Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFG |
Texto Completo: | http://repositorio.bc.ufg.br/tede/handle/tede/6083 |
Resumo: | Introduction: Heart failure represents a complex clinic syndrome in which several mechanisms are involved. Patient’s prognosis is bad and Chagas disease, between other etiologies, has the worse prognosis in heart failure. There are some controversies in relation to many factors that possibly identify the patients with especially high risk of death in heart failure. Although more than 40 variables have been identified as prognostic predictors in HF, there is no consensus about its applicability in clinical practice. Objectives: Identify the association between clinical and laboratory factors in chagasic heart failure with severe ventricular disfunction; analyze the association between prognostic factors and mortality rate; examine the global survival of this population in a 7 years and 6 months follow up. Methods: The present study is a cutting of the “Randomized, Multicenter Celular Therapy in Cardiopathies - Chagas Cardiopathy”, with retrospective analysis of the data collected prospectively. The following variables were analyzed: age, arterial pressure (AP) ejection fraction (EF), plasmatic sodium, creatinina, 6 minutes walking test (6MWT), nonsustained ventricular tachycardia (NSVT), electrocardiogram QRS width, echocardiogram indexed left atrium volume (iLAV) and functional class. Results: From the 60 participants, 53 (88,3%) died during the total follow up period (90 months) and 7 (11.7%) remained alive until the end of the period. The general accumulated survival probability of the severe Chagas etiology patients, identified in our study, was about 11%. The systolic arterial pressure did not correlate in a significant manner to the mortality outcome, although the increasing in 10 mmHg in systolic arterial pressure resulted in a reduction of 4% in the risk of death. There was no statistical significance to the variables age, ejection fraction, 6MWT and QRS width in relation to the outcome mortality. There was statistical significance in relation to plasmatic sodium and creatinina, with the outcome mortality, in the univariate analyses. However, after adjust to the multivariate analyses model, they lost significance. From the variables used in the Cox regression model, only NSVT and the indexed atrium volume remained as independent mortality predictors. Unsustained ventricular thachycardia presented a significant risk value – HR = 2,11 (95% CI, 1,04 – 4,31) p<0,05. iLAV values >72 ml/m2 were associated to a significant risk in mortality – HR = 3,51 (95% CI, 1,63 – 7,52), p<0,05. Conclusions: In Chagas etiology heart failure patients, with important ventricular function commitment, the presence of Holter NSVT and the iLAV > 72mL/m2 gives them a worse prognosis. This population prognosis is bad, with a cumulated survival probability of only 11% in 7.5 years. |
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Rassi, Salvadorhttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4705156T2Rassi, SalvadorSá, Luiz Antônio Batista deFreitas Junior, Aguinaldo Figueiredo deAssis, Thais Rochahttp://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4605987D1Costa , Sandra de Araújo2016-09-01T14:20:53Z2016-08-05COSTA, S. A. Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave. 2016. 105 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2016.http://repositorio.bc.ufg.br/tede/handle/tede/6083Introduction: Heart failure represents a complex clinic syndrome in which several mechanisms are involved. Patient’s prognosis is bad and Chagas disease, between other etiologies, has the worse prognosis in heart failure. There are some controversies in relation to many factors that possibly identify the patients with especially high risk of death in heart failure. Although more than 40 variables have been identified as prognostic predictors in HF, there is no consensus about its applicability in clinical practice. Objectives: Identify the association between clinical and laboratory factors in chagasic heart failure with severe ventricular disfunction; analyze the association between prognostic factors and mortality rate; examine the global survival of this population in a 7 years and 6 months follow up. Methods: The present study is a cutting of the “Randomized, Multicenter Celular Therapy in Cardiopathies - Chagas Cardiopathy”, with retrospective analysis of the data collected prospectively. The following variables were analyzed: age, arterial pressure (AP) ejection fraction (EF), plasmatic sodium, creatinina, 6 minutes walking test (6MWT), nonsustained ventricular tachycardia (NSVT), electrocardiogram QRS width, echocardiogram indexed left atrium volume (iLAV) and functional class. Results: From the 60 participants, 53 (88,3%) died during the total follow up period (90 months) and 7 (11.7%) remained alive until the end of the period. The general accumulated survival probability of the severe Chagas etiology patients, identified in our study, was about 11%. The systolic arterial pressure did not correlate in a significant manner to the mortality outcome, although the increasing in 10 mmHg in systolic arterial pressure resulted in a reduction of 4% in the risk of death. There was no statistical significance to the variables age, ejection fraction, 6MWT and QRS width in relation to the outcome mortality. There was statistical significance in relation to plasmatic sodium and creatinina, with the outcome mortality, in the univariate analyses. However, after adjust to the multivariate analyses model, they lost significance. From the variables used in the Cox regression model, only NSVT and the indexed atrium volume remained as independent mortality predictors. Unsustained ventricular thachycardia presented a significant risk value – HR = 2,11 (95% CI, 1,04 – 4,31) p<0,05. iLAV values >72 ml/m2 were associated to a significant risk in mortality – HR = 3,51 (95% CI, 1,63 – 7,52), p<0,05. Conclusions: In Chagas etiology heart failure patients, with important ventricular function commitment, the presence of Holter NSVT and the iLAV > 72mL/m2 gives them a worse prognosis. This population prognosis is bad, with a cumulated survival probability of only 11% in 7.5 years.Introdução: A insuficiência cardíaca (IC) representa uma síndrome clínica complexa em que vários mecanismos estão envolvidos. O prognóstico dos pacientes é ruim e a doença de Chagas, dentre as várias etiologias, possui o pior prognóstico na IC. Há controvérsia em relação aos fatores que possivelmente identificam os pacientes com risco especialmente alto de morte na insuficiência cardíaca. Apesar de mais de 40 variáveis terem sido identificadas como preditoras de prognóstico na IC, não há consenso sobre a sua utilidade na prática clínica. Objetivos: Identificar a associação de fatores clínicos e laboratoriais com o prognóstico na IC chagásica com disfunção ventricular grave, bem como analisar a associação de fatores prognósticos com a taxa de mortalidade e a sobrevida global desta populção, em um seguimento de 7 anos e seis meses. Métodos: Este é um recorte do “Estudo Multicêntrico, Randomizado de Terapia Celular em Cardiopatias (EMRTCC) – Cardiopatia Chagásica”, com análise retrospectiva de dados colhidos prospectivamente. Analisamos as seguintes variáveis: idade, pressão arterial (PA), fração de ejeção (FE), sódio plasmático, creatinina, teste de caminhada de 6 minutos (TC6M), taquicardia ventricular não sustentada (TVNS), largura do QRS, volume do átrio esquerdo indexado e classe funcional. Resultados: Do total de 60 participantes, 53 (88,3%) foram à óbito durante o período total de seguimento (90 meses) e 7 (11.7%) permaneceram vivos no final do mesmo. A probabilidade de sobrevida geral acumulada dos pacientes portadores de insuficiência cardíaca grave de etilogia chagásica, identificados neste estudo, foi de aproximadamente 11%. A pressão arterial sistólica não se correlacionou de uma maneira significante em relação ao desfecho de mortalidade, no entanto a cada incremento de 10mmHg resultou numa redução de 4% no risco de morte. Não houve significância estatística para as variáveis idade, fração de ejeção, TC6M e largura do complexo QRS, em relação ao desfecho de mortalidade. Houve significância estatística em relação ao sódio plasmático e a creatinina com o desfecho de mortalidade, na análise univariada. Entretanto, após o ajuste do modelo na análise multivariada, perderam significância. Das variáveis utilizadas no modelo de regressão de Cox, apenas a TVNS e o volume do átrio esquerdo indexado permaneceram como preditores independentes de mortalidade. A taquicardia ventricular não sustentada apresentou valor de risco significativo – HR = 2,11 (IC 95% 1,04 – 4,31) p < 0,05. Valores de VAEi >72 ml/m2 estavam associados a um aumento significativo na mortalidade HR = 3,51 (IC 95% 1,63 – 7,52), p<0,05. Conclusões: Em pacientes portadores de insuficiência cardíaca de etiologia chagásica com importante comprometimento da função ventricular, a presença de TVNS ao Holter e o VAEi > 72mL/m2 ao ecocardiograma conferem a eles um pior prognóstico. A probabilidade de sobrevida acumulada desta população é ruim, sendo de apenas 11% em 7.5 anos.Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-01T14:20:11Z No. of bitstreams: 2 Dissertação - Sandra Araujo Costa - 2016.pdf: 529840 bytes, checksum: 6bdc6db95202e88ef1d8d13ea39bd922 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-01T14:20:53Z (GMT) No. of bitstreams: 2 Dissertação - Sandra Araujo Costa - 2016.pdf: 529840 bytes, checksum: 6bdc6db95202e88ef1d8d13ea39bd922 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5)Made available in DSpace on 2016-09-01T14:20:53Z (GMT). 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dc.title.por.fl_str_mv |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
dc.title.alternative.eng.fl_str_mv |
Prognostic factors in chagasic heart failure with severe ventricular disfunction |
title |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
spellingShingle |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave Costa , Sandra de Araújo Prognóstico Insuficiência cardíaca Miocardiopatia chagásica Prognosis Heart failure Chagas cardiomyopathy MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
title_short |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
title_full |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
title_fullStr |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
title_full_unstemmed |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
title_sort |
Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave |
author |
Costa , Sandra de Araújo |
author_facet |
Costa , Sandra de Araújo |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Rassi, Salvador |
dc.contributor.advisor1Lattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4705156T2 |
dc.contributor.referee1.fl_str_mv |
Rassi, Salvador |
dc.contributor.referee2.fl_str_mv |
Sá, Luiz Antônio Batista de |
dc.contributor.referee3.fl_str_mv |
Freitas Junior, Aguinaldo Figueiredo de |
dc.contributor.referee4.fl_str_mv |
Assis, Thais Rocha |
dc.contributor.authorLattes.fl_str_mv |
http://buscatextual.cnpq.br/buscatextual/visualizacv.do?id=K4605987D1 |
dc.contributor.author.fl_str_mv |
Costa , Sandra de Araújo |
contributor_str_mv |
Rassi, Salvador Rassi, Salvador Sá, Luiz Antônio Batista de Freitas Junior, Aguinaldo Figueiredo de Assis, Thais Rocha |
dc.subject.por.fl_str_mv |
Prognóstico Insuficiência cardíaca Miocardiopatia chagásica |
topic |
Prognóstico Insuficiência cardíaca Miocardiopatia chagásica Prognosis Heart failure Chagas cardiomyopathy MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
dc.subject.eng.fl_str_mv |
Prognosis Heart failure Chagas cardiomyopathy |
dc.subject.cnpq.fl_str_mv |
MEDICINA::ANATOMIA PATOLOGICA E PATOLOGIA CLINICA |
description |
Introduction: Heart failure represents a complex clinic syndrome in which several mechanisms are involved. Patient’s prognosis is bad and Chagas disease, between other etiologies, has the worse prognosis in heart failure. There are some controversies in relation to many factors that possibly identify the patients with especially high risk of death in heart failure. Although more than 40 variables have been identified as prognostic predictors in HF, there is no consensus about its applicability in clinical practice. Objectives: Identify the association between clinical and laboratory factors in chagasic heart failure with severe ventricular disfunction; analyze the association between prognostic factors and mortality rate; examine the global survival of this population in a 7 years and 6 months follow up. Methods: The present study is a cutting of the “Randomized, Multicenter Celular Therapy in Cardiopathies - Chagas Cardiopathy”, with retrospective analysis of the data collected prospectively. The following variables were analyzed: age, arterial pressure (AP) ejection fraction (EF), plasmatic sodium, creatinina, 6 minutes walking test (6MWT), nonsustained ventricular tachycardia (NSVT), electrocardiogram QRS width, echocardiogram indexed left atrium volume (iLAV) and functional class. Results: From the 60 participants, 53 (88,3%) died during the total follow up period (90 months) and 7 (11.7%) remained alive until the end of the period. The general accumulated survival probability of the severe Chagas etiology patients, identified in our study, was about 11%. The systolic arterial pressure did not correlate in a significant manner to the mortality outcome, although the increasing in 10 mmHg in systolic arterial pressure resulted in a reduction of 4% in the risk of death. There was no statistical significance to the variables age, ejection fraction, 6MWT and QRS width in relation to the outcome mortality. There was statistical significance in relation to plasmatic sodium and creatinina, with the outcome mortality, in the univariate analyses. However, after adjust to the multivariate analyses model, they lost significance. From the variables used in the Cox regression model, only NSVT and the indexed atrium volume remained as independent mortality predictors. Unsustained ventricular thachycardia presented a significant risk value – HR = 2,11 (95% CI, 1,04 – 4,31) p<0,05. iLAV values >72 ml/m2 were associated to a significant risk in mortality – HR = 3,51 (95% CI, 1,63 – 7,52), p<0,05. Conclusions: In Chagas etiology heart failure patients, with important ventricular function commitment, the presence of Holter NSVT and the iLAV > 72mL/m2 gives them a worse prognosis. This population prognosis is bad, with a cumulated survival probability of only 11% in 7.5 years. |
publishDate |
2016 |
dc.date.accessioned.fl_str_mv |
2016-09-01T14:20:53Z |
dc.date.issued.fl_str_mv |
2016-08-05 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
COSTA, S. A. Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave. 2016. 105 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2016. |
dc.identifier.uri.fl_str_mv |
http://repositorio.bc.ufg.br/tede/handle/tede/6083 |
identifier_str_mv |
COSTA, S. A. Fatores prognósticos na insuficiência cardíaca chagásica com disfunção ventricular grave. 2016. 105 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Goiás, Goiânia, 2016. |
url |
http://repositorio.bc.ufg.br/tede/handle/tede/6083 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.program.fl_str_mv |
-1006864312617745310 |
dc.relation.confidence.fl_str_mv |
600 600 600 |
dc.relation.department.fl_str_mv |
1545772475950486338 |
dc.relation.cnpq.fl_str_mv |
7337577453819502453 |
dc.rights.driver.fl_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.publisher.program.fl_str_mv |
Programa de Pós-graduação em Ciências da Saúde (FM) |
dc.publisher.initials.fl_str_mv |
UFG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Faculdade de Medicina - FM (RG) |
publisher.none.fl_str_mv |
Universidade Federal de Goiás |
dc.source.none.fl_str_mv |
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Repositório Institucional da UFG - Universidade Federal de Goiás (UFG) |
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tasesdissertacoes.bc@ufg.br |
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