≤ 0,05. Resultados: Dentre 49 mulheres com idade média de 49,7 ± 12,2 anos, identificamos 5 casos de cardiotoxicidade (10%), aos 3 (n = 2) e 6 (n = 3) meses de seguimento. Strain foi associado de forma independente ao evento (p = 0,004; HR = 2,77; IC95%: 1,39-5,54), tendo como ponto de corte o valor absoluto de -16,6 (ASC = 0,95; IC95%: 0,87-1,0) ou redução de 14% (ASC = 0,97; IC95%: 0,9-1,0). Conclusão: A redução de 14% do strain (ou valor absoluto de -16,6) foi capaz de identificar precocemente pacientes que podem evoluir com cardiotoxicidade associada ao antracíclico e/ou trastuzumab.

7.
Cad Saude Publica ; 32(1)2016 Jan.
Artigo em Português | MEDLINE | ID: mdl-26886364

RESUMO

Probabilistic record linkage has been used increasingly to identify outcomes in cohort studies. This study aimed to assess the method's accuracy for identifying deaths in a cohort of 450 patients admitted to a university hospital for decompensated heart failure over a six-year period. Vital status of cohort members was determined from electronic patient file data (gold standard). OpenRecLink software was used to link cohort records with those from the Mortality Information System, aimed at identifying deaths. Only 53.6% of patients had vital status known at the end of follow-up, and 59.3% of these had died. The method showed 97.9% sensitivity, 100% specificity, 100% positive predictive value, 97% negative predictive value, and 98.8% accuracy. The results suggest probabilistic record linkage as a valuable tool for identifying deaths in cohort studies.


Assuntos
Insuficiência Cardíaca/mortalidade , Registro Médico Coordenado/normas , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Registro Médico Coordenado/métodos
8.
Cad. Saúde Pública (Online) ; 32(1): e00097415, 2016. tab
Artigo em Português | LILACS-Express | ID: biblio-952237

RESUMO

Resumo O relacionamento probabilístico de registros vem sendo cada vez mais empregado na identificação de desfechos em estudos de coorte. O objetivo deste trabalho foi avaliar a acurácia deste método na identificação de óbitos em uma coorte de 450 pacientes admitidos em um hospital universitário por insuficiência cardíaca descompensada, em um período de seis anos. O estado vital dos membros da coorte foi determinado a partir dos registros no prontuário eletrônico dos pacientes (padrão-ouro). O software OpenRecLink foi utilizado para relacionar os registros da coorte com aqueles da base do Sistema de Informações de Mortalidade, visando à identificação de óbitos. Apenas 53,6% pacientes apresentavam estado vital conhecido ao final do seguimento e destes 59,3% haviam falecido. O método apresentou sensibilidade de 97,9%, especificidade de 100%, valor preditivo positivo de 100%, valor preditivo negativo de 97% e acurácia de 98,8%. Esses resultados sugerem que o relacionamento probabilístico de registros é uma valiosa ferramenta na identificação de óbitos para estudos de coorte.


Abstract Probabilistic record linkage has been used increasingly to identify outcomes in cohort studies. This study aimed to assess the method's accuracy for identifying deaths in a cohort of 450 patients admitted to a university hospital for decompensated heart failure over a six-year period. Vital status of cohort members was determined from electronic patient file data (gold standard). OpenRecLink software was used to link cohort records with those from the Mortality Information System, aimed at identifying deaths. Only 53.6% of patients had vital status known at the end of follow-up, and 59.3% of these had died. The method showed 97.9% sensitivity, 100% specificity, 100% positive predictive value, 97% negative predictive value, and 98.8% accuracy. The results suggest probabilistic record linkage as a valuable tool for identifying deaths in cohort studies.


Resumen La vinculación probabilística de registros es cada vez más empleada para identificar los resultados de los estudios de cohortes. El objetivo de este estudio fue evaluar la exactitud de este método en la identificación de las muertes en una cohorte de 450 pacientes ingresados en un hospital universitario por insuficiencia cardíaca descompensada en un período de seis años. El estado vital de integrantes de la cohorte se determinó a partir de los datos en los registros médicos electrónicos de pacientes (patrón oro). El software OpenRecLink fue utilizado para relacionar los registros de la cohorte con los de la base del Sistema de Información sobre Mortalidad, dirigido a la identificación de las muertes. Sólo el 53,6% de los pacientes presentaban estado vital conocido al final del seguimiento y de éstos el 59,3% habían muerto. El método tuvo una sensibilidad de un 97,9%, una especificidad de un 100%, valor predictivo positivo de un 100%, valor predictivo negativo de un 97% y exactitud de un 98,8%. Estos resultados sugieren que la vinculación probabilística de registros es una herramienta valiosa para la identificación de las muertes en los estudios de cohortes.

9.
Arq. bras. cardiol ; 104(5): 387-393, 05/2015. tab, graf
Artigo em Inglês | LILACS | ID: lil-748149

RESUMO

Background: No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease. Objective: To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes. Methods: Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life. Results: This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and 'general health perception' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and 'physical functioning' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01). Conclusion: Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains. .


Fundamento: Não há estudos que tenham descrito e avaliado a associação entre hemodinâmica, limitações físicas e qualidade de vida em pacientes com hipertensão pulmonar (HP) sem doença cardiovascular ou respiratória concomitante. Objetivo: Descrever o perfil hemodinâmico, a qualidade de vida e a capacidade física de pacientes com HP dos grupos I e IV e estudar a associação entre esses desfechos. Métodos: Estudo transversal em que foram incluídos pacientes com HP dos grupos clínicos I e IV e classes funcionais II e III, submetidos a avaliações hemodinâmica (cateterismo), de tolerância ao exercício e de qualidade de vida. Resultados: Foram avaliados 20 pacientes com idade média de 46,8±14,3 anos. Eles apresentaram pressão de encunhamento arterial pulmonar de 10,5±3,7 mmHg, distância percorrida no teste de caminhada de 6 minutos (DTC6M) de 463±78 m, consumo de oxigênio no pico do exercício de 12,9±4,3 mLO2.kg-1.min-1 e domínios de qualidade de vida com escores < 60%. Houve associação entre índice cardíaco (IC) e equivalente ventilatório de CO2 (r=-0,59; p<0,01), IC e equivalente ventilatório de oxigênio (r=-0,49; p<0,05), pressão atrial direita (PAD) e domínio 'estado geral de saúde' (r=-0,61; p<0,01), PAD e DTC6M (r=-0,49; p<0,05), resistência vascular pulmonar (RVP) e domínio 'capacidade funcional' (r=-0,56; p<0,01), RVP e DTC6M (r=-0,49, p<0,05) e índice de RVP e capacidade física (r=-0,51; p<0,01). Conclusão: Pacientes com HP dos grupos I e IV e classes funcionais II e III apresentam redução da capacidade física e dos componentes físico e mental de qualidade de vida. As variáveis hemodinâmicas IC, pressão arterial pulmonar diastólica, PAD, RVP e índice de RVP associam-se com a tolerância ao exercício e domínios da qualidade de vida. .


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Hemodinâmica/fisiologia , Hipertensão Pulmonar/fisiopatologia , Qualidade de Vida , Pressão Sanguínea/fisiologia , Estudos Transversais , Teste de Esforço/métodos , Consumo de Oxigênio , Prognóstico , Valores de Referência , Testes de Função Respiratória , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Caminhada/fisiologia
10.
Arq Bras Cardiol ; 104(5): 387-93, 2015 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25742419

RESUMO

BACKGROUND: No studies have described and evaluated the association between hemodynamics, physical limitations and quality of life in patients with pulmonary hypertension (PH) without concomitant cardiovascular or respiratory disease. OBJECTIVE: To describe the hemodynamic profile, quality of life and physical capacity of patients with PH from groups I and IV and to study the association between these outcomes. METHODS: Cross-sectional study of patients with PH from clinical groups I and IV and functional classes II and III undergoing the following assessments: hemodynamics, exercise tolerance and quality of life. RESULTS: This study assessed 20 patients with a mean age of 46.8 ± 14.3 years. They had pulmonary capillary wedge pressure of 10.5 ± 3.7 mm Hg, 6-minute walk distance test (6MWDT) of 463 ± 78 m, oxygen consumption at peak exercise of 12.9 ± 4.3 mLO2.kg-1.min-1 and scores of quality of life domains < 60%. There were associations between cardiac index (CI) and ventilatory equivalent for CO2 (r=-0.59, p <0.01), IC and ventilatory equivalent for oxygen (r=-0.49, p<0.05), right atrial pressure (RAP) and 'general health perception' domain (r=-0.61, p<0.01), RAP and 6MWTD (r=-0.49, p<0.05), pulmonary vascular resistance (PVR) and 'physical functioning' domain (r=-0.56, p<0.01), PVR and 6MWTD (r=-0.49, p<0.05) and PVR index and physical capacity (r=-0.51, p<0.01). CONCLUSION: Patients with PH from groups I and IV and functional classes II and III exhibit a reduction in physical capacity and in the physical and mental components of quality of life. The hemodynamic variables CI, diastolic pulmonary arterial pressure, RAP, PVR and PVR index are associated with exercise tolerance and quality of life domains.


Assuntos
Tolerância ao Exercício/fisiologia , Exercício/fisiologia , Hemodinâmica/fisiologia , Hipertensão Pulmonar/fisiopatologia , Qualidade de Vida , Adulto , Pressão Sanguínea/fisiologia , Estudos Transversais , Teste de Esforço/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Prognóstico , Valores de Referência , Testes de Função Respiratória , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Caminhada/fisiologia
11.
Arq Bras Cardiol ; 103(4): 315-22, 2014 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-25352505

RESUMO

BACKGROUND: Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. OBJECTIVES: To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. METHODS: Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. RESULTS: The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ≥ 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). CONCLUSIONS: Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality.


Assuntos
Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Idoso , Brasil/epidemiologia , Estudos Transversais , Ecocardiografia , Feminino , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Tromboembolia/etiologia
12.
Arq. bras. cardiol ; 103(4): 315-322, 10/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-725315

RESUMO

Background: Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. Objectives: To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. Methods: Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. Results: The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ≥ 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). Conclusions: Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality. .


Fundamento: Estudos sobre fibrilação atrial (FA) na insuficiência cardíaca descompensada (ICD) são muito escassos no Brasil. Objetivos: Determinar a prevalência, os tipos e os fatores associados à FA em pacientes hospitalizados por ICD; analisar perfil de risco embólico e taxa de anticoagulação; e avaliar o impacto da FA na mortalidade hospitalar e no tempo de internação. Métodos: Estudo seccional de casos incidentes, retrospectivo, observacional. Analisaram-se 659 internações consecutivas por ICD entre 01/01/2006 a 31/12/2011. Risco embólico foi avaliado pelo acrônimo CHADSVASc. Na análise univariada, foram utilizados o qui-quadrado, teste t de Student ou Mann Whitney. Na análise multivariada, utilizou-se a regressão logística. Resultados: A prevalência de FA foi de 40%, predominando o tipo permanente (73,5%). No modelo multivariado, a FA se associou à idade avançada (p < 0,0001), etiologia não isquêmica (p = 0,02), disfunção ventricular direita (VD) (p = 0,03), menor pressão arterial sistólica (PAS) (p = 0,02), maior fração de ejeção (FE) (p < 0,0001) e aumento atrial esquerdo (AE) (p < 0,0001). A mediana do CHADSVASc foi quatro e 90% tinham escore ≥ 2. A taxa de anticoagulação foi de 52,8% na admissão e 66,8% na alta, sendo menor em escores mais elevados. O grupo com FA apresentou maior mortalidade hospitalar (11,0% versus 8,1%, p = 0,21) e internação mais prolongada (20,5 ± 16 versus 16,3 ± 12, p = 0,001). Conclusões: A FA é frequente na ICD, predominando o tipo permanente. Associa-se com idade avançada, etiologia não isquêmica, disfunção de VD, menor PAS, maior FE e aumento AE. O perfil de risco embólico é elevado e a anticoagulação é subutilizada. ...


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Mortalidade Hospitalar , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Brasil/epidemiologia , Estudos Transversais , Ecocardiografia , Hospitalização , Tempo de Internação , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Estatísticas não Paramétricas , Tromboembolia/etiologia
13.
Arq Bras Cardiol ; 0: 0, 2014 Aug 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-25211202

RESUMO

Background: Studies on atrial fibrillation (AF) in decompensated heart failure (DHF) are scarce in Brazil. Objectives: To determine AF prevalence, its types and associated factors in patients hospitalized due to DHF; to assess their thromboembolic risk profile and anticoagulation rate; and to assess the impact of AF on in-hospital mortality and hospital length of stay. Methods: Retrospective, observational, cross-sectional study of incident cases including 659 consecutive hospitalizations due to DHF, from 01/01/2006 to 12/31/2011. The thromboembolic risk was assessed by using CHADSVASc score. On univariate analysis, the chi-square, Student t and Mann Whitney tests were used. On multivariate analysis, logistic regression was used. Results: The prevalence of AF was 40%, and the permanent type predominated (73.5%). On multivariate model, AF associated with advanced age (p < 0.0001), non-ischemic etiology (p = 0.02), right ventricular dysfunction (p = 0.03), lower systolic blood pressure (SBP) (p = 0.02), higher ejection fraction (EF) (p < 0.0001) and enlarged left atrium (LA) (p < 0.0001). The median CHADSVASc score was 4, and 90% of the cases had it ≥ 2. The anticoagulation rate was 52.8% on admission and 66.8% on discharge, being lower for higher scores. The group with AF had higher in-hospital mortality (11.0% versus 8.1%, p = 0.21) and longer hospital length of stay (20.5 ± 16 versus 16.3 ± 12, p = 0.001). Conclusions: Atrial fibrillation is frequent in DHF, the most prevalent type being permanent AF. Atrial fibrillation is associated with more advanced age, non-ischemic etiology, right ventricular dysfunction, lower SBP, higher EF and enlarged LA. Despite the high thromboembolic risk profile, anticoagulation is underutilized. The presence of AF is associated with longer hospital length of stay and high mortality.

14.
Arq. bras. cardiol ; 101(4): 336-343, out. 2013. ilus, graf, tab
Artigo em Português | LILACS | ID: lil-690573

RESUMO

FUNDAMENTO: A hipertensão arterial pulmonar é uma doença grave e progressiva. O maior desafio clínico é seu diagnóstico precoce. OBJETIVO: Avaliar a presença e a extensão do realce tardio miocárdico pela ressonância magnética cardíaca bem como verificar se o percentual da massa de fibrose miocárdica é indicador de gravidade. MÉTODOS: Estudo transversal com 30 pacientes com hipertensão arterial pulmonar dos grupos I e IV, submetidos às avaliações clínica, funcional e hemodinâmica, e à ressonância magnética cardíaca. RESULTADOS: A média de idade dos pacientes foi de 52 anos, com predomínio do gênero feminino (77%). Dentre os pacientes, 53% apresentavam insuficiência ventricular direita ao diagnóstico, e 90% encontravam-se em classe funcional II/III. A média do teste de caminhada de 6 minutos foi de 395 m. No estudo hemodinâmico com o cateterismo direito, a média da pressão arterial pulmonar foi de 53,3 mmHg, do índice cardíaco de 2,1 L/min.m², e a mediana da pressão atrial direita foi de 13,5 mmHg. Realce tardio do miocárdio pela ressonância magnética cardíaca foi encontrado em 28 pacientes. A mediana da massa de fibrose foi 9,9 g e do percentual da massa de fibrose de 6,17%. A presença de classe funcional IV, insuficiência ventricular direita ao diagnóstico, teste de caminhada de 6 minutos < 300 metros e pressão atrial direita > 15 mmHg, com índice cardíaco < 2,0 L/min.m², teve associação significativa com maior percentual de fibrose miocárdica. CONCLUSÃO: O percentual da massa de fibrose miocárdica mostra-se um marcador não invasivo com perspectivas promissoras na identificação do paciente portador de hipertensão pulmonar com fatores de alto risco.


BACKGROUND: Pulmonary arterial hypertension is a severe and progressive disease. Its early diagnosis is the greatest clinical challenge. OBJECTIVE: To evaluate the presence and extension of the delayed myocardial contrast-enhanced cardiovascular magnetic resonance, as well as to verify if the percentage of the myocardial fibrosis mass is a severity predictor. METHODS: Cross-sectional study with 30 patients with pulmonary arterial hypertension of groups I and IV, subjected to clinical, functional and hemodynamic evaluation, and to cardiac magnetic resonance. RESULTS: The mean age of patients was 52 years old, with female predominance (77%). Among the patients, 53% had right ventricular failure at diagnosis, and 90% were in functional class II/III. The mean of the 6-minute walk test was 395m. In hemodynamic study with right catheterism, the mean average pulmonary arterial pressure was 53.3mmHg, of the cardiac index of 2.1L/ min.m², and median right atrial pressure was 13.5 mmHg. Delayed myocardial contrast-enhanced cardiovascular magnetic resonance was found in 28 patients. The mean fibrosis mass was 9.9 g and the median percentage of fibrosis mass was 6.17%. The presence of functional class IV, right ventricular failure at diagnosis, 6-minute walk test < 300 meters and right atrial pressure > 15mmHg, with cardiac index < 2.0L/ min.m², there was a relevant association with the increased percentage of myocardial fibrosis. CONCLUSION: The percentage of the myocardial fibrosis mass indicates a non-invasive marker with promising perspectives in identifying patients with high risk factors for pulmonary hypertension.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meios de Contraste , Hipertensão Pulmonar/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Direita/fisiopatologia , Estudos Transversais , Diagnóstico Precoce , Teste de Esforço , Hipertensão Pulmonar/fisiopatologia , Medição de Risco , Fatores de Risco , Curva ROC , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo
15.
Arq Bras Cardiol ; 101(4): 336-43, 2013 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23979779

RESUMO

BACKGROUND: Pulmonary arterial hypertension is a severe and progressive disease. Its early diagnosis is the greatest clinical challenge. OBJECTIVE: To evaluate the presence and extension of the delayed myocardial contrast-enhanced cardiovascular magnetic resonance, as well as to verify if the percentage of the myocardial fibrosis mass is a severity predictor. METHODS: Cross-sectional study with 30 patients with pulmonary arterial hypertension of groups I and IV, subjected to clinical, functional and hemodynamic evaluation, and to cardiac magnetic resonance. RESULTS: The mean age of patients was 52 years old, with female predominance (77%). Among the patients, 53% had right ventricular failure at diagnosis, and 90% were in functional class II/III. The mean of the 6-minute walk test was 395 m. In hemodynamic study with right catheterism, the mean average pulmonary arterial pressure was 53.3 mmHg, of the cardiac index of 2.1 L/min.m(2), and median right atrial pressure was 13.5 mmHg. Delayed myocardial contrast-enhanced cardiovascular magnetic resonance was found in 28 patients. The mean fibrosis mass was 9.9 g and the median percentage of fibrosis mass was 6.17%. The presence of functional class IV, right ventricular failure at diagnosis, 6-minute walk test < 300 meters and right atrial pressure > 15 mmHg, with cardiac index < 2.0 L/min.m(2), there was a relevant association with the increased percentage of myocardial fibrosis. CONCLUSION: The percentage of the myocardial fibrosis mass indicates a non-invasive marker with promising perspectives in identifying patients with high risk factors for pulmonary hypertension.


Assuntos
Meios de Contraste , Hipertensão Pulmonar/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Direita/fisiopatologia , Adulto , Idoso , Estudos Transversais , Diagnóstico Precoce , Teste de Esforço , Hipertensão Pulmonar Primária Familiar , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Fatores de Tempo
16.
Rev. bras. ecocardiogr. imagem cardiovasc ; 26(2): 115-120, abr.-jun. 2013. ilus, mapas
Artigo em Português | LILACS | ID: lil-678706

RESUMO

A eficácia do tratamento de tumores como linfoma Hodgkin e o câncer de mama com o uso da radioterapia reduziu, significativamente, a morbidade e mortalidade desses pacientes. Todavia, com o aumento da sobrevida, as complicações cardiovasculares, entre elas, as lesões valvares começaram a surgir, anos ou até décadas após a radioterapia. O acompanhamento com o ecodopplercardiograma, após a radioterapia, é indispensável como medida de detecção precoce e acompanhamento evolutivo, devido ao seu baixo custo e fácil acesso. O objetivo deste estudo é relatar quatro casos de pacientes que desenvolveram lesão valvar aórtica após radioterapia.


Treatment efficacy of tumors like Hodgkin’s Lymphoma and breast cancer with the use of radiotherapy has significantly reduced morbidity and mortality of these patients. However, with the increase of survival, cardiovascular complication, e.g., valvar lesions has arisen years to decades after the end of radiotherapy. The following with echocardiography after radiotherapy is an essential step in early detection and following, because of low cost and easy access. The aim of this paper is to report four cases of patients that developed aortic valvar lesion after radiotherapy.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças das Valvas Cardíacas/complicações , Ecocardiografia Doppler/métodos , Estenose da Valva Aórtica/complicações , Neoplasias Cardíacas/complicações , Radioterapia/efeitos adversos , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco , Revascularização Miocárdica/métodos , Revascularização Miocárdica
17.
Rev. bras. cardiol. (Impr.) ; 25(6): 479-488, nov.-dez. 2012. tab, graf
Artigo em Português | LILACS | ID: lil-667096

RESUMO

Fundamentos: A insuficiência cardíaca é um graveproblema de saúde pública com alto custo, frequenteshospitalizações e elevada mortalidade. Conhecer as características clínicas, laboratoriais e ecocardiográficas dos pacientes com insuficiência cardíaca (IC)descompensada é fundamental para o clínico. A partirdo registro ADHERE, elaborou-se um escore para avaliaro risco de mortalidade hospitalar com acurácia limitada na coorte de derivação (área sob a curva ROC - ASC 0,76). Objetivos: Avaliar o desempenho do escore ADHERE na população de hospital universitário no Rio de Janeiro e testar os parâmetros ecocardiográficos que, associados ao escore ADHERE, melhorariam sua acurácia. Métodos: Estudo retrospectivo, observacional de 634 casos internados com IC descompensada no Hospital Universitário Clementino Fraga Filho, no período de 01/01/2006 a 28/02/2011, dentre os quais, 413 continham dados do ecoDopplercardiograma, constituindo a população do estudo. Resultados: A mediana das idades foi 64 anos, com predomínio do sexo masculino (55,0%) e disfunção sistólica do ventrículo esquerdo (82,1%). A área sob acurva ROC do escore ADHERE da população geral e daqueles que realizaram ecoDopplercardiograma foi diferente do valor derivado do estudo ADHERE (0,63 vs.0,62 vs. 0,76, respectivamente). Associando a pressão sistólica de artéria pulmonar ao modelo preditivo de mortalidade hospitalar, houve incremento para 0,70(IC95% 0,59-0,80).Conclusões: Nesta coorte de pacientes com IC descompensada, a estimativa do risco de mortalidade utilizando somente o escore ADHERE foi limitada. O parâmetro ecocardiográfico pressão sistólica de artéria pulmonar adicionou informação prognóstica independente, permitindo modesto incremento na acurácia desse escore.


Background: Heart failure (HF) is a major public health problem with high costs, frequent hospitalizations andhigh mortality rates. An awareness of clinical aspects and the laboratory and echocardiography findings ofdecompensated HF patients is crucial for clinicians. Through the ADHERE registry, a score was constructed to evaluate the risk of in-hospital death, with limitedaccuracy for the derivation cohort (ROC area under the curve - AUC 0.76).Objectives: To evaluate the ADHERE score performance in a university hospital population in Rio de Janeiro, testing echocardiography parametersthat, in association with the ADHERE score, would improve its accuracy.Methods: Retrospective observational study of 634 cases hospitalized for decompensated HF in the Clementino Fraga Filho University Hospital betweenJanuary 1, 2006 and February 28, 2011, of whom 413 included echoDopplercardiogram data, constituting the study population.Results: The median age was 64 years old, with male predominance (55.0%) and systolic dysfunction of the left ventricle (82.1%). The ADHERE score area under the ROC curve for the general population and patients with echoDopplercardiograms differed from the ADHERE study values (0.63 vs. 0.62 vs 0.76 respectively). Associating the pulmonary artery systolic pressure with the predictive in-hospital mortality model resulted in an increase to 0.70 (CI 95% 0.59-0.80). Conclusions: In this cohort of decompensated HFpatients, the in-hospital death risk estimate using only the ADHERE score was limited. The pulmonary artery systolic pressure parameter added independent prognostic data, allowing a modest increase in the accuracy of this score.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ecocardiografia Doppler/métodos , Hospitalização/tendências , Insuficiência Cardíaca/mortalidade , Estudos Observacionais como Assunto , Estudos Prospectivos
18.
Rev. bras. ecocardiogr. imagem cardiovasc ; 25(3): 236-239, jul.-set. 2012. ilus
Artigo em Espanhol | LILACS | ID: lil-641361

RESUMO

A Miocardiopatia Hipertrófica (MCH) é uma doença caracterizada por ampla expressão genotípica e fenotípica, com curso clínico heterogêneo. A diversidade genética e fatores ambientais formam a base dessa heterogeneidade. É a causa mais comum de morte súbita em atletas jovens. A MCH medioventricular corresponde a 1% dos casos; pode estar associada a aneurisma apical e progressão para disfunção sistólica. Logo, o reconhecimento desse subgrupo, pelo estudo ecocardiográfico, é fundamental para melhor estratificação e acompanhamento desses pacientes. Neste relato, serão apresentados dois casos de miocardiopatia hipertrófica medioventricular, com aneurisma apical associado, seguidos de revisão da literatura.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/diagnóstico , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Ecocardiografia/métodos , Morte Súbita , Fatores de Risco
19.
Arq Bras Cardiol ; 98(5): 375-83, 2012 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22858653

RESUMO

In the past two years we observed several changes in the diagnostic and therapeutic approach of patients with acute heart failure (acute HF), which led us to the need of performing a summary update of the II Brazilian Guidelines on Acute Heart Failure 2009. In the diagnostic evaluation, the diagnostic flowchart was simplified and the role of clinical assessment and echocardiography was enhanced. In the clinical-hemodynamic evaluation on admission, the hemodynamic echocardiography gained prominence as an aid to define this condition in patients with acute HF in the emergency room. In the prognostic evaluation, the role of biomarkers was better established and the criteria and prognostic value of the cardiorenal syndrome was better defined. The therapeutic approach flowcharts were revised, and are now simpler and more objective. Among the advances in drug therapy, the safety and importance of the maintenance or introduction of beta-blockers in the admission treatment are highlighted. Anticoagulation, according to new evidence, gained a wider range of indications. The presentation hemodynamic models of acute pulmonary edema were well established, with their different therapeutic approaches, as well as new levels of indication and evidence. In the surgical treatment of acute HF, CABG, the approach to mechanical lesions and heart transplantation were reviewed and updated. This update strengthens the II Brazilian Guidelines on Acute Heart Failure to keep it updated and refreshed. All clinical cardiologists who deal with patients with acute HF will find, in the guidelines and its summary, important tools to help them with the clinical practice for better diagnosis and treatment of their patients.


Assuntos
Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Doença Aguda , Brasil , Insuficiência Cardíaca/mortalidade , Humanos
20.
Arq Bras Cardiol ; 98(1): e15-21, 2012 Jan.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-22323328

RESUMO

Among the cardiovascular diseases, heart failure (HF) has a high rate of hospitalization, morbidity and mortality, consuming vast resources of the public health system in Brazil and other countries. The correct determination of the filling pressures of the left ventricle by noninvasive or invasive assessment is critical to the proper treatment of patients with decompensated chronic HF, considering that congestion is the main determinant of symptoms and hospitalization. Physical examination has shown to be inadequate to predict the hemodynamic pattern. Several studies have suggested that agreement on physical findings by different physicians is small and that, ultimately, adaptive physiological alterations in chronic HF mask important aspects of the physical examination. As the clinical assessment fails to predict hemodynamic aspects and because the use of Swan-Ganz catheter is not routinely recommended for this purpose in patients with HF, noninvasive hemodynamic assessment methods, such as BNP, echocardiography and cardiographic bioimpedance, are being increasingly used. The present study intends to carry out, for the clinician, a review of the role of each of these tools when defining the hemodynamic status of patients with decompensated heart failure, aiming at a more rational and individualized treatment.


Assuntos
Insuficiência Cardíaca/fisiopatologia , Hemodinâmica/fisiologia , Monitorização Fisiológica/métodos , Exame Físico/métodos , Cardiografia de Impedância/métodos , Ecocardiografia/métodos , Insuficiência Cardíaca/sangue , Humanos , Peptídeo Natriurético Encefálico/sangue
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA