Clinical determinants and prognostic significance of the electrocardiographic strain pattern in chronic kidney disease patients.

The electrocardiographic (ECG) strain pattern (Strain) is a marker of left ventricular hypertrophy (LVH) severity that provides additional prognostic information beyond echocardiography (ECHO) in the community level. We sought to evaluate its clinical determinants and prognostic usefulness in chronic kidney disease (CKD) patients. We evaluated 284 non-dialysis-dependent patients with CKD stages 3 to 5 (mean age, 61 years [interquartile range, 53-67 years]; 62% men). Patients were followed for 23 months (range, 13-32 months) for cardiovascular (CV) events and/or death. Strain patients (n = 37; 13%) were using more antihypertensive drugs, had higher prevalence of peripheral vascular disease and smoking, and higher levels of C-reactive protein, cardiac troponin, and brain natriuretic peptide (BNP). The independent predictors of Strain were: left ventricular mass index (LVMI), BNP, and smoking. During follow-up, there were 44 cardiovascular events (fatal and non-fatal) and 22 non-CV deaths; and Strain was associated with a worse prognosis independently of LVMI. Adding Strain to a prognostic model of LVMI improved in 15% the risk discrimination for the composite endpoint and in 12% for the CV events. Strain associates with CV risk factors and adds prognostic information over and above that of ECHO-assessed LVMI. Its routine screening may allow early identification of high risk CKD patients.

Clinical determinants and prognostic significance of the electrocardiographic strain pattern in chronic kidney disease patients

The electrocardiographic (ECG) strain pattern (Strain) is a marker of left ventricular hypertrophy (LVH) severity that providesadditional prognostic information beyond echocardiography (ECHO) in the community level. We sought to evaluateits clinical determinants and prognostic usefulness in chronic kidney disease (CKD) patients. We evaluated 284 nondialysis-dependent patients with CKD stages 3 to 5 (mean age, 61 years [interquartile range, 53–67 years]; 62% men).Patients were followed for 23 months (range, 13–32 months) for cardiovascular (CV) events and/or death. Strain patients(n » 37; 13%) were using more antihypertensive drugs, had higher prevalence of peripheral vascular disease and smoking,and higher levels of C-reactive protein, cardiac troponin, and brain natriuretic peptide (BNP). The independent predictors ofStrain were: left ventricular mass index (LVMI), BNP, and smoking. During follow-up, there were 44 cardiovascular events(fatal and non-fatal) and 22 non-CV deaths; and Strain was associated with a worse prognosis independently of LVMI.Adding Strain to a prognostic model of LVMI improved in 15% the risk discrimination for the composite endpoint and in12% for the CV events. Strain associates with CV risk factors and adds prognostic information over and above that ofECHO-assessed LVMI. Its routine screening may allow early identification of high risk CKD patients.

Tele-ECG (tele-eletrocardiografia à distância via celular) / Tele-ECG (Tele-Echocardiography by distance of cellular phone)

O Instituto Dante Pazzanese de Cardiologia(IDPC) presta atendimento a paciente de diversas regiões; dentre estes, observou-se uma parcela significativa de pacientes externos provenientes de localidades distantes, vindos de Unidades Básicas de Saúde (UBS) que normalmente não possuem especialista em cardiologia. Muitos destes pacientes poderiam ser evitados, reduzindo os custos logísticos da operação, inclusive o custo social. O Sistema Tele-EGG tem como objetivo aplicar uma solução em telemedicina, que consiste de um eletrocardiógrafo convencional, de 12 derivações simultâneas, interligado a um módulo de transmissão/recepção de dados que utiliza a telefonia móvel (celular) para enviar o sinal de ECG e os dados do paciente para uma central de exames. Valendo-se da mobilidade que o sistema oferece, a instalação dos equipamentos, nos mais variados locais, independe de haver uma estrutura fixa com microcomputadores e internet de banda larga: basta haver um sinal de telefonia celular. A central de exames consiste de uma sala de terminais de computadores...