Relationship between left atrial volume and diastolic dysfunction in 500 Brazilian patients.

BACKGROUND: Left atrial volume index (LAVI) increase has been associated to left ventricle (LV) diastolic dysfunction (DD), a marker of cardiovascular events (atrial fibrillation, stroke, heart failure, death). OBJECTIVE: To evaluate the relationship between LAVI and diferente grades od DD in Brazilian patients submitted to echocardiogram, studying LAVI increase determinants in this sample. METHODS: We have selected 500 outpatients submitted to echocardiography, after excluding arrhythmia, valvar or congenital cardiopathy, permanent pacemaker or inadequate ecocardiographic window. LAVI was obtained according to Simpson's method. DD was classified according to current guidelines. The clinical and echocardiographic variables were submitted to linear regression multivariate analysis. RESULTS: Mean age was 52 ± 15 years old, 53% were male, 55% had arterial hypertension, 9% had coronary artery disease, 8% were diabetic, 24% were obese, 47% had LV hypertrophy. The mean ejection fraction of the left ventricle was 69.6 ± 7,2%. The prevalence of DD in this sample was 33.8% (grade I: 66%, grade II: 29% e grade III: 5%). LAVI increased progressively according to DD grade: 21 ± 4 mL/m² (absent), 26 ± 7 mL/m² (grade I), 33 ± 5 mL/m² (grade II), 50 ± 5 mL/m2 (grade III) (p < 0,001). In this sample, LAVI increase independent predictors were age, left ventricular mass, relative wall thickness, LV ejection fraction and E/e' ratio. CONCLUSION: DD contributes to left atrial remodeling. LAVI increases as an expression of DD severity and is independently associated to age, left ventricle hypertrophy, systolic dysfunction and increased LV filling pressures.

Estudo OPTIMIZE: Subanálise dos Pacientes Tratados no Instituto Dante Pazzanese de Cardiologia / OPTIMIZE Trial: Subanalysis of Patients Treated at Instituto Dante Pazzanese de Cardiologia

Introdução: O OPTIMIZE constituiu um estudo prospectivo conduzido em 33 centros no Brasil, que randomizou pacientes para receber terapia antiplaquetária dupla por 3 ou 12 meses, após o implante de stents com eluição de zotarolimus. Nosso propósito foi avaliar os resultados dos pacientes tratados no Instituto Dante Pazzanese de Cardiologia e, posteriormente, compará-los aos de outros centros envolvidos do estudo. Métodos: Foram incluídos pacientes com angina estável ou síndrome coronariana aguda de baixo risco. O objetivo primário foi avaliar a incidência de eventos clínicos e cerebrais adversos, uma combinação de morte por qualquer causa, infarto agudo do miocárdio, acidente vascular encefálico ou sangramento maior aos 12 meses. Resultados: Entre abril de 2010 e março de 2012, incluímos 624 (20%) pacientes no OPTIMIZE. Aos 12 meses, não houve diferença significativa entre os grupos (3 vs. 12 meses de terapia antiplaquetária dupla) quanto à incidência de eventos clínicos e cerebrais adversos (3,8% vs. 6,7%; p = 0,15), eventos cardíacos adversos maiores (6,7% vs. 7,1%; p > 0,99) e nem de trombose do stent (0 vs. 1,3%; p = 0,12). O teste de heterogeneidade mostrou que a variabilidade observada nos resultados do Instituto Dante Pazzanese e dos outros centros não foi maior que a esperada para ocorrer por acaso ( p = 0,064). Conclusões : Nos pacientes ...

Background: OPTIMIZE was a prospective study conducted in 33 Brazilian sites that randomized patients to receive dual antiplatelet therapy for 3 or 12 months after zotarolimus eluting stent implantation. Our objective was to evaluate the outcomes of patients treated at Instituto Dante Pazzanese de Cardiologia and compare them to the outcomes of patients from other participating study sites. Methods: Patients with stable angina or low risk acute coronary syndrome were included in the study. The primary outcome was the incidence of adverse clinical and cerebral events, a composite of all cause of death, myocardial infarction, stroke, or major bleeding at 12 months. Results: Between April/2010 and March/2012, we included 624 (20%) patients in the OPTIMIZE study. At 12 months, there was no significant difference between groups (3 vs. 12 months of dual antiplatelet therapy) for net adverse clinical and cerebral events (3.8% vs. 6.7%; p = 0.15), major adverse cardiac events (6.7% vs. 7.1; p > 0.99) or stent thrombosis (0 vs. 1.3%; p = 0.12). The heterogeneity test showed that the variability observed in the results of Instituto Dante Pazzanese de Cardiologia and in the remaining sites was not greater than the expected to occur by chance (p = 0.064). Conclusions: In patients treated at Instituto Dante Pazzanese de Cardiologia, 3 months of dual antiplatelet therapy was not inferior to 12 months of therapy for the occurrence of net adverse clinical ...