Desnutrição na miocardiopatia dilatada: correlaçäo com índices ecocardiográficos da funçäo ventricular esquerda / Malnutrition in dilated cardiomyopathy: correlation with echocardiographic indices of left ventricular function

RESUMO

Objetivo - Avaliar a ocorrência de desnutriçäo protéico-calórica grave e sua correlaçäo com a funçäo contrátil do VE na miocardiopatia dilatada (MD) com ICC. Métodos - Grupo A - 51 pacientes com ICC classe III ou IV, 36 homens, idade 51,9 ñ 15,6 anos, com MD sem disfunçäo valvar; grupo B - 25 coronariopatas, 20 homens, idade 57,2 ñ 10,5 anos, sem ICC. Medidas de prega cutânea tricipial (PCT) e de circunferência muscular do braço (CMB) foram realizadas em todos os pacientes, e quando ambas abaixo do quinto percentil populacional definiu-se a presença de desnutriçäo protéico-calórica grave. No grupo A, determinou-se a fraçäo de ejeçäo FE), o diâmetro diastólico (DD) e o volume sistólico (VS) do VE pela ecocardiografia. Comparou-se a funçäo do VE entre os miocardiopatas Ad (desnutridos graves) e An (os restantes). Análise de correlaçäo foi realizada entre os valores de PCT e CMB e os dados ecocardiográficos de funçäo do VE, nos pacientes com miocardiopatia e ICC. Resultados - Desnutriçäo ocorreu em 7/51 (13,7%) do Gr. A, e em nenhum paciente do B. Os valores de PCT foram 8,9 ñ 4,47 cm para o Gr. A e 23,48 ñ 8,52 para o B (p < 0,001). A CMB foi de 22,45 ñ 3,13 cm no Gr. A e 23,58 ñ 8,52 no B (p = 0,03). A FE foi de 36,29 ñ 9m43% no subgrupo Ad e 37,84 ñ 9,78 no AN (p = 0,70). O DD foi de 70,90 ñ 11,3 mm no subgrupo Ad e 70,75 ñ 8,54 no An (p = 0,98). O VS foi de 113,0 ñ 52,7 ml no subgrupo Ad e 137,6 ñ 56,8 no An (p = 0,45). Näo foi encontrada correlaçäo entre as medidas antropométricas e os valores de FE, DD e VS do VE, nos miocardiopatas com ICC. Conclusäo - Desnutriçäo foi freqüente nos pacientes com MD e ICC severa; a espessura da PCT, relacionada às reservas calóricas, foi mais afetada. O grau de disfunçäo do VE näo se correlacionou com o estado nutricional

ABSTRACT

Purpose - To evaluate the incidence of severe protein-calorie malnutrition in patients with dilated cardiomyopathy (DC), and its correlation with left ventricular contractility. Methods - Group A-51 patients with DC in decompensated congestive heart failure class III or IV, 36 men, aged 51.9 ± 15.6 years. Group B - 25 patients ad mitted for elective myocardial revascularization with normal LV contractility, 20 men, aged 57.2 ± 10.5 years. Tricipital skinfold thickness (TS) and mid-arm muscle circumference (MAMC) were obtained in all patients. Severe protein-calorie malnutrition was defined when both measurements were below the fifth populational percentile (Frisancho tables). In Group Am the echocardiographic left ventricular (LV) diastolic diameter (DD), ejection fraction (EF) and systolic volume (SV) were obtained. Those LV parameters were compared between DC patients with and without severe malnutrition. Correlation analysys were performed between TS, MAMC and LV DD, EF, and SV, in the patients of Group A. Results - Severe malnutrition occured in 7/51 (13.7%) of Group A, and none in Group B. TS values were of 8.90 ± 4.47 cm in Gr. A and 23.48 ± 8.52 in B (p < 0,001). MAMC measured 22.25 ± 3.13 cm in Gr. A and 23.58 ± 8.52 in B (p = 0,03), LVEF was of 36.29 ± 9.43% in severe malnutrition patients and of 37.84 ± 9,78 in the other patients of Group A (p = 0.70). Conversely, LVDD was of 70.90 ±11.3 mm vs. 70.75 ± 8.54 mm (p = 0.98), and LVSV was of 113.0 ± 52,7 ml vs. 137.6 ± 56.8 (p = 0.45), when compared severe malnutrition with the rest of patients of Group A. No correlation was found between TS and MAMC and LV, EF, DD and SV in Group A. Conclusion - malnutrition was frequent in patients with DC and heart failure. TS measurements, reflecting caloric reserves, were more affecting. Echocardiographic parameters of LV function did not corelate with nutritional status. Key words nutntional disorders,dilated cardiomyopathy, heart failure.