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Fernando Antônio Botonihttp://lattes.cnpq.br/2595419593124753Manoel Otávio da Costa RochaAna Thereza ChavesBruno Ramos NascimentoEnio Roberto Pietra Pedrosohttp://lattes.cnpq.br/3103245378594868Carla Paixão Miranda2019-11-22T15:35:47Z2019-11-22T15:35:47Z2016-11-10http://hdl.handle.net/1843/31211A doença de Chagas, causada pelo Trypanosoma cruzi (T.cruzi), foi descoberta e descrita pelo médico Brasileiro Carlos Chagas em 1909 (CHAGAS, 1909). Lamentavelmente, depois de já ter completado um século de sua descrição original, representa ainda um terrível impacto sobre a humanidade. A cardiopatia chagásica, e consequente insuficiência cardíaca, não parecem diferir das outras formas de miocardiopatias quanto a sua fisiopatologia. Acredita-se, portanto, que os resultados dos estudos que relacionam prognóstico e o metabolismo do ferro na insuficiência cardíaca podem ser extrapolados àqueles portadores de cardiomiopatia chagásica. Objetivou-se verificar se os marcadores da cinética do ferro guardam relação com a morbidade e a etiologia da cardiomiopatia chagásica em relação a miocardiopatia não chagásica.Neste estudo observacional e transversal no qual, foram selecionados consecutivamente 80 pacientes com doença de Chagas (dCh) - sendo 40 com Cardiomiopatia Chagásica Crônica (CCC), e 40 com a forma indeterminada (IND) além de 40 com miocardiopatia não chagásica (NCh). A seleção foi feita no Ambulatório de Referência em doença de Chagas do Hospital das Clínicas da (UFMG) e também no Ambulatório de Cardiologia do Ambulatório Bias Fortes. Utilizou-se como critério de seleção a presença de diâmetro diastólico do ventrículo esquerdo (VED) maior que 55 mm ou 2,7 cm/m2 e pelo menos um dos seguintes: fração de ejeção do ventrículo esquerdo (FEVE) menor que 55% (Simpson modificado) e/ou déficit de função do ventrículo esquerdo segmentar para os grupos CCC e NCh. Além de sorologia positiva para T.cruzi nos grupos CCC e da IND. Este último de acordo com os critérios para classificação na forma indeterminada, ou seja eletrocardiograma normal, Rx tórax normal ou seja não ter alteração intestinal e assintomático do ponto de vista cardiovascular. Foram excluídos pacientes com quaisquer co-morbidades evitando assim, interferências nos resultados e análise dos dados. No grupo CCC 50 % era do sexo masculino, IND 52,2% e no NCh 12,5%. A idade média foi de 50,98 ± 5,88 no CCC, 49,68 ± 5,28 no IND e 49,20±10,09 no NCh. Clinicamente estavam funcionalmente distribuídos conforme a NYHA 30% na classe funcional I, 37,5% na II, 20% na III e 12,5% na IV no grupos CCC, 100% do grupo IND era I, e no NCh 80% na I, 15% na II, 2,5% na III e 2,5% na IV. Os marcadores da cinética do ferro correlacionaram-se negativamente com o diâmetro diastólico do ventrículo esquerdo VED – índice de saturação de transferrina (IST) (r=0.949, p=0.0035), Ferro sérico (FeSe) (r=-0.959, p=0.0041), ferritina (r=-0.974, p=0.0026) e positivamente com a capacidade total de ligação do ferro (CTLF) (r=0.965, p=0.0035). A relação E/e correlacionou negativamente com o IST (r=-0.970, p=0.0030) e o FeSe (r=-0.998, p=0.0002) e positivamente com a CTLF (r=0.949, p=0.0051), a FEVE também correlacionou positivamente com IST (r=0.894, p=0.0041), FeS (r=0.958, p=0.0042) e ferritina (r=0.949, p=0.0051) entretanto, a CTLF correlacionou negativamente (r=-0.894, p=0.00041) no grupo IND. Na análise de correlação os marcadores da cinética do ferro correlacionaram-se negativamente com o VED, (r=0.950, p=0.0005), IST (r=-0.894, p=0.0004), CTLF (r=-0.983, p=0.00017) e a ferritina (r=-0.997, p=0.0003) no grupo CCC, a relação E/e correlacionou negativamente com o IST (r=-0.918, p=0.0010), e o FeSe (r=-0.990, p=0.00028), positivamente na CTLF (r=0.998, p=0.0002) e ferritina (r=0.975, p=0.0005) no grupo CCC. Na análise de correlação no NCh o VED correlacionou negativamente com IST (r=-0.895, p=0.0040), FeSe (r=-0.947, p=0.0015) e ferritina (r=-0.975, p=0.0005) e positivamente com a CTLF (r=0.893, p=0.0042), a relação E/e correlacionou negativamente com o IST (r=0.949, p=0.0024) e ferritina sérica (r=-0.976, p=0.0024) e positivamente FeSe (r=0,962, p=0.009) e CTLF (r=0.962, p=0.0009), a FEVE correlacionou negativamente com o FeSe (r=-0.953, p=0.0047) e ferritina (r=0.976, p=0.0024) e positivamente com a CTLF (r=0.960, p=0.0047) no mesmo grupo.(T.cruzi). Observou-se, diferença estatística (ANOVA-one Way) para FeSe entre os grupos CCC (93,15 ± 36,53), IND (125,30 ± 22,79) e NCh (114,77 ± 18,90) (p=0.0004), índice de saturação de transferrina IST no CCC (29,48 ± 6,59), no IND (30,95±7,06) e no NCh (39,70 ± 7,54) (p= 0.0001), capacidade total de ligação do ferro CTLF no CCC (297,30 ± 36,46), no IND (196,52 ± 56,95) e no NCh (275,18 ± 33,48) (p= 0.0001), ferritina no CCC (134,55, 1,56-42,36), no IND (156,25, 1,72 – 42,20) no NCh (112,95, 2,88-42,66) (p=0.0004). Verificou-se também, que o FeSe (IC% 95% 1.00-1.04; p=0.0014), o IST (IC 95% 1.02-1.22); (p=0.0012) e o sexo (IC 95% 1.0714.43 p=0.0038) associaram-se independentemente ao grau de disfunção ventricular na cardiomiopatia chagásica a partir do modelo de risco proporcional Hard ration (HR) multivariada. Conclui-se, portanto, que pacientes com CCC demonstraram maior alteração no metabolismo do ferro em relação a forma indeterminada e outras formas de miocardiopatias correlacionando-se com o grau de disfunção ventricular e remodelagem miocárdica.The Chagas disease, caused by Trypanosoma cruzi (T.cruzi), was discovered and described by the Brazilian doctor, Carlos Chagas, in 1909 (CHAGAS, 1909). Unfortunately, even after having completed a century since its original description, it continues to have a terrible impact on humanity. Chagas’ heart disease and its consequent heart failure does not seem to differ from other forms of cardiomyopathies when looking at its pathophysiology. However, we believe that the results of studies related to the prognostics and iron metabolism in heart failure can be extrapolated to those patients diagnosed with Chagasic cardiomyopathy. In this cross-sectional observational study, 80 consecutive patients with Chagas disease (Chd) were selected, of which 40 had Chronic Chagasic Cardiomyopathy (CCC) and 40 had an undetermined form. Another 40 patients had a non-Chagistic cardiomyopathy (NCh). The objective was to verify if the iron kinetic indicators have a relationship with the morbidity and etiology of Chagasic cardiomyopathy compared with the non-Chagasic cardiomyopathy. The selection was done at the renowned Chagas treatment outpatient unit of the Hospital das Clinicas of the Federal University of Minas Gerais (UFMG) and for the reference patients, at the Bias Fortes Cardiology outpatient unit. The selection criteria used was the presence of a left ventricular diastolic diameter (LVD) greater than 55 mm or 2.7 cm/m2 and at least one of the following: left ventricular ejection fraction (LVEF) less than 55% (Simpson, modified) and/or a function deficit of the left ventricular segment in the CCC and NCh groups, along with a serology that showed positive for T.cruzi for the CCC and IND groups. This latter criteria was in accordance with the ones for the classification of the undetermined form. Patients with any other co-morbidity possibilities were excluded in order to avoid confusion in the analyses of the data. In group CCC, 50% were male, in the IND one, 52.2%, and in the NCh one, 12.5%. The average age was 50.98 ± 5.88 for CCC, 49.68 ± 5.28 for IND and 49.20±10.09 for NCh. Clinically, there were functionally distributed according to NYHA: 30% in functional class I, 37.5% in II, 20% in III, and 12.5% in IV for the CCC group; 100% of the IND group were in I, and 80% of the NCh were in I, while 15% were in II, 2.5% in III and 2.5% in IV. The iron kinetic indicators correlated negatively with the left ventricular diastolic diameter (LVD) – transferrin saturation index TSAT (r=-0.949, p=0.0035), FeSe (r=-0.959, p=0.0041), ferritin (r=-0.974, p=0.0026) and positively with the total iron bonding capacity TIBC (r=0.965, p=0.0035). The relationship E/e negatively correlated with TSAT (r=-0.970, p=0.0030) and FeSe (r=0.998, p=0.0002) and positive with TIBC (r=0.949, p=0.0051). In addition, LVEF also positively correlated with TSA (r=0.894, p=0.0041), FeSe (r=0.958, p=0.0042) and ferritin (r=0.949, p=0.0051), while TIBC correlated negatively (r=-0.894, p=0.0041) in the IND group. In the correlation analysis, the iron kinetic indicators correlated negatively with LVD (r=-0.950, p<0.05), TSAT (r=-0.894, p<0.004), TIBC (r=-0.983, p<0.0017) and ferritin (r=-0.997, p<0.003) in the CCC group, while the E/e relationship correlated negatively with STI (r=-0.918, p=0.0010) and FeSe (r=-0.990, p=0.0028), positively in TIBC (r=0.998, p=0.0020) and ferritin (r=0.975, p=0.0005) in the CCC group. In the correlation analysis for the NCh group, the LVD correlated negatively with TSAT (r=-0.895, p=0.0040), FeSe (r=-0.947, p=0.0015) and ferritin (r=-0.975, p=0.0005), and positively with TIBC (r=0.893, p=0.0042), while the E/e relationship correlated negatively with TSAT (r=-0.949, p=0.0024) and serum ferritin (r=-0.976, p=0.0024), and positively with FeSe (r=0.962, p=0.0009) and TIBC (r=0.962, p=0.0009). In addition, LVEF correlated negatively with serum iron (r=-0.953, p=0.0047) and ferritin (r=0.976, p=0.0024) and positively with TIBC (r=0.960, p=0.0047) in the same group. (T.cruzi), 41 males (34%) with ages varying between 26 and 56 years of age (average of 49.95±7.42) grouped together as non-Chagasic cardiomyopathy (CCC). The NCh group included 40 patients between the ages of 39 and 59.23 (average of 49.20±10.09), a majority of whom were in the functional classes I and II of the New York Heart Association (NYHA). Consecutive selection was done among patients attended at the renowned Chagas treatment outpatient unit of the Hospital das Clinicas of the Federal University of Minas Gerais (UFMG) and for the reference patients, at the Bias Fortes Cardiology outpatient unit. The selection criteria used was the presence of a left ventricular diastolic diameter (LVD) greater than 55 mm or 2.7 cm/m2. Patients with any other co-morbidity possibilities were excluded in order to avoid confusion in the analyses of the data. The primary objective was to verify if the iron kinetic indicators have a relationship with the morbidity and etiology of Chagasic cardiomyopathy compared with the non-Chagasic cardiomyopathy. As a secondary objective, we analyzed the FeSe levels, TIBC, TSAT and ferritin. We observed the statistical difference (ANOVA-one Way) for FeSe among the CCC (93.15 ± 36.53), IND (125.30 ± 22.79) and NCh (114.77 ± 18.90) groups, as well as the transferrin saturation index (STI) in the CCC (29.48 ± 6.59), IND (30.95±7.06) and NCh (39.70 ± 7.54). Also analyzed was the total iron bonding capacity for iron (TIBC) in the CCC (297.30 ± 36.46), in the IND (196.52 ± 56.95) and in the NCh (275.18 ± 33.48) groups, together with the ferritin in the CCC (134.55, 1.56-42.36), in the IND (156.25, 1.72 – 42.20) and in the NCh (112.95, 2.88-42.66) groups. It was also verified that the FeSe (IC% 95% 1.00-1.04; p<0.014), TSAT (IC 95% 1.02-1.22; p<0.012) and gender (IC 95% 1.07-14.43 p=0.038) associated independently of the degree of ventricular dysfunction in the Chagasic cardiomyopathy according the multivariable proportional risk model, Hard ration (HR). Therefore, it can be concluded that patients with CCC demonstrated to have a greater alteration in the iron metabolism compared to the undetermined form and other forms of cardiomyopathies correlated with the degree of ventricular dysfunction and cardiomyopathy remodeling.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Ciências da Saúde - Infectologia e Medicina TropicalUFMGBrasilMEDICINA - FACULDADE DE MEDICINACardiomiopatia Chagásica/metabolismoDistúrbiosdo Metabolismo do FerroVolume SistólicoFerro/usoterapêuticoCardiomiopatia chagásicaMetabolismo do ferroFração de ejeçãoDiâmetro diastólico do ventrículo esquerdoAnálise do metabolismo do ferro na cardiopatia chagásica crônicainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/31211/2/license.txt34badce4be7e31e3adb4575ae96af679MD52ORIGINALCAPA DURA.pdfCAPA DURA.pdfapplication/pdf2351607https://repositorio.ufmg.br/bitstream/1843/31211/1/CAPA%20DURA.pdfab3a478373c7bc52363ee9f3e0783769MD51TEXTCAPA DURA.pdf.txtCAPA DURA.pdf.txtExtracted texttext/plain156331https://repositorio.ufmg.br/bitstream/1843/31211/3/CAPA%20DURA.pdf.txt25b39f6b46750bc11374513a89b725dcMD531843/312112019-11-23 03:12:09.476oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2019-11-23T06:12:09Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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