Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas

Detalhes bibliográficos
Autor(a) principal: Nakazone, Marcelo Arruda
Data de Publicação: 2017
Tipo de documento: Tese
Idioma: por
Título da fonte: Biblioteca Digital de Teses e Dissertações da FAMERP
Texto Completo: http://bdtd.famerp.br/handle/tede/488
Resumo: Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide, representing a major public health issue, with an increasing incidence and prevalence. The likelihood of survival may vary significantly among different etiologies and subsets of patients with CHF. In this context, CHF secondary to Chagas cardiomyopathy (CC) shows a poorer prognosis compared to other etiologies, mainly in Latin American where the disease is endemic. Objectives: [Article 1] to determine whether the presence of Left Ventricular Reverse Remodeling (LVRR) could predict long-term mortality in patients with CC; [Article 2] to evaluate the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in patients with CHF secondary to CC; [Article 3] to develop and to validate a simple method for predicting long-term mortality in ambulatory CHF patients in an area where Chagas disease is endemic. Material and Methods: From January 2000 to December 2010, [Article 1] the medical charts of 159 patients were reviewed. LVRR was defined as an increase of left ventricular ejection fraction and a decrease of left ventricular end-diastolic diameter by 2D-echocardiography. A Cox proportional hazards model was used to evaluate the ability of LVRR to predict all-cause mortality; [Article 2] a total of 232 patients were studied. The creatinine clearance was estimated according to CKD-EPI equation and CKD was defined as CrCl<60 mL/min/1.73m2. Anemia was defined as hemoglobin <12 g/dL for women and <13 g/dL for men. Cox proportional hazards models were used to establish independent predictors for long-term mortality; [Article 3] The development cohort included 450 patients receiving evidence-based treatment for CHF, prospectively followed. Independent prognostic factors were identified using logistic regression analysis and thresholds defined to stratify low-, intermediate-, and -high-risk groups. The CALLM Risk Score was validated in an independent retrospective cohort with 228 individuals. Results: [All Articles] LVRR, chronic kidney disease (CKD) and anemia were not associated with late-mortality, hospitalizations, cardiogenic shock, or heart transplantation indication. The CALLM risk score showed good discrimination and consistent calibration to predict mortality in our series. Conclusions: [All Articles] LVRR, CKD and anemia have no impact on outcomes of patients with CC. The CALLM risk score represents a simple method that allows prediction of survival in a real-world in ambulatory CHF patients in an area where Chagas disease is endemic. The model provides an accurate identification of a subgroup of high-risk patients who should be closely managed.
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spelling Bestetti, Reinaldo Bulgarellihttp://lattes.cnpq.br/2617500897651333Maia, Lilia NigroNogueira, Paulo RobertoBocchi, Edimar AlcidesIssa, Victor Sarli28875365830http://lattes.cnpq.br/7972799324719305Nakazone, Marcelo Arruda2018-11-23T18:54:53Z2017-09-29Nakazone, Marcelo Arruda. Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas. 2017. 119 f. Tese (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.1344http://bdtd.famerp.br/handle/tede/488Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide, representing a major public health issue, with an increasing incidence and prevalence. The likelihood of survival may vary significantly among different etiologies and subsets of patients with CHF. In this context, CHF secondary to Chagas cardiomyopathy (CC) shows a poorer prognosis compared to other etiologies, mainly in Latin American where the disease is endemic. Objectives: [Article 1] to determine whether the presence of Left Ventricular Reverse Remodeling (LVRR) could predict long-term mortality in patients with CC; [Article 2] to evaluate the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in patients with CHF secondary to CC; [Article 3] to develop and to validate a simple method for predicting long-term mortality in ambulatory CHF patients in an area where Chagas disease is endemic. Material and Methods: From January 2000 to December 2010, [Article 1] the medical charts of 159 patients were reviewed. LVRR was defined as an increase of left ventricular ejection fraction and a decrease of left ventricular end-diastolic diameter by 2D-echocardiography. A Cox proportional hazards model was used to evaluate the ability of LVRR to predict all-cause mortality; [Article 2] a total of 232 patients were studied. The creatinine clearance was estimated according to CKD-EPI equation and CKD was defined as CrCl<60 mL/min/1.73m2. Anemia was defined as hemoglobin <12 g/dL for women and <13 g/dL for men. Cox proportional hazards models were used to establish independent predictors for long-term mortality; [Article 3] The development cohort included 450 patients receiving evidence-based treatment for CHF, prospectively followed. Independent prognostic factors were identified using logistic regression analysis and thresholds defined to stratify low-, intermediate-, and -high-risk groups. The CALLM Risk Score was validated in an independent retrospective cohort with 228 individuals. Results: [All Articles] LVRR, chronic kidney disease (CKD) and anemia were not associated with late-mortality, hospitalizations, cardiogenic shock, or heart transplantation indication. The CALLM risk score showed good discrimination and consistent calibration to predict mortality in our series. Conclusions: [All Articles] LVRR, CKD and anemia have no impact on outcomes of patients with CC. The CALLM risk score represents a simple method that allows prediction of survival in a real-world in ambulatory CHF patients in an area where Chagas disease is endemic. The model provides an accurate identification of a subgroup of high-risk patients who should be closely managed.A Insuficiência Cardíaca Sistólica Crônica (ICC) é causa líder de morbidade e mortalidade em todo o mundo, representando um dos maiores problemas de saúde pública, com crescente elevação de incidência e prevalência. A probabilidade de sobrevida pode variar dentre as diferentes etiologias e cenários de pacientes com ICC. Neste contexto, ICC secundária à Cardiomiopatia Chagásica (CC) mostra um pior prognóstico comparado às demais etiologias, principalmente na América Latina onde a doença é endêmica. Objetivos: [Artigo1] determinar se a presença de Remodelamento Reverso Ventricular Esquerdo poderia predizer mortalidade a longo prazo em pacientes com CC; [Artigo 2] avaliar a performance de predição de risco da equação Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) e anemia em pacientes com ICC secundária a CC; [Artigo 3] desenvolver e validar um método simples para predizer mortalidade a longo prazo em nível ambulatorial de pacientes com ICC em área endêmica de Doença de Chagas. Material e Métodos: De Janeiro a Dezembro de 2010, [Artigo 1] o prontuário médico de 159 pacientes foram revisados. Remodelamento Reverso Ventricular Esquerdo foi definido como um aumento da fração de ejeção ventricular esquerda associada a uma redução do diâmetro diastólica final do ventrículo esquerdo por ecocardiografia bidimensional. O modelo de riscos proporcionais de Cox foi utilizado para avaliar a habilidade do Remodelamento Reverso Ventricular Esquerdo predizer mortalidade por todas as causas; [Artigo 2] um total de 232 pacientes foram estudados. O clearance de creatinina foi estimado de acordo com a equação CKD-EPI e doença renal crônica foi definida como clearance de creatinina <60 mL/min/1.73m2. Anemia foi definida como hemoglobina <12 g/dL para mulheres e <13 g/dL para homens. O modelo de riscos proporcionais de Cox foi utilizado para estabelecer preditores independentes de mortalidade a longo prazo; [Artigo 3] a cohort de desenvolvimento incluiu 450 pacientes prospectivamente seguidos sob tratamento otimizado para ICC. Fatores prognósticos independentes foram identificados usando análises de regressão logística e os grupos foram estratificados como de baixo, moderado e alto risco. O escore de risco CALLM foi validade em uma coorte retrospectiva independente com 228 indivíduos. Resultados: (Todos os Artigos) Remodelamento Reverso Ventricular Esquerdo, Doença Renal Crônica e Anemia não foram associados com mortalidade tardia, hospitalizações, choque cardiogênico, ou indicação para transplante cardíaco. O escore de risco CALLM mostrou boa discriminação e consistente calibração em predizer mortalidade em nossa casuística. Conclusões: (Todos os Artigos) Remodelamento Reverso Ventricular Esquerdo, Doença Renal Crônica e Anemia não têm impacto nos desfechos de nossos pacientes com CC. O escore de risco CALLM representa um método simples que permite predizer sobrevida em população de mundo real em nível ambulatorial de pacientes com ICC em área na qual a Doença de Chagas é endêmica. O modelo providencia acurácia para identificar um subgrupo de pacientes de alto risco que deveria ser manuseado de maneira mais rigorosa.Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-23T18:54:53Z No. of bitstreams: 1 MarceloArrudaNakazone_tese.pdf: 12463951 bytes, checksum: c5d67bb9d506a5a533cf4ea3ee1e2dd0 (MD5)Made available in DSpace on 2018-11-23T18:54:53Z (GMT). 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dc.title.por.fl_str_mv Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
title Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
spellingShingle Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
Nakazone, Marcelo Arruda
Chagas Disease
Chagas Cardiomyopathy
Heart Failure
Doença de Chagas
Cardiomiopatia Chagásica
Insuficiência Cardíaca
CIENCIAS DA SAUDE::8765449414823306929::600
title_short Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
title_full Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
title_fullStr Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
title_full_unstemmed Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
title_sort Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas
author Nakazone, Marcelo Arruda
author_facet Nakazone, Marcelo Arruda
author_role author
dc.contributor.advisor1.fl_str_mv Bestetti, Reinaldo Bulgarelli
dc.contributor.advisor1Lattes.fl_str_mv http://lattes.cnpq.br/2617500897651333
dc.contributor.referee1.fl_str_mv Maia, Lilia Nigro
dc.contributor.referee2.fl_str_mv Nogueira, Paulo Roberto
dc.contributor.referee3.fl_str_mv Bocchi, Edimar Alcides
dc.contributor.referee4.fl_str_mv Issa, Victor Sarli
dc.contributor.authorID.fl_str_mv 28875365830
dc.contributor.authorLattes.fl_str_mv http://lattes.cnpq.br/7972799324719305
dc.contributor.author.fl_str_mv Nakazone, Marcelo Arruda
contributor_str_mv Bestetti, Reinaldo Bulgarelli
Maia, Lilia Nigro
Nogueira, Paulo Roberto
Bocchi, Edimar Alcides
Issa, Victor Sarli
dc.subject.eng.fl_str_mv Chagas Disease
Chagas Cardiomyopathy
Heart Failure
topic Chagas Disease
Chagas Cardiomyopathy
Heart Failure
Doença de Chagas
Cardiomiopatia Chagásica
Insuficiência Cardíaca
CIENCIAS DA SAUDE::8765449414823306929::600
dc.subject.por.fl_str_mv Doença de Chagas
Cardiomiopatia Chagásica
Insuficiência Cardíaca
dc.subject.cnpq.fl_str_mv CIENCIAS DA SAUDE::8765449414823306929::600
description Chronic heart failure (CHF) is a leading cause of morbidity and mortality worldwide, representing a major public health issue, with an increasing incidence and prevalence. The likelihood of survival may vary significantly among different etiologies and subsets of patients with CHF. In this context, CHF secondary to Chagas cardiomyopathy (CC) shows a poorer prognosis compared to other etiologies, mainly in Latin American where the disease is endemic. Objectives: [Article 1] to determine whether the presence of Left Ventricular Reverse Remodeling (LVRR) could predict long-term mortality in patients with CC; [Article 2] to evaluate the risk prediction performance of the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and anemia in patients with CHF secondary to CC; [Article 3] to develop and to validate a simple method for predicting long-term mortality in ambulatory CHF patients in an area where Chagas disease is endemic. Material and Methods: From January 2000 to December 2010, [Article 1] the medical charts of 159 patients were reviewed. LVRR was defined as an increase of left ventricular ejection fraction and a decrease of left ventricular end-diastolic diameter by 2D-echocardiography. A Cox proportional hazards model was used to evaluate the ability of LVRR to predict all-cause mortality; [Article 2] a total of 232 patients were studied. The creatinine clearance was estimated according to CKD-EPI equation and CKD was defined as CrCl<60 mL/min/1.73m2. Anemia was defined as hemoglobin <12 g/dL for women and <13 g/dL for men. Cox proportional hazards models were used to establish independent predictors for long-term mortality; [Article 3] The development cohort included 450 patients receiving evidence-based treatment for CHF, prospectively followed. Independent prognostic factors were identified using logistic regression analysis and thresholds defined to stratify low-, intermediate-, and -high-risk groups. The CALLM Risk Score was validated in an independent retrospective cohort with 228 individuals. Results: [All Articles] LVRR, chronic kidney disease (CKD) and anemia were not associated with late-mortality, hospitalizations, cardiogenic shock, or heart transplantation indication. The CALLM risk score showed good discrimination and consistent calibration to predict mortality in our series. Conclusions: [All Articles] LVRR, CKD and anemia have no impact on outcomes of patients with CC. The CALLM risk score represents a simple method that allows prediction of survival in a real-world in ambulatory CHF patients in an area where Chagas disease is endemic. The model provides an accurate identification of a subgroup of high-risk patients who should be closely managed.
publishDate 2017
dc.date.issued.fl_str_mv 2017-09-29
dc.date.accessioned.fl_str_mv 2018-11-23T18:54:53Z
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dc.identifier.citation.fl_str_mv Nakazone, Marcelo Arruda. Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas. 2017. 119 f. Tese (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.
dc.identifier.uri.fl_str_mv http://bdtd.famerp.br/handle/tede/488
dc.identifier.doi.por.fl_str_mv 1344
identifier_str_mv Nakazone, Marcelo Arruda. Evolução clínica da insuficiência cardíaca sistólica crônica secundária à doença de chagas comparada às demais cardiomiopatias de etiologias não-chagásicas. 2017. 119 f. Tese (Programa de Pós-Graduação em Ciências da Saúde) - Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto.
1344
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