Survival – ABC CARDIOL

IJCS

Original Article

Is Hypertension a Predictor of Mortality in People Living With HIV/AIDS?

Gustavo Eduardo Fante et al. Pedro Antonio Pagote Dall’Omo Karina Bobato do Valle Arcelio Benetoli … Jean Fernando Sandeski Zuber Camila Marineli Martins Erildo Vicente Muller

Abstract

Background:

Hypertension is a chronic non-communicable disease that increases cardiovascular risk and significantly contributes to mortality. It is one of the most prevalent conditions among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).

Objectives:

The objective of this study was to investigate hypertension as a predictor of mortality in people living with HIV/AIDS, analyzing the association of prior diagnosis of hypertension with morbidity and mortality in this population.

Methods:

This retrospective cohort study evaluated the medical records of 1207 patients receiving treatment at the Specialized Care Service (SAE) of a city in the state of Paraná over 264 months.

Results:

Among patients diagnosed with HIV/AIDS, 13.1% had hypertension. During the analyzed period, 52 deaths were recorded (4.31%), 30.77% of which occurred among patients with hypertension (p = 0.0002). Lower survival was observed among patients with hypertension (p < 0.0001), and mortality was significantly higher among women with hypertension (p < 0.0001). The hazard ratio (HR) for the general population was 3.1 (95% confidence interval [CI]: 1.7–5.6), with an HR of 1.7 for men (95% CI: 0.7–3.7) and 8.2 for women (95% CI: 3.1–21.6).

Conclusions:

Hypertension was a significant predictor of mortality in people living with HIV/AIDS, with a particularly strong impact among women.

Read Full Article

ABC

Original Article

Implantation of Pacemakers in Patients with Chagas disease: A Case-Control Study of Associated Contextual Factors and Prognosis

Sâmara Fernandes Leite et al. Maria Carmo Pereira Nunes Cesar Augusto Taconeli Mathaus Henrique Reis Silva … Dardiane Santos Cruz Lea Campos Oliveira Ester Cerdeira Sabino Marco Paulo Tomáz Barbosa Antonio Luis Pinho Ribeiro Ariela Mota Ferreira Desirée Sant’Ana Haikal

Abstract

Background

Chronic Chagas cardiomyopathy (CCC) is the most severe manifestation of Chagas disease and may present with bradyarrhythmias requiring pacemaker (PM) implantation.

Objective

1. To identify contextual factors associated with PM implantation among individuals with CCC. 2. To assess the prognosis (death) in these groups over a 4-year follow-up period.

Method

1. Nested case-control study within the SaMi-Trop cohort. We matched cases (patients with CCC who had a PM implanted between waves 1 and 2 of the study) with controls at a 1:3 ratio, considering equivalence in baseline cardiac severity. Independent variables related to the municipal context were considered. Binary logistic regression was conducted. 2. Survival analysis to evaluate the prognosis of these groups, adjusted for clinical variables (Cox regression), considering death as the outcome. Conclusions were based on a significance level of 5%.

Results

The study included 46 cases and 138 controls. The odds of PM implantation were higher among individuals residing in municipalities with: larger population (odds ratio [OR]: 3.6; 95% confidence interval [CI]: 1.3 to 9.6), higher coverage of the Family Health Strategy (OR: 5.3; 95% CI: 1.8 to 15.8), and with a lower number of electrocardiographs per thousand inhabitants (OR: 2.6; 95% CI: 1.0 to 6.6). Considering 4 years of follow-up, death was observed in 32.6% of cases and 21.2% of controls. Only ejection fraction affected survival (relative risk: 7.2; 95% CI: 3.6 to 14.2).

Conclusion

Contextual factors interfered with PM implantation. However, PM implantation did not influence death over 4 years of follow-up, which was associated only with ejection fraction.

Read Full Article

ABC

Original Article

Survival Analysis and Factors Associated with Mortality in Heart Failure Patients in the ELSA-Brasil Cohort

Ana Paula de Oliveira Lédo et al. Sheila Maria Alvim Matos Maria da Conceição Almeida Luciana Pereira Fernandes Roque Aras

Abstract

Background

Heart failure (HF) is one of the leading causes of morbidity and mortality worldwide. Few studies have evaluated the survival and prognostic factors of patients with this condition in light of the therapeutic advances of recent decades.

Objectives

To describe the survival, possible factors associated with mortality, and clinical characteristics of participants with HF in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods

The cohort followed 15105 participants from 2008 to 2023. Sociodemographic variables, laboratory tests, electrocardiogram, two-dimensional echocardiogram, lifestyle habits, comorbidities, and medication use were evaluated. Survival probability was estimated using Kaplan-Meier curves and log-rank tests. Cox regression modeling was used to calculate the crude and adjusted Hazard Ratios (HR) with their respective 95% confidence intervals. The significance criterion was p<0.05.

Results

During the inclusion phase, 251 participants with an HF diagnosis were selected (2008-2010). Over approximately 12.3 years of follow-up, 48 (19%) died. The overall survival of participants with HF at 2, 6, 10, and 12.3 years of follow-up was 96%, 89%, 82%, and 80%, respectively. The mortality risk was 4.5 times higher (HR: 4.46; 95% CI: 3.3–5.9) compared to the unaffected group (p<0.01), and even after applying an adjusted model, the mortality risk remained twice as high (HR: 1.77; 95% CI: 1.3–2.4). Variables associated with a worse prognosis included male sex, advanced age, systolic dysfunction (LVEF<45%), hypertension, diabetes mellitus, and chronic kidney disease.

Conclusion

We found high mortality among participants with HF in the ELSA-Brasil cohort.

Read Full Article

ABC

Original Article

The Impact of Severe Heart Disease on Causes of Death and Survival after Disability Retirement

Cesar Romaro Pozzobon et al. Gabriel Porto Soares Ronir Raggio Luiz Gláucia Maria Moraes de Oliveira

Abstract

Background:

Noncommunicable diseases contribute to premature deaths and limitations. Disability retirement is linked to chronic conditions, particularly cardiovascular diseases. The II Brazilian Guideline for Severe Heart Disease established criteria for cardiovascular disease classification. However, there is a lack of research in this topic within federal institutions.

Objectives:

Evaluate the survival and causes of death among disabled retirees at UFRJ, focusing on the impact of severe heart disease.

Methods:

A retrospective cohort study based on retirement and death records over 15 years. Retirements were categorized into three groups: full retirement due to severe heart disease, full retirement due to other diseases and proportional. Causes of death were obtained from death certificates. Mortality rates, survival and the presence of matching diagnoses between retirement and death were evaluated. Chi-square, log-rank, Cox models, Kaplan-Meier curves were utilized. Statistical significance with a 95% confidence interval, considering p<0.05.

Results:

There were 630 retirements, 368 (51.4%) in females, with an average age of 52.9 (SD=7.8) years, and 169 (26.8%) deaths. Mortality was higher in professors (37.0%; p=0.113), in the age group between 65 and 70 years (48.4%; p=0.004), in males (34.0%; p=0.001), and in full retirements due to severe heart disease (41.5%; p<0.001). Matching diagnoses between retirement and death were more frequent in professors (74.1%; p=0.026) and in full retirements due to severe heart disease (72.7%; p<0.001).

Conclusions:

Severe heart disease diagnosis is associated with higher mortality and shorter survival in disabled retirees. Its frequent occurrence in retirement and death diagnoses underscores its significance in this context.

Read Full Article

IJCS

Review Article

Use of Extracorporeal Membrane Oxygenation in Adult Patients During Cardiac Arrest

Cibelle Alves et al. Sarah Queiroz Pimentel Francine Jomara Lopes

Abstract

Background

Integrated extracorporeal membrane oxygenation (ECMO) in the treatment of cardiopulmonary resuscitation (CPR) is described as extracorporeal cardiopulmonary resuscitation (ECPR). It is used to ensure recovery of cardiac output when it is not possible to obtain sustained return of spontaneous circulation (ROSC) through conventional CPR methods. The comparison between ECPR and conventional CPR is a dilemma that has been frequently discussed.

Objective

To identify in the literature the use of ECMO in adult patients during cardiac arrest (CA) in and pre- and in-hospital settings.

Method

This is an integrative review using the following guiding question: What is the evidence in the literature on the use of ECMO in adult patients with cardiorespiratory arrest in the pre- and in-hospital setting? It consists of primary studies, published in full and available in Portuguese, English, and Spanish.

Results

The search identified 559 publications in the literature, of which 13 were articles read in full, after applying the inclusion criteria. Of these, 3 were disregarded due to unavailability in the complete format; 7 did not respond to the guiding question, and 3 studies were included. The studies were analyzed according to the 2020 version of the PRISMA Model.

Conclusion

ECPR is a practice adopted when CPR is refractory to conventional life support and concomitantly with this management. There are no significant differences in the rate of favorable neurological outcomes when comparing the pre- and in-hospital scenarios. In short, the development of institutional protocols with selection and exclusion criteria for ECPR is considered relevant.

Read Full Article

ABC

Original Article

Survival of Heart Transplant Patients with Chagas’ Disease Under Different Antiproliferative Immunosuppressive Regimens

Silas Ramos Furquim et al. Luana Campoli Galbiati Monica S. Avila Fabiana G. Marcondes-Braga … Julia Fukushima Sandrigo Mangini Luis Fernando Bernal da Costa Seguro Iascara Wozniak de Campos Tania Mara Varejão Strabelli Fernanda Barone Audrey Rose da Silveira Amancio de Paulo Luciana Akutsu Ohe Mariana Cappelletti Galante Fabio Antonio Gaiotto Fernando Bacal

Abstract

Background

Chagas’ disease (CD) is an important cause of heart transplantation (HT). The main obstacle is Chagas’ disease reactivation (CDR), usually associated to high doses of immunosuppressants. Previous studies have suggested an association of mycophenolate mofetil with increased CDR. However, mortality predictors are unknown.

Objectives

To identify mortality risk factors in heart transplant patients with CD and the impact of antiproliferative regimen on survival.

Methods

Retrospective study with CD patients who underwent HT between January 2004 and September 2020, under immunosuppression protocol that prioritized azathioprine and change to mycophenolate mofetil in case of rejection. We performed univariate regression to identify mortality predictors; and compared survival, rejection and evidence of CDR between who received azathioprine, mycophenolate mofetil and those who changed from azathioprine to mycophenolate mofetil after discharge (“Change” group). A p-value < 0.05 was considered statistically significant.

Results

Eighty-five patients were included, 54.1% men, median age 49 (39-57) years, and 91.8% were given priority in waiting list. Nineteen (22.4%) used azathioprine, 37 (43.5%) mycophenolate mofetil and 29 (34.1%) switched therapy; survival was not different between groups, 2.9 (1.6-5.0) x 2.9 (1.8-4.8) x 4.2 (2.0-5.0) years, respectively; p=0.4. There was no difference in rejection (42%, 73% and 59% respectively; p=0.08) or in CDR (T. cruzi positive by endomyocardial biopsy 5% x 11% x 7%; p=0.7; benznidazole use 58% x 65% x 69%; p=0.8; positive PCR for T. cruzi 20% x 68% x 42% respectively; p=0.1) rates.

Conclusions

This retrospective study did not show difference in survival in heart transplant patients with CD receiving different antiproliferative regimens. Mycophenolate mofetil was not associated with statistically higher rates of CDR or graft rejection in this cohort. New randomized clinical trials are necessary to address this issue.

Read Full Article

IJCS

Editorial

Cardiorespiratory Optimal Point: A New Kid in the Block or an Established Star?

Summary

COP researchers have already conducted very important research that must be expanded, including larger and more diverse and better defined populations, with patients around the world, different cardiovascular and non-cardiovascular diseases, tests using a treadmill (more experience with treadmill CPET is needed), and evaluation of the prognostic values of sub-maximal parameters, such as COP and eventually VO ₂ at VT1, versus the maximal parameters, such as pVO ₂ , VE/VCO ₂ slope, and OUES.

A clear answer is needed: Is the information obtained from a submaximal CPET enough, or should it be considered only as an alternative when it is not possible to perform a maximal CPET or when peak VO ₂ was not reached?

[…]

Read Full Article

ABC

Research Letter

Ten-Year Survival of Heart Failure Patients with Left Ventricular Ejection Fraction of 40-59%: A Potential Phenotypic Classification?

Luiz Claudio Danzmann et al. Luiz Carlos Bodanese Aline Petracco Petzold Anna Paula Tscheika … Ellen Hettwer Magedanz Lucas Celia Petersen Evgeny Belyavskiy Fernanda Lourega Chieza

Abstract

Definitions of left ventricular ejection fraction (LVEF) cut-off values for HF with mildly reduced LVEF (HFmrEF) have been a subject of debate, in the face of evidence that some drugs used in the treatment of HF with LFEV < 40% (HFrEF) are also effective in patients with LVEF < 60%. The aim of this study was to compare overall survival and cardiovascular survival in HF patients with LVEF of 40-59% in patients with HFrEF and HF with LVEF ≥ 60%. Patients with decompensated HF who met the Framingham diagnostic criteria at hospital admission between 2009 and 2011 were included. Patients were divided into HFrEF, HF with LVEF 40-59%, and HF with LVEF ≥ 60%. The Kaplan-Meier was used to determine ten-year overall survival and cardiovascular survival. The statistical significance was established at p<0.05. A total of 400 patients were included, with a mean age of 69 ± 14 years. Cardiovascular survival in patients with HF and LVEF of 40-59% was not significantly different than in patients with HFrEF (adjusted Hazard Ratio [HR] 0.86; 95% Confidence Interval [CI] 0.61-1.22, Ptrend = NS), but was statistically different compared with patients with LVEF ≥ 60% (adjusted HR of 0.64; 95% CI 0.44-0.94, Ptrend = 0.023). No difference was found in 10-year survival between the LVEF groups. Patients with HF and LVEF ≥ 60% had significantly higher cardiovascular survival compared with the other groups.

Read Full Article

ABC

Editorial

Treatment Evolution and the Impact of Pre-Surgical Predictors on Outcomes of Patients with Congenital Heart Disease

Congenital heart disease (CHD) is the most common class among malformations. These are important malformations that can compromise the patient’s survival and quality of life. Although there is slight variation among many population-based studies, CHD occurs in approximately 1% of live births (data range from 4 to 10 per 1000 live births), with a similar prevalence worldwide. It is also the main cause of mortality from birth, and its incidence is considered high given its severity.^–

Critical CHD is often lethal in the absence of treatment. Since the first repair using cardiopulmonary bypass in 1953, accurate diagnosis and effective treatment have become feasible, even in the case of more complex congenital heart lesions. Effective surgical therapies have increased life expectancy.

[…]

Read Full Article

IJCS

Original Article

Congenital Heart Disesase: A Retrospective Analysis from a Tertiary Referral Centre in Portugal

Diogo Faim et al. Joaquim Tiago Rui Castelo Andreia Francisco … Rosa Alves António Pires

Abstract

Background:

Congenital heart disease is the leading cause of mortality among all congenital malformations.

Objectives:

To evaluate the incidence of congenital heart diseases in a central maternity hospital in Portugal from January 2003 to December 2018 and to determine survival in the first year of life.

Methods:

Retrospective analysis of newborns diagnosed with congenital heart diseases within 72 hours after birth. Malformations were divided according to pathophysiology. Cumulative survival analysis was performed by the Kaplan-Meier test. Stastical significance was set at p <0.05.

Results:

A total of 297 newborns with cardiac malformation was recorded among 47,198 live births (incidence of 6:1000), 16% associated with extra-cardiac disease. The most frequent congenital heart diseases were left-to-right shunt lesions (n = 216), followed by cyanotic (n = 41), acyanotic obstructive (n = 31) and miscellaneous (n = 9). Seventy (24%) patients had prenatal diagnosis, 88% of them cyanotic defects, and a positive association was found between prenatal diagnosis and mortality (p <0.001). Coarctation of the aorta was associated with gestational diabetes (p = 0.014). Atrial septal defect was more common in females (p = 0.02). Mortality rate due to heart disease was 3.4%. Patients with cyanotic disease, 99%, 97%, 97%, respectively, for patients with left-to-right shunt lesions, and 97%, 97%,97% for those with obstructive lesion cases.

Conclusion:

The incidence of congenital heart disease was 6:1000, mostly left-to-right shunt lesions. Heart disease accounted for only half of deaths, and cyanotic diseases have a high nonspecific mortality rate.

Read Full Article

ABC

Editorial

Progress in Heart Transplantation in Brazil: is it Time to Build a National Database?

Mônica Samuel Avila et al. Deborah de Sá Pereira Belfort

Heart transplantation (HT) is the therapy of choice for advanced heart failure. Survival has greatly improved since the first heart transplant 50 years ago, especially after the introduction of calcineurin inhibitors and better management of complications related to immunosuppression. In Latin America, Brazil is renowned for the high number of HTs performed annually. Despite its importance, reports on survival, immunosuppression and complications of HT are scarce in Brazil.

A retrospective open cohort of HT in Brazil is presented in this issue of Arquivos Brasileiros de Cardiologia. The article shows important data regarding epidemiology, survival and complications of HT recipients between 2000 and 2015. Median survival in this cohort was 8.3 years, and one- and 5-year survival rates were 70.9% and 59.5%, respectively. These results are better than those from 1984 to 1999, when the one- and 6-year survival rates were 66% and 54% respectively, suggesting improvement in post-transplant care. However, this median survival is lower than 12.2-year survival and one- and 5-year survival of 81% and 69% reported by the International Society of Heart and Lung Transplantation (ISHLT), probably due to sociodemographic and economic differences between Brazil and developed countries.

[…]

Read Full Article

ABC

Original Article

Sixteen Years of Heart Transplant in an Open Cohort in Brazil: Analysis of Graft Survival of Patients using Immunosuppressants

Natália Cristina Cardoso Freitas et al. Mariangela Leal Cherchiglia Charles Simão Filho Juliana Alvares-Teodoro … Francisco de Assis Acurcio Augusto Afonso Guerra Junior

Abstract

Background:

Heart transplant is the main therapeutic alternative for advanced heart failure patients. Several risk factors affect these patients’ survival; however, few studies about the topic are available in Brazil.

Objectives:

To review the survival rates of heart transplant patients in the Brazilian Public Health System (Sistema Único de Saúde – SUS) between 2000 and 2015.

Methods:

This is a non-concurrent, open cohort study, involving cardiac transplant patients in Brazil. The cumulative survival probability was estimated by the Kaplan-Meier curve, and the curve comparison was done using the Log-Rank test. The Cox model was used to calculate the Hazard-Ratio (HR). Analyses were conducted at the 95% confidence level.

Results:

The heart transplant survival rate median in Brazil, during the period, was 8.3 years. Each additional year in the recipient’s age, the occurrence of infections, and the performance of the surgical procedure in the South Region were associated with a higher risk of graft loss. A higher use ratio of immunosuppressants mycophenolate and azathioprine acted as a protection factor.

Conclusions:

The analyses conducted provide the first information about the median survival time in heart transplant patients in Brazil. The difference noticed among the geographical regions may be related to the different treatment protocols adopted in the country, especially in the early 2000s. The rate of mycophenolate and azathioprine use as a protection factor suggests that, despite the absence of differences among therapeutic strategies, use of these drugs may favor survival of certain patients. The study provides robust epidemiological data, which are relevant for public health.

Read Full Article

ABC

Research Letter

COVID-19 Chain of Survival 2020

Sergio Timerman et al. Helio Penna Guimarães Carlos Eduardo Rochitte Thatiane Facholi Polastri Marcelo Antônio Cartaxo Queiroga Lopes

Abstract

The term Chain of Survival provides a useful metaphor for the elements involved in the COVID-19 management. The 5 links of the COVID-19 Chain of Survival are:

A strong Chain of Survival can improve the chances of survival and recovery for victims of COVID-19.

[…]

Read Full Article

ABC

Artigo Original

Prognostic determinants of patients with chronic systolic heart failure secondary to systemic arterial hypertension

Dalva M.S. Rolande et al. João Paulo Fantini Augusto Cardinalli Neto José A. Cordeiro Reinaldo B. Bestetti

BACKGROUND: Systemic arterial hypertension (SAH) is an important cause of chronic systolic heart failure (CHF) in underdeveloped countries. It would be desirable to know predictors of mortality for patients with this condition in order to provide proper scientific treatment. OBJECTIVE: To determine risk factors for all-cause mortality in patients with CHF secondary to SAH in the current era of heart failure therapy for left ventricular systolic dysfunction. METHODS: All patients routinely and prospectively followed at the Cardiomyopathy Clinic of our Institution from January, 2000 to April, 2008 with the diagnosis of CHF secondary to SAH were screened for the study. Cox proportional hazards model was used to establish independent predictors of all-cause mortality. RESULTS: One hundred thirty patients were included; 74 (57%) were male. Thirty one (24%) patients died, 5 (4%) underwent heart transplantation, and 94 (72%) were alive at study end. Survival probability at 12, 24, 36, 48, and 60 months was 96%, 93%, 84%, 79%, and 76%, respectively. Age (Hazard Ratio=1,05, 95% Confidence Interval 95% 1,01 to 1,08, p value=0,01), left ventricular diastolic dimension (Hazard Ratio=1,08; 95% Confidence Interval 1,02 to 1,09; p value=0,003), and B-Blocker therapy (Hazard Ratio=0,41; 95% Confidence Interval 0,19 to 0,86; p value=0,02) were found to be independent predictors of mortality. CONCLUSION: Age, left ventricular diastolic dimension and underuse of Beta-Blocker therapy were independent predictors of mortality for patients with CHF secondary to SAH in the population studied.

Read Full Article

ABC

Point of view

Optimized approach in cardiocerebral resuscitation

Karl B. Kern et al. Sergio Timerman Maria Margarita Gonzalez José Antônio Ramires

Cardiocerebral Resuscitation (CCR) is a new approach to the resuscitation of patients with out-of-hospital cardiac arrest (OHCA). The first major component of CCR is continuous chest compressions (also referred to as chest compression-only CPR or “hands-only CPR”) advocated as part of CCR for all bystanders who witness a sudden collapse of presumed cardiac origin. The second component of CCR is a new ACLS treatment algorithm for Emergency Medical Services. This algorithm emphasizes uninterrupted chest compressions regardless of other ongoing assignments as part of the rescue effort. A third component has recently been added to CCR, namely aggressive post-resuscitation care. Cardiocerebral resuscitation has increased bystander participation and has improved survival rates in a number of communities. Now is the time for other communities to re-examine their own outcomes with cardiac arrest and consider joining those cities and communities that have doubled and even tripled their survival from OHCA.

Read Full Article

ABC

Review Article

Percutaneous coronary intervention for stable patients: is there any benefit beyond symptom relief?

Goran Stankovic

The indications for percutaneous coronary intervention (PCI) continue to evolve because of the steady improvement in technology, broadened patient and lesion selection criteria, and new evidence from clinical trials. Considerable controversy was generated by the main results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, in which no difference in long-term outcome was reported for stable patients with coronary disease randomized to an initial strategy of PCI plus optimal medical therapy versus optimal medical therapy alone. In patients with chronic stable angina, medical therapy remains the cornerstone and should be optimized for all patients, while the major achievable goals of PCI are to affect symptoms, either by decreasing or preventing them, reducing the need for subsequent procedures and relieving ischemia. In patients with stable coronary artery disease, however, no reduction in death or myocardial infarction has been observed, and these limitations of PCI in this clinical setting need to be emphasized. The message from the COURAGE trial may be refined based on recently presented nuclear and angiographic sub-studies, such that patients with substantial residual ischemia on optimal medical therapy should be considered for crossover PCI, as it is associated with greater likelihood of death and myocardial infarction. However, those findings need to be confirmed by prospective evaluation before being widely accepted by the interventional community.

Read Full Article

ABC

Artigo Original

Evaluation of heart failure prognostic factors in patients referred for heart transplantation

Cleópatra Medina Noronha Areosa et al. Dirceu Rodrigues Almeida Antônio Carlos C. de Carvalho Angelo A. V. de Paola

OBJECTIVES: To evaluate the survival of patients with heart failure submitted to cardiac transplantation screening as well as identify poor prognostic factors using a risk score to identify patients with higher death risk. METHODS: 330 male and female patients aged 12 to 74 years old, referred for heart transplantation from January 1986 to November 2001 were evaluated. Clinical, laboratory, electrocardiographic, Holter monitoring, echocardiographic and radionuclide ventriculography data were analyzed. RESULTS: The median follow up period was 5 years; patients’ survival rate was 84.5% in the first year, 74.3% in the second year, 68.9% in the third year and 60.5% in the fifth year. The prognostic variables selected through the univariate analysis were: age, Chagas’ disease etiology for cardiomyopathy, NYHA functional classes III and IV, orthopnea, systolic blood pressure, mean blood pressure, pulse pressure, plasma urea, sodium, glucose, albumin, bilirubin, hemoglobin, and mean heart rate. The prognostic variables at the multivariate analysis were: ejection fraction, blood urea, and hemoglobin. The risk score: RR=exp[(-0.0942401 x ejection fraction) + (0.0105207 x blood urea) + (-0.2974991 x hemoglobin) + (-0.0132898 x age) + (-0.0099115 x blood glucose)] discriminated the population with a higher death risk. CONCLUSION: Patients’ survival was satisfactory despite heart failure severity, suggesting they can be maintained on optimized clinical treatment until persistent clinical deterioration takes place. Ejection fraction, ventricular diameters, and clinical functional class alone should not be used as an indication for heart transplantation. The risk score could help discriminate the population with the poorest prognosis.

Read Full Article

ABC

Artigo Original

Valve replacement with the Omnicarbon valve prosthesis: a 10-year follow-up

Santiago Florez et al. Salvatore Di Stefano Yolanda Carrascal Juan Bustamante … Enrique Fulquet José Ramón Echevarria Casquero Elena Javier Gualis Luis Fiz

OBJECTIVE: We retrospectively examined the outcomes of 264 patients who underwent consecutive Omnicarbon valve implantation surgery between April 1985 and May 1995. METHODS: At the time of surgery, patients who received this mechanical prosthesis averaged 57±11 years of age. Omnicarbon valves were placed in the aortic position in 36% of the cases, in the mitral position in 44%, and in both positions in 20%. Follow-up was carefully performed, with most patients undergoing physical examination at our clinic. While taking the case history, cardiac physicians specifically questioned the patient about valve-related complications. RESULTS: Accumulated total patient-years is 1291, with a mean follow-up time of 5.4 years. Survival at 10 years is 79.4±3.9%, including all causes of death and early mortality. Complications recorded during the 11-year study include: thromboembolism (0.1%), hemorrhage (0.4%), endocarditis (0.2%), and nonstructural failure (1.2%). No hemolytic anemia, valve thrombosis, or structural failure was detected during this long-term experience. Functional capability of these patients was subjectively assessed by the NYHA classification system. With follow-up time averaging over 5 years, 97% of our Omnicarbon valve patients are in NYHA I or II. CONCLUSION: The Omnicarbon mechanical prosthesis provides a good clinical performance for up to 10 years in both the aortic and mitral positions. Results indicated a low incidence of thromboembolism and of hemorrhagic complications.

Read Full Article

ABC

Artigo Original

Major clinical characteristics of patients surviving 24 months or more after hospitalization due to decompensated heart failure

Mucio Tavares de Oliveira Jr et al. Manoel Fernandes Canesin Robson Tadeu Munhoz Carlos Henrique Del Carlo … Airton Scipioni José Antonio Franchini Ramires Antonio Carlos Pereira Barretto

OBJECTIVE: To study the major clinical characteristics of patients with heart failure who survived more than 24 months after hospitalization for compensation. METHODS: The study comprised 126 patients with heart failure in functional class III or IV, with a mean age of 51.7 years. Most patients were men (73%), had a mean ejection fraction (EF) of 0.36 and left ventricular diastolic diameter (DD) of 7.13 cm. The major clinical and laboratory characteristics were assessed, and, on follow-up, 25 (19.8%) patients, who survived more than 24 months after hospital discharge, were identified. Data of survivors (G1) were compared with those of patients who died (G2) before 24 months. RESULTS: In G1, the following levels were greater: serum sodium (138.3±3.4 vs 134.5±5.8 mEq/L; P=0.001); blood pressure levels (120.0 vs 96.7 mm Hg; P=0.003); and LVEF levels (0.40±0.08 vs 0.34±0.09; P=0.004); and the following levels were lower: urea (59.8 vs 76.3 mg/dL; P=0.007); prothrombin time (12.9 vs 14.8 seconds; P=0.001); LVDD (6.78±0.55 vs 7.22±0.91; P=0.003); and LA diameter (4.77 vs 4.99cm; P=0.0003). More survivors were found among patients with idiopathic cardiomyopathy and arterial hypertension than among patients with Chagas’ disease and coronary artery disease. In multivariate analysis, the following variables remained as independent predictors of mortality: LVDD > 7.8 cm (HR 1.95); Na 14 seconds (HR 1.69). CONCLUSION: The study allowed predicting which patients with heart failure will have a good survival after hospital discharge and those with a greater chance of a long survival after discharge.

Read Full Article

ABC

Original Article

Some predictors of cardiovascular mortality among the elderly population of Botucatu (SP)

Tania Ruiz et al. Mirela D. Sanchís Ana Maria Fioravante Xavier C. Piqué

OBJECTIVE: To detect factors associated with cardiovascular mortality in the elderly of Botucatu. METHODS: We evaluated 29 variables of interest in a cohort of patients aged ³60 using data from a survey conducted between 1983/84. The elderly cohort was analyzed in 1992 to detect the occurrence of cardiovascular deaths. Survival analysis was performed using the Kaplan-Meier method, the log-rank test, and Cox regression analysis. Three models were adapted for each group of variables, and a final model was chosen from those variables selected from each group. RESULTS: We identified predictor for cardiovascular death according to age for elderly males not supporting the family, not possessing a vehicle, and previous cardiovascular disease. In elderly females, the predictor variables were previous cardiovascular disease and diabetes mellitus. CONCLUSION: Socioeconomic indicators (family heading and vehicle ownerrship) may be added to well stabilished medical factors (diabete mellitus and hypertension to select target groups for programs intended to reduce deaths due to cardiovascular diseases in elderly people.

Read Full Article